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Flashcards in Schizophrenia and Bipolar Deck (98):
0

Mental state in which the individual appears to have lost touch with reality

Psychosis

1

The most common cause of chronic psychosis

schizophrenia

2

A belief not based on fact or reality

delusion

3

3 classes of symptoms seen in schizophrenia

1. positive symptoms
2. negative symptoms
3. cognitive impairment

4

2 most consistent anatomical correlations to schizophrenia

1. decreased brain volume (decreased brain volume)
2. enlarged ventricles

5

Area of the brain that is important in higher cognitive function and working memory and has decreased metabolic activity in schizophrenia

prefrontal cortex

6

First drug discovered to treat schizophrenia

chlorpromazine

7

Neurotransmitter most commonly associated with schizophrenia

dopamine

8

Antagonism at this receptor in the striatum is thought to increase striatal DA release and may help to counteract D2 blockade, theory for why SGAs have less EPS than FGAs

5HT2A receptor

9

Mechanism of antipsychotic drugs

D2 dopamine receptor antagonists

10

involuntary movements usually to the face and tongue but also to the trunk and limbs that develops after months to years of antipsychotic therapy and can be irreversible

tardive dyskinesia

11

A perception disturbance in sensory experiences of the environment

Hallucination

12

Brain system involved in the negative symptoms of schizophrenia

mesocortical

13

Drug that marked the transition the SGAs and differed from FGAs in its significant decrease in motor SEs

Clozapine

14

Assigning importance to things that aren't important

aberrant salience

15

Antipsychotic that is a D2 receptor partial agonist and acts as a dopamine stabilizer

aripiprazole

16

Antipsychotic that has proven to be superior in treatment resistant patients

clozapine

17

A person diagnosed with schizophrenia must have at least 2 of the following 3 things

1. delusions
2. hallucinations
3. disorganized speech

18

Length of symptoms needed for diagnosis of schizophrenia

6 months

19

2 low potency SGAs

1. clozapine
2. quetiapine

20

Inhibition of these 2 receptors is thought to be lead to weight gain associated with antipsychotics

H1 and 5HT2C

21

Diagnosis of symptoms of schizophrenia have occurred for less than 6 months

schizophreniform disorder

22

schizophrenia + bipolar disorder

schizoaffective disorder

23

Symptom of psychosis that responds best to medications

hallucinations

24

Most common form of hallucination

auditory

25

minimum length of antipsycholic drug therapy for schizophrenia

1-2 years, usually lifelong

26

3 medium potency FGAs

1. loxapine
2. perphenazine
3. thiothixene

27

3 extrapyrimidal SEs that result from disruption of DA signaling in the substantia nigra to the striatum, important for motor function

1. akathisia (uncontrollable restlessness)
2. dystonia (involuntary movements)
3. parkinsonism (bradykinesia, tremor)

28

4 medications that can be used adjunctively in schizophrenia if aggression or hostility is present

lamotrigine, divalproex, topiramate, lithium

29

2 characteristics of drugs that have the highest risk of movement disorders

1. high potency
2. slow dissociation (most FGAs)

30

SGA that has the highest risk of akathisia

aripiprazole

31

antagonism at this receptor results in side effects such as blurred vision, urinary retention, dry mouth, and constipation

M1

32

Antagonism at this receptor leads to sedation SE of antipsychotics

H1

33

3 high potency FGAs

1. trifluoperazine
2. fluphenazine
3. haloperidol

34

The most activating antipsychotic (take in the morning)

aripiprazole

35

Potency of meds that have the most anticolinergic SEs and sedation

low potency

36

antagonism of this receptor results in hypotension SE of antipsychotics

alpha-1

37

antipsychotics that have the highest risk of hypotension

low potency and lloperidone

38

Minimum time needed to see full effect of antipsychotics

12 weeks

39

Antipsychotics that have the highest risk of hyperprolactinemia

FGAs and risperidone/paliperidone

40

3 receptors that are involved in metabolic issues associated with SGAs

5HT2C, M3 and H1

41

2 SGAs that have the highest risk of Torsades de Pointes

1. ziprasidone
2. Iloperidone

42

Symptoms of schizophrenia that are new mental phenomena which unaffected people do not normally experience (hallucinations, delusions)

Positive symptoms

43

2 SGAs that have the highest risk of metabolic issues

1. clozapine
2. olanzapine

44

5 SGAs that have intermediate risk of metabolic issues

quetiapine, risperidone, paliperidone, Iloperidone, asenapine

45

3 most important antipsychotics to not abruptly discontinue

1. clozapine
2. quetiapine
3. Ilperidone

46

FGA that has an intermediate risk of metabolic issues

chlorpromazine

47

3 SGAs that have a low risk of metabolic SEs

ziprasidone, lurasidone, aripiprazole

48

All FGAs have a higher risk of Torsades de Pointes than SGAs but this FGA has the highest risk

Thioridazine

49

3 antipsychotics included in FDA warning for increased incidence of stroke in elderly patients with dementia

1. risperidone
2. olanzapine
3. aripiprazole

50

Dietary restriction with ziprasidone

take with at least 500 calories

51

4 drug characteristics that lead to increased risk of neuroleptic malignant syndrome

1. high dose
2. high potency
3. IV
4. dehydration

52

Antipsychotic that has the highest risk of seizures

clozapine

53

4 SEs that clozapine has the highest incidence of

1. metabolic changes
2. sedation
3. constipation
4. sialorrhea (drooling)

54

Antipsychotic that has the lowest risk of seizures

Quetiapine

55

2 SEs that clozapine has the lowest incidence of

1. movement disorders
2. NMS

56

2 drugs that can be used IM to treat dystonia

1. benztropine
2. benadryl

57

Antipsychotic that is technically a FGA but has some 5HT2A activity and is often used in children

loxapine

58

Rare but life-threatening SE of antipsychotics that involves fever, encephalopathy, unstable vitals, elevated enzymes and muscle rigidity

Neuroleptic malignant syndrome

59

Schedule for CBC monitoring with clozapine

weekly for 6 months, then every 2 weeks for 6 months then monthly thereafter

60

2 antipsychotics that are long acting injections given every 1-4 weeks and are good for poor adherance

1. fluphenazine decanoate
2. haloperidol decanoate

61

A potentially fatal drop in WBC associated with clozapine

agranulocytosis

62

Enzyme that tobacco induces and cloazpine is a substrate

CYP1A2

63

5 black-box warnings for clozapine

1. agranulocytosis
2. seizures
3. myocarditis
4. orthostasis
5. antipsychotics in elderly

64

Dietary restriction with asenapine

no food or drink for 10-15 minutes

65

Brain system involved in the positive symptoms of schizophrenia

mesolimbic

66

Dietary restriction with lurasidone

take with at least 350 calories

67

2 low potency FGAs

1. chlorpromazine
2. thioridazine

68

2 high potency SGAs

1. risperidone
2. paliperidone

69

Symptoms of mania but less severe and episodes are not severe enough to cause marked impairment

hypomanic episode

70

Symptoms of schizophrenia in which the individual has a loss of normal mental functions (amotivation, social withdraw)

Negative symptoms

72

Route of elimination of lithium

kidney

73

therapeutic window of lithium

0.6-1.5 mM

74

Cation that lithium mimics in excitable tissues

Na+

75

Neurotransmitters whose release is inhibited by lithium

NE and DA

76

Second messenger created via PIP2 hydrolysis that activates calcium release from intracellular stores

IP3

77

Manic episode + major depressive episode

Bipolar I disorder

78

Duration of time in which a persistently elevated, expansive or irritable mood must occur to classify as a manic episode

7 days, but if hospitalization is required there is no minimum duration

79

4 AEDs that can be used in the management of bipolar disorder

Valproic acid, lamotrigine, carbamazepine, oxcarbazine

80

Only medication used in bipolar disorder that is truly a mood stabilizer

Lithium

81

Time required to see initial response in treatment of acute manic episode (see improvements in sleep and agitation first)

7-14 days

83

SE that is the reason why lamotrigine must be titrated slowly

Stephen-Johnson syndrome

84

Order of increasing risk of mood switch for antidepressants

Bupropion < SSRIs < Venlafaxine < MAOIs < TCAs

86

5 drugs that are not recommended as monotherapy for bipolar mania

1. Gabapentin
2. Lamotrigine
3. Tiagabine
4. Topiramate
5. Verapamil

87

EKG abnormality seen with lithium toxicity

flat or inverted T waves

88

Amount of time that the acute phase lasts for bipolar disorder

sustained response >4 weeks

89

Time required to see full response in treatment of an acute manic episode

4-8 weeks

90

Second messenger generated via hydrolysis of PIP2 that activates protein kinase C

DAG

91

The most effective agent for classic euphoric mania

Lithium

92

3 SGAs that are both anti-manic and anti-depressive

1. Quetiapine
2. Lurasidone
3. Olanzapine + fluoxatine

93

AED that has mostly anti-depressant effects and should not be used as monotherapy for manic episodes

Lamotrