3320 schizophrenia and Tx

psychosis

severe mental condition with disorganized personality, deterioration in social functioning, distortion of/loss of contact with reality, altered cognition and perception, impaired ability to determine what is real/not real, hallucinations and delusional thinking

positive symptoms

symptoms that should not be present

disturbances in thought process/content and perception

hallucinations, delusions, paranoia, disorganized/bizarre thoughts/behavior/speech

negative symptoms

absence of qualities that should be present

disturbances in affect, anhedonia, alogia, apathy, anosognosia, anergia, lack of abstract thinking ability, impaired memory and attention

1st gen typical antipsychotics

dopamine 2 receptor antagonists, reduce positive symptoms but have little effect on negative symptoms, anticholinergic and antihistamine side effects, extrapyramidal symptoms and tardive dyskinesia, neuroleptic malignant syndrome

extrapyramidal symptoms (1st gen/typicals)

dystonia, akathisia, akinesia, pseudoparkinsonism

Tx for extrapyramidal symptoms

anticholinergics, antihistamines, dopamine agonists

neuroleptic malignant syndrome

excessive blockage of dopamine receptors

elevated CPK, hyperpyrexia, autonomic instability, rigidity, mental status change, rhabdomyolysis

tardive dyskinesia

involuntary repetitive jerky movements of face/arms/legs, fidgety movements and restlessness, muscle twitch and tremors, abnormal postures similar to dystonia, dysphagia, grimacing, smacking lips, protruding tongue

worsened by anticholinergics

dystonia

slow twisting/turning movements, rapid involuntary movements, tremor, abnormal postures that come and go (twisted neck or torso), permanent postural changes

2nd gen/atypical antipsychotics

serotonin and dopamine receptor antagonists, effective on positive and negative symptoms, anti-alpha-adrenergic effects, photosensitivity, seizures, metabolic syndrome, increased risk for diabetes/HTN/cancer/CVD

metabolic syndrome S/S

weight gain, dyslipidemia, hyperglycemia, insulin resistance

1st gen/typical antipsychotic drugs

chlorpromazine (Thorazine), fluphenazine (Prolixin), haloperidol (Haldol), loxapine, perphenazine (Trilafon), pimozide (Orap), thioridazine/mellaril, trifluoperazine (Stelazine)

2nd gen/atypical antipsychotic drugs

palperidone (Invega), iloperidone (Fanapt), ziprasidone (Geodon), risperidone (Risperidal), clozapine (Clozaril), quetiapine (Seroquil), lurasidone (Latuda), olanzapine (Zyprexa), asenapine (Saphris)

3rd gen antipsychotics

subset of 2nd gen/atypical antipsychotics, reduce dopamine activity in some brain regions and increase dopamine activity in other brain regions,

3rd gen antipsychotic drugs

aripiprazole (Abilify), brexpiprazole (Rexulti), and cariprazine (Vraylar)