Neural System 5: Schizophrenia and Bipolar

Question 1

what is Schizophrenia?

Answer 1

psychotic illness w/periods of psychosis

chronic dysfunction of mood, cognition, and social behavior

Question 2

Etiology of Schizophrenia

Answer 2

Unknown

possible genetic disposition and birth complications

Question 3

Possible pathophysiology of Schizophrenia

Answer 3

Possible cause

reduced prefrontal blood flow during cognitive tasks along with dopamin “dysregulation” (imbalance with overactivity and underactivity in various brain regions)

Question 4

what are the types of symptoms (categories) that Schizophrenic patients can have?

Answer 4

1. Positive - presence of behaviors
2. Negative - diminished/absent behaviors
3. Cognitive - impaired behaviors

Question 5

what are some positive symptoms of schizophrenia?

Answer 5

1. hallucinations
2. disturbed reality
3. abnormal motor behaviors

Question 6

What are some negative symptoms of schizophrenia?

Answer 6

1. diminished speech
2. flattened emotions
3. social withdrawal

Question 7

what are some cognitive symptoms of schizophrenia?

Answer 7

1. reduced attention
2. decreased executive function

Question 8

what is the overall goal for treatment in schizophrenia?

Answer 8

reduce symptoms and mediate AE while improving function and QOL

Question 9

what schizophrenic symptoms are easier/harder to treat?

Answer 9

easier = positive symptoms

harder = negative symptoms

Question 10

what types of medications are typically used to treat schizophrenia?

Answer 10

antipsychotics

at a min takes 4-6 weeks to observe changes

Question 11

what are the classifications of antipsychotics?

Answer 11

1. First generation (FGA) = older, more AE
2. Second generation (SGA) = newer, less EPS and TD AEs

Question 12

what is the 1st line trx for schizophrenia and why?

Answer 12

SGA = there are less extrapyramidal symptoms and tardive dyskinesia

Question 13

what are extrapyramidal symptoms?

Answer 13

collection of symptoms that are drug induced movement disorders. include:

1. actue dystonia
2. akathesia
3. delayed tardive dyskinesia
4. acute parkinsonism

Question 14

what is tardive dyskinesia?

Answer 14

repetitive and involuntary movements such as grimicing and eye blinking

*orofacial dyskinesia

Question 15

T/F: tardive dyskinesia can be irreversible if left untreated and unnoticed?

Answer 15

TRUE

Question 16

what is acute dystonia?

Answer 16

spasm of muscles of tongue, face, neck and back

Question 17

what is akathesia?

Answer 17

restlessness and inability to stay still, manifests with finger-tapping, pacing

Question 18

MOA of first generation antipsychotics?

Answer 18

block dopamine receptors in mesolimbic tract where excess dopamine may contribute to postive symptoms

Question 19

SGA drugs on our list

Answer 19

quetiapine (Seroquel)

Question 20

quetiapine (Seroquel) MOA

Answer 20

block D2 receptors but less than FGA; more affinity for 5-HT receptors

*variable effect on histamine, muscarinic and alpha receptors = more variable AE

Question 21

SGA binding to D2 receptors AEs

Answer 21

1. Motor = bradykinesia, and possible EPS
2. Endocrine (higher risk for metabolic syndromes)
3. Neuroleptic malignant syndrome

Question 22

if SGAs bind to other receptors what possible AEs can occur?

Answer 22

1. H1 receptors
   
   • sedation and wt gain
2. Muscarinic receptors
   
   1. ABCDs
3. a1 receptors
   
   1. hypotension, dizziness

Question 23

Rehab concerns for FGAs

Answer 23

1. CV risks
2. caution with UV exposure
3. imapired thermoregulation = caution with overexertion
4. monitor for EPS

Question 24

Rehab concerns for SGAs

Answer 24

1. wt gain, hyperglycemia, and lipid abnormalities
2. CV abnormalities risk
3. risk for heat intolerance

Question 25

what are the types of Bipolar Disorder?

Answer 25

1. Bipolar I disorder 2. Bipolar II disoder

Question 26

what is Bipolar I disorder (aka manic-depression illness)

Answer 26

one manic episode accompanied by history of one or more major depressive episodes

Question 27

what is Bipolar II disoder?

Answer 27

major depressive disorder accompanied by at least one hypomanic or milder manic phases

Question 28

what is hypomania?

Answer 28

at least 4 days of elevated/irritable mood combined with over-activity

Question 29

Pathogenesis of Bipolar Disoder?

Answer 29

Unknown appears to be dysregulation in dopamine and serotonin systems

Question 30

what regions of the brain are altered in Bipolar disoder and how?

Answer 30

1. limbic-cortical dysfunction * hippocampus and prefrontal cortex have diminished acitivty w/smaller volumes * amygdala is hyperactivity leading to emotional sensitivity

Question 31

how is Bipolar disorder treated?

Answer 31

1. acute depressive episode = SSRI, bupropion 2. acute manic episode = lithium 3. maintenance trx = lithium

Question 32

what is the role of Lithium in treatment of Bipolar Disorder?

Answer 32

1. Management of acute manic or hypomanic episode 2. prevention of further manic and depressive episodes

Question 33

If lithium is so effective in lots of patients what is the drawback?

Answer 33

Lots of AEs

Question 34

Common AEs of Lithium?

Answer 34

1. GI 2. weight gain 3. polydipsia and polyuria 4. CNS issues * mental dullness, decreased memory and concentration, fine hand tremor, fatigue and muscle weakness

Question 35

why does lithium require plasma concentration monitoring?

Answer 35

can be toxic and toxicity can occur at doses close to therapeutic levels

Question 36

what are signs of Lithium toxicity?

Answer 36

1. persitent diarrhea 2. vomiting 3. coarse tremor 4. mild ataxia 5. drowsiness 6. muscular weakness

Question 37

what circumstances can alter lithium concentrations and increase the risk of toxicity?

Answer 37

1. medial illness 2. crash diets and Na+ restriction diets 3. strenuous exercise 4. very hot climate 5. surgery 6. advanced age 7. prenancy and delivery

Question 38

T/F: Lithium is assocaited with many DDIs?

Answer 38

TRUE

Question 39

What other medication class can be used in the treatment of Bipolar Disorder?

Answer 39

Anticonvulsant medications 1. Valproic acid (VPA 2. Carbamazepine

Question 40

what boxed warnings are there for anticonvulsants meds used to treat Bipolar Disorder?

Answer 40

1. Valproix acid = hepatotoxicity 2. Carbamazepine = Stevens-Johnson Syndrome and toxi epidermal necrolysis (TEN)