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Therapeutics > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

Define schizophrenia.

A

A chronic psych disorder characterized by disruptions in perception, thought, affect, behaviour and cognition which cause significant disturbances in interpersonal relationships and in the ability to function in society on a daily basis.

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2
Q

What are the types of hallucinations?

A

Auditory, visual, tactile, olfactory, and gustatory.

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3
Q

Define hallucinations.

A

A false sensory perception not associated with real external stimuli.

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4
Q

Define auditory hallucinations.

A

A false perception of sight.

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5
Q

Define visual hallucinations.

A

A false perception of touch.

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6
Q

Define tactile hallucinations.

A

A false perception of touch.

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7
Q

Define olfactory hallucinations.

A

A false perception of smell.

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8
Q

Define gustatory hallucinations.

A

A false perception of taste.

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9
Q

Define delusions.

A

A false belief based on incorrect inference.

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10
Q

Define paranoid/persecutory delusions.

A

A false belief that one is being harassed, followed, cheated, persecuted, or poisoned.

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11
Q

Define grandiose delusions.

A

An exaggerated conception of one’s importance, power, or identity.

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12
Q

Define religious delusions.

A

A false belief concerning a religious issue.

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13
Q

Define somatic delusions.

A

A false belief about one’s body.

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14
Q

Define ideas of reference delusions.

A

A belief that something refers to you specifically or has a special meaning intended just for you.

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15
Q

Define thought broadcasting delusions.

A

A belief that one’s thoughts can be heard by others.

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16
Q

Define thought insertion delusions.

A

A belief that others have implanted thoughts in one’s mind.

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17
Q

Define thought withdrawal delusions.

A

A belief that others are removing one’s thought.

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18
Q

Define loosening of associations.

A

Flow of thought in which ideas switch from 1 topic to another in an unrelated way.

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19
Q

Define flight of ideas.

A

Constant switching from 1 thought to another, but ideas are connected (racing mind).

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20
Q

Define tangentiality.

A

Person never gets to the point.

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21
Q

Define circumstantiality.

A

Person gets to the point eventually, but includes a lot of unnecessary info.

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22
Q

Define neologisms.

A

New words created by patient.

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23
Q

Define thought blocking.

A

An abrupt interruption in train of thought.

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24
Q

Define poverty of thought.

A

No thoughts. Appear vague and empty.

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25
Q

What are the 4 clinical courses of schizophrenia?

A

Premorbid, prodromal, acute/psychotic, burnout.

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26
Q

What’s the stress vulnerability model?

A

Genetic predisposition + life stressors = biological/chemical changes that result in disorder.

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27
Q

What are the positive symptoms of schizophrenia?

A

Hallucinations, delusions, disorganizaton (thoughts, speech, behaviours), hostility, agitation, aggression.

28
Q

What are the negative symptoms of schizophrenia?

A

Alogia, avolition/apathy, affective flattening, anhedonia, asocial.

29
Q

What are the cognitive deficits in schizophrenia?

A

Focusing and sustaining attention, memorial and serial learning, abstraction, concentration, prioritizing, problem solving, judgement.

30
Q

What are the mood symptoms in schizophrenia?

A

Depression, hopelessness, suicidality, anxiety.

31
Q

What does ziprasidone (Zeldox) interact with?

A

ZIP + potent 3A4 inhibitor or QT prolongation med = QTc prolongation.

32
Q

What does risperidone interact with?

A

RISP + potent 2D6 inhibitor (ie. paxil) = increased parent drug

33
Q

What does clozapine interact with?

A

CLOZ + 1A2 inducer (smoking) = decreased cloz levels.

34
Q

What does aripiprazole (Ability) interact with?

A

ARIPIP + potent 2D6 or 3A4 inducers/inhibitors = double/half dose.

35
Q

What does lurasidone (latuda) interact with?

A

LUR + strong 3A4 inhibitor (ketoconazole, fluoxetine, fluvoxamine) or + strong 3A4 inducer (rifampin) = CI

36
Q

Three situations in which clozapine is recommended:

A
  1. Treatment resistant patients
  2. Persistent suicidal ideation or behaviour
  3. When persistent hostility and aggressive behaviour present
37
Q

What antipsychotic requires a 500 cal meal with dose?

