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CDM 4 Exam 2 > Schizophrenia > Flashcards

Schizophrenia Flashcards

(96 cards)

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1
Q

Positive symptoms

A

Delusions
Hallucinations
Disorganized Speech
Grossly disorganized/catatonic behavior

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2
Q

Negative Symptoms

A

Blunted affect
Alogia
Avolition
Anhedonia
Asociality

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3
Q

Delusions

A

fixed, false beliefs generally outside of the cultural or societal norms

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4
Q

Hallucinations

A

a sensory perception with no basis in external stimulation

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5
Q

Disorganized speech

A

frequent derailment or loose associations (constantly moving from one topic to another), tangentiality, incoherence, or repetition of words

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6
Q

Grossly disorganized/catatonic behavior

A

may range from silliness to catatonia to purposelessness movement to agitation

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7
Q

Blunted affect

A

emotional blunting or difficulty expressing emotion

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8
Q

Alogia

A

inability to speak

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9
Q

Avolition

A

lack of desire or motivation to pursue self-initiated goals

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10
Q

Anhedonia

A

inability to experience pleasurable emotions

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11
Q

Asociality

A

inability or unwillingness to participate in normal social situations

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12
Q

Schizophrenia DSM 5 diagnosis

A

> 2 symptoms (positive, negative, cognitive) must be present for a significant percent of time during a 1 month period (less if successfully treated)
1 symptom must be delusions, hallucinations, or disorganized speech
1 areas of function (work, relationships, self-care)
lasting at least 6 months

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13
Q

Etiology

A

No known causes
May have genetic link

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14
Q

Onset

A

May be abrupt or insidious; late teens-mid 30s

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15
Q

Mesocortical

A

Function: cognitive, social, emotions, stress response
Low DA –> negative sx and cognitive sx
(Tx: worsens negative sx)

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16
Q

Mesolimbic

A

Function: arousal, stimulus processing, reward, memory
Excess DA –> positive sx
(Tx: relief of positive sx)

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17
Q

Nigrostriatal

A

Function: movement
Normal DA –> no dysfunction
(Tx: extrapyramidal sx)

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18
Q

Tuberoinfundibular

A

Function: regulates prolactin
Normal DA –> no dysfunction
(Tx: hyperprolactinemia)

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19
Q

Acute phase

A

decrease Threat to self/others

decrease Symptoms
Agitation
Hostility
Anxiety
Abnormal sleep

Develop treatment plan

1-2 weeks

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20
Q

Stabilization

A

Prevent relapse

decrease Symptoms
Positive/negative/ cognitive

Optimize med regimen
Dose/adverse effects
Monitoring
Adherence

3-4 weeks

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21
Q

Maintenance

A

Prevent relapse
- increase Functioning
- increase QoL
- Monitoring
Prodromal symptoms
Adverse effects
Adherence

lifelong

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22
Q

Maintenance

A

Prevent relapse
- increase Functioning
- increase QoL
- Monitoring
Prodromal symptoms
Adverse effects
Adherence

lifelong

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23
Q

Non-pharm therapy

A

ACT
cognitive remediation
Family pychoeducation
illness self-management training
supported employment

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24
Q

First Gen Antipsychotics (FGA)

A

acute agititation/deliruim

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25
Tourette's syndrome FGA
Haloperidol, pimozide
26
Nausea/vomiting FGA
Chlorpromazine, perphenazine, prochlorperazine
27
intractable hiccups FGA
Chlorpromazine
28
FGA MOA
blockade of DA2 receptors in the mesolimbic area and mesocortical area of the brain
29
FGA dosing general
Onset is within a few days, may begin to respond within a few weeks, full benefit in 4-6 weeks Discontinuation should be a slow taper over several weeks to months
30
FGA dosing Acute treatment
Increase dose until behavior improves or adverse effects limit dose IM/IV formulations are 2-4 x more potent and should only be used in acute settings
31
extrapyramidal symptoms
Most common with high-potency FGAs, especially at high doses Onset: within 2-3 weeks of starting treatment or dose increase (except for tardive dyskinesia)
32
Pseudoparkinsonism
Tremor (at rest), bradykinesia, shuffling gate, masked facies, stooped posture Reversible: dose decrease or add anticholinergic agent (e.g. benztropine)
33
Akathisia
Subjective report of “inner restlessness;” pacing; unable to stay still Reversible: dose decrease or switch antipsychotic, add propranolol or anticholinergic
34
Acute dystonia
Spastic involuntary muscle contractions; usually within 24-96 hours dose change Moderate/severe: (IV or IM) benztropine 1-2mg or diphenhydramine 25-50mg Mild: (PO) benztropine 1-2mg daily or twice daily
35
Tardive Dyskinesia symptoms
Myoclonic jerks, tics, chorea, dystonia Often involving the face/mouth More likely to occur after long-term antipsychotic treatment (months-years) Potentially irreversible
36
Tardive Dyskinesia Risk
Long-term, high-dose, high-potency FGA Older age, female sex
37
Tardive Dyskinesia Monitoring
AIMS or DISCUS Every 6 months (FGA) or 12 months (SGA)
38
Tardive Dyskinesia Treatment
Discontinue antipsychotic and switch to one with lower risk (limited evidence showing this improves symptoms) VMAT2 inhibitor
39
VMAT2 inhibitors MOA
reversible inhibition of VMAT2 which is a transporter that packages DA into presynaptic vesicles in preparation for release into synaptic cleft
40
Deutetrabenazine warnings
QT prolongation Parkinsonism Depression or suicidality
41
Deutetrabenazine ADE
Somnolence and fatigue Diarrhea
42
Deutetrabenazine DDI
Strong 2D6 inhibitors: reduce dose Other drugs with QT prolongation
43
Deutetrabenazine counseling
Take with food
44
Valbenazine Warnings
QT prolongation (2D6 or 3A4 inhibitors) Parkinsonism Depression or suicidality
45
Valbenazine ADE
Somnolence and fatigue Sedation
46
Valbenazine DDI
Strong 3A4 or 2D6 inhibitors: reduce dose Avoid MAOIs and strong 3A4 inducers Digoxin: monitor and adjust digoxin dose
47
Valbenazine counseling
Avoid driving or operating heavy machinery
48
Neuroleptic Malignant Syndrome (NMS) Presentation
muscular rigidity, hyperthermia, altered mental status, autonomic dysfunction
49
Neuroleptic Malignant Syndrome (NMS) onset
1-2 weeks after initiation/change in dose, can occur as soon as 1-3 days
50
Neuroleptic Malignant Syndrome (NMS) resolution
Discontinue antipsychotic, sx usually subside in 1-2 weeks
51
Neuroleptic Malignant Syndrome (NMS) mortality rate
12%, up to 20% in patients who receive inadequate NMS treatment
52
Neuroleptic Malignant Syndrome (NMS) reoccurance
30-50%; ways to reduce risk are waiting at least 2 weeks to restart antipsychotic therapy or use different class antipsychotic of lower potency
53
FGA monitoring parameters
QTc prolongation (EKG and serum K+) Hyperprolactinemia (screen for symptoms, prolactin level if indicated) AIMS/DISKUS screening for EPS
54
FGA pro
Extremely effective at reducing positive symptoms
55
FGA con
Do not treat negative symptoms, often exacerbate them instead High risk of side effects Movement disorders are common and can become permanent
56
SGA MOA
5HT2-DA antagonism D2 partial agonism D2 antagonism with rapid dissociation 5-HT1A partial agonism & 5-HT2A antagonism
57
SGA indications
Tx-refractory or suicidal behavior in schizophrenia -Clozapine
58
SGAs: Dosing
Start at low dose and titrate on basis of tolerability and response Acute psychosis: increase dose until symptoms improve or AE limit dose Use divided doses for 1-2 weeks to decrease AE; then change to daily dosing
59
SGA tapering
Consider half life and patient-specific factors 25% reduction in TDD weekly or slower Discontinuation symptoms begin 2-3 days after abrupt stop and may last up to 14 days
60
SGA metabolic syndrome risk
highest Clozapine Olanzapine Quetiapine Risperidone Paliperidone Iloperidone Asenapine Aripiprazole Lurasidone Ziprasidone Lowest
61
5HT2C antagonist
Stimulates appetite and thus weight gain
62
M3 antagonist
Impaired insulin secretion from pancreas
63
H1 antagonist
Sedation; decreased physical activity
64
BMI monitoring
Baseline, 1 mo, 2 mo, 3 mo, quaterly
65
Waist monitoring
Baseline, annual
66
A1C monitoring
Baseline, 3 mo, Annual
67
Lipid monitoring
Baseline, 3 mo, annual
68
BP monitoring
ALL (Baseline, 1 mo, 2 mo, 3 mo, 6 mo, quarterly, annual)
69
SGA: Hyperprolactinemia symptoms
Females Oligomenorrhea to amenorrhea Galactorrhea when not pregnant/ breast feeding Painful intercourse Hirsutism Males Erectile dysfunction Gynecomastia
70
SGA: Hyperprolactinemia clinical pearls
Levels do NOT correlate with symptoms Only treat/intervene if symptomatic
71
SGA: Hyperprolactinemia worst offenders
Risperidone Paliperidone
72
SGA: Hyperprolactinemia treatment
Consider DA partial agonists (prolactin-sparing) Aripiprazole Brexpiprazole Cariprazine
73
All SGA have demonstrated some level of
QT prologation Increased risk: ziprasidone > quetiapine > iloperidone > risperidone ~ paliperidone ~ clozapine
74
Encourage frequent monitoring or discontinuation if QT/QTc ___
>500 ms
75
SGA side effects
constipation dry mouth sedation orthostatsis
76
Managing SGA constipation
Exercise, increase fluid intake, stool softeners
77
Managing SGA Dry mouth
Increase fluid intake, sugarless candy or gum, saliva substitutes, fluoride rinses, mouth washes
78
Managing SGA sedation
Administer dose at bedtime, decrease/divide dose between AM and PM, switch to AP with less sedative properties
79
Managing SGA orthostasis
Avoid changing posture quickly, decrease/divide dose, switch to AP without antiadrenergic properties
80
Treatment Resistant
Lack of significant improvement in symptoms despite treatment with at least two antipsychotics from two different antipsychotic classes at the recommended dosage for a period of at least 2-8 weeks
81
guidelines suggest ____ as treatment of choice for treatment-resistant patients
Clozapine
82
Clozapine has a weak affinity for
DA receptors, and strong affinity for alpha, muscarinic, and histamine receptors --> SIDE EFFECTS
83
Clozapine warnings
Agranulocytosis --> BOXED WARNING Orthostasis/syncope --> BOXED WARNING Myocarditis and cardiomyopathy --> BOXED WARNING Seizures --> BOXED WARNING QTc prolongation
84
Clozapine CI
Myeloproliferative disorders Clozapine-induced agranulocytosis Severe CNS depression Paralytic ileus
85
Clozapine ANC level normal
ANC ≥ 1500/mm3
86
Clozapine ANC monitoring
Weekly x 6 mo Every 2 weeks for mo 6-12 Monthly after 12 mo
87
Long-acting injectables pros
Easy adherence monitoring Don’t need to take a med every day Regular contact with medical staff Easier to discriminate between non-adherence and lack of response/relapse decrease overdose risk More stable plasma concentrations
88
Long-acting injectables cons
Long time before effective dose/steady state achieved Less flexibility with dose adjustments Injection site reactions Requires frequent visits with medical staff Some require overlap with PO formulation until steady state achieved
89
Pregnancy and lactation
NOT recommended to stop antipsychotic during pregnancy Avoid antipsychotics with anticholinergic side effects Breastfeeding is not recommended
90
Children
Children tend to gain more weight than adults and have more EPS
91
Elderly
More susceptible to antiadrenergic (falls/orthostasis) and antimuscarinic (urinary retention, constipation, memory) side effects Boxed warning in older adults for increased mortality in dementia-related psychosis
92
Ziprasidone should be taken with a _____meal
500+ calorie
93
Lurasidone should be taken with a ___ meal
350+ calorie
94
causes heavy sedation
Quetiapine, olanzapine, clozapine
95
causes restlessness
Aripiprazole
96
causes gynecomastia
Risperidone, paliperidone

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