schizo and meds Flashcards
(42 cards)
Schizophrenia
- lack of coherence in mental fn
- disconnected mind
- thinking, feeling, perceiving, behaving, and experiencing operate without the normal linkages that make mental life comprehensible and effective
- some substances mimic schizo
epidemiology
- prevalence: 1% worldwide, onset late teens, early 20’s
- co-morbidity/substance abuse: 40-50%, nicotine dependence 70-90%, risk for suicide
- some people use substances to treat mental disorder
- nicotinic pathway helps to feel better for those with mental illness
hallmarks of thought disorders (3)
-disturbed thinking
-preoccupation with frightening inner experiences (delusions, hallucinations)
-marked disturbances in: affect-flat, inappropriate (seems strange for situation)
:behavior-unpredictable, bizarre
:social interactions-isolation
neurobiology (6)
- dopamine hypothesis of schizophrenia: too much dopamine
- alternative biochemical hypotheses: not sure of etiology, other nt are involved
- early brain injury
- genetic findings: genetic vulnerability, if 1st relative then greater chance of having it
- neuroanatomical findings: brain disease, brains look different not how you were raised
- stress may precipitate in someone who is genetically vulnerable but it does not cause schizophrenia
sx to dx schizo
- lasts at least 6 mo
- includes at least 1 month of two or more active-phase sx such as : bizzare delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative behavior
course of disease
-pre-psychotic early sx: 1 mo to 1 yr before psychotic episode/break
:intrusive thoughts, preoccupied with thinking about it over and over again, later become more withdrawn
-acute phase: positively id pos sx, w/o tx stay in acute
-maintenance phase: dereased acute sx in severity, in hosptal and get better
-stabilization phase: rest of life in remission, mild sx persist
sx of schizo (8)
- alteration in thinking: concrete thinking, delusions (false but based in reality), thought broadcasting (they can read my thoughts), thought insertion (people putting thoughts into your head)
- alterations in perception: hallucinations
- alteration in speech: associative looseness (tangential) neologisms, echolalia (repeating what you are saying), clang associations (list of rhyming words), word salad (jumble of different words with no sense)
- alterations in behavior: bizarre, motor agitation, stereotyped behaviors (same thing over and over again, 2 thumbs up), waxy flexibility (catatonic-risk for med probs, any movement they just stay that way)
- positive sx: hallucinations, delusions, bizarre behavior, paranoia
- neg sx: apathy, lack of motivation, anhedonia, poor social fn, poverty of thought
- cog sx: trouble with attention, memory, problem solving, and decision-making, cant manage life
- depressive sx: go along with mental disorder, leads to relapse, substance abuse, suicide
subtypes of schizo (5)
- paranoid
- disorganized
- catatonic
- undifferentiated (most unorganized)
- residual-continued negative sx, wont be brought into our attention at hospital because not as bad if only neg
uses of antipsychotic drugs (4)
- manage acute pos psychiatric sx
- induce remission
- maintain stability
- prevent relapse
drugs to treat schizo
-traditional (typical): primarily treat hallucinations and delusions
:lots of s.e include extrapyramidal effects and tardive dyskinesia
-atypical: relieve both pos and neg sx of schizo
:less likely to cause distressing EPS
:many of these drugs have metabolic s.e
continuity of care (4)
- follow-up care
- use of approp resources and services
- med and sx monitoring
- ongoing training and assistance with skills needed for independent living
goals of tx (5)
- safety in all settings
- stabilization of antipsychotic med
- ct and fam edu about schizo and its tx
- physical care of ct
- psychosocial support of ct and fam
interventions (7)
- antipsychotic med
- adjunctive pharmacotherapies: other meds to treat s.e, anxiety
- electroconvulsive therapy: for catatonic, and must be very severe, mostly for dperession
- psychological interventions: group sessions, indiv therapy doesnt really work for shizo
- fam interventions, really hard on the families, lots of stress associated
- vocational rehab, schizo is hard to get a job with bad sx
- assertive community tx and case management
desired outcomes of tx (7)
- decr freq of hallucinations and delusions
- ability to recognize hallucinations or delusional thoughts
- more logical and reality-based thought processes
- improved ability to concentrate
- improved ability to interact with others
- approp affect and mood
- antipsychotics affect total CNS and look for clinical manifestations instead of blood levels
important neurotransmitters (6)
- dopamine
- norepinephrine
- serotonin
- glutamate
- acetylcholine
- gaba
Dopamine (6)
:fine muscle movement
- integration of emotions and thoughts
- decision making
- stimulates hypothalamus to release hormones
- decr in dopamine in parkinsons, depression
- incr in dopamine in schizophrenia, mania
norepinephrine
:level in brain affects mood
:stimulates sympathetic branch of autonomic nervous system for fight or flight in response to stress
-decr in norep in depression
-incr in norep in mania, anxiety states, schizo
serotonin (4)
:plays a role in sleep regulation, hunger mood states, and pain perception
:plays a role in aggression and sexual behavior
-decr in serotonin in depression
-incr in serotonin in anxiety states
gaba (5)
:plays a role in inhibition, reduces aggression, excitation, and anxiety
:may play a role in pain perception
:has anticonvulsant and muscle-relaxing properties
-decr in gaba in anxiety disorders, schizo, huntington’s chorea (very aggressive behavior)
-incr in gaba reduces anxiety
acetylcholine (7)
:plays a role in learning, memory
:regulates mood: mania, sexual aggression
:affects sexual and aggressive behavior
:stimulates parasympathetic nervous system
:there are nicotinic and muscarinic receptors
-decr in acetylcholine in alzheimers, huntington’s chorea, parkinsons
-incr in acetylcholine in depression
antipsychotics meds treat sx of psychosis
(major tranquilizers, neuroleptics)
sx: positive (incr in dopamine), negative (decr in dopamine), cognitive fn impairments, aggressive, depressive/anxious sx
typical/traditional antipsychotics
- mech of action: block d2 receptors for dopamine, antagonists for muscarinic receptors for acetylcholine, alpha 1receptors for norepinephrine and histamine receptors
- blockage of dopamine reduces pos sx but also leads to motor abnormalities
- blockage of muscarinic receptors of acetylcholine system, dry mouth, urinary retention, constipation, tachycardia, blurred vision
- norepinephrine antagonists: affects smooth muscles: veins are more relaxed and can cause orthostatic hypotension
traditional med s.e
-affects dopamine, norepinephrine, and histamine
-main sx is drowsiness when start antipsychotic, improves with time
extrapyramidal sx: dystonia, pseudoparkinsonism, akathisia, tardive dyskinesia, drowsiness, anticholinergic effects, cardiovascular, wt gain, poikilothermia (can’t maintain body temp),
-neropleptic malignant syndrome: potentially fatal mortality rate 10%, inc muscle tone, autonomic dysfn, incr fever, labile htn, tachypnic, tachycardiac, muscles breakdown, renal failure, myoglobin goes through myoglobin, must take temp, stop meds, tx=icu,
- endocrine (diabetes), depot injection: lifelong injection 1/mo, great for noncompliant but very expensive and not for every med
-sexual s.e: lack of interest
atypical antipsychotics
s. e: metabolic syndrome, can cause pt to become very hungry, more wt gain
- clozapine: risk for agranulocytosis: lack of wbc production, check lab values, let us know if you have sore throat, can die from infection and seizures
- zyprexa: sedation and wt gain
- seroquel: orthostatic hypotension, metabolic syndrome
- geodon: need baseline EKG
- resperdal: highest risk of EPS
- takes a couple weeks to work