A

Ziprasidone (Zeldox)

38
Q

What antipsychotic requires a 350 cal meal with dose?

A

Lurasidone (Latuda)

39
Q

What are some predictors of poor response?

A

Male, pre or peri natal injury, move severe hallucinations or delusions, impairment in attention, poor pre-morbid functioning, longer duration of untreated psychosis, and development of EPS.

40
Q

What agents can you use w/ APs as augmenting agents?

A

Lithium, valproate, benzos, electroconvulsive therapy. Note adequate trial of augmenting agent is 8-10 weeks. May use a second AP to augment Tx w/ clozapine.

41
Q

What are the symptoms of dopaminergic rebound?

A

Supersensitivity psychosis

42
Q

What are symptoms of cholinergic rebound?

A

Flu like symptoms; nausea, vomiting, diarrhea, diaphoresis, insomnia.

43
Q

What are symptoms of histaminic rebound?

A

Insomnia; improvement in weight gain, glucose intolerance, dyslipidemias, sedation.

44
Q

What are symptoms of adrenergic rebound?

A

HTN, tachycardia, tremor, restlessness.

45
Q

What are symptoms of serotonergic rebound?

A

Serotonin syndrome (agitation, diaphoresis, fever, tremor, confusion) or NMS like symptoms.

46
Q

What are the Therapeutic Alternative for Managing Side Effects?

A
  1. D/C med
  2. Do not alter med
  3. Reduce the dosage
  4. Alter the dosage schedule
  5. Add a non-pharm Tx
  6. Add a pharm Tx
  7. Switch to alternative med
47
Q

How do you treat orthostatic hypotension and reflex tachycardia?

A

Divided dosing until tolerance develops.

48
Q

How do you treat dry mouth?

A

Sugarless candy/gum, Biotene, good oral hygiene.

49
Q

How do you treat dry eyes?

A

Artificial tears.

50
Q

How do you treat blurred vision?

A

Tolerance in a few weeks; if persists or bothersome, use pilocarpine eye drops.

51
Q

How do you treat constipation?

A

Promote fluid, fibre, and exercise, bulk former, stool softener.

52
Q

How do you treat urinary retention?

A

Reduce dose, switch agents or add bethanechol. (Must treat this)

53
Q

How do you treat anticholinergic delirium?

A

D/C AP and other anticholinergics, restart AP when resolved at a lower dose or switch agents.

54
Q

How do you treat sedation?

A

Switch to hs dosing, decrease caffeine intake. Tolerance usually develops.

55
Q

How do you treat weight gain?

A

Lifestyle modification, metformin, topiramate.

56
Q

How do you treat hyperprolactinemia?

A

Drop dose, switch agent, add dopamine receptor agonist (bromocriptine or amantadine) for amenorrhea/galactorrhea; add sildenafil, yohimbine or cyproheptadine for sexual dysfunction.

57
Q

How do you treat acute dystonias?

A

Benztropine IM stat and lower AP dose, or add regular Tx w/ benztropine po.

58
Q

How do you treat akathisia?

A

Dose reduction, anticholinergics less effective, add benzo (lorazepam), add low dose propranolol

59
Q

How do you treat pseudo-parkinsonism?

A

Dose reduction, add anticholinergic (qam and 4pm), add propranolol if tremor primary concern.

60
Q

What are the risk factors for tardive dystonias and tardive dyskinesias?

A

Total dose/duration of Tx, age >40, females, presence of an affective component, severe movements early in treatment.

61
Q

How do you treat tardive dystonias and tardive dyskinesias?

A

Use lowest effective dose, switch to SGA or TGA if not already on one, D/C any anticholinergics, Vitamin E

62
Q

How do you treat neuroleptic malignant syndrome (NMS)?

A

Stop antipsychotic and initiate supportive Tx (antipyretics, antihypertensives, rehydration). May resume same AP again.

63
Q

How do you treat seizures due to APs?

A

1st seizure: decrease dose or switch; if seizure persists D/C med or add AED (not phenytoin, use epival).

64
Q

How do you treat dyslipidemias?

A

Diet, lipid lowering agents (statins)

65
Q

How do you treat diabetes?

A

Diet, exercise, switch AP, addition of oral hypoglycemic

Therapeutics (9 decks)

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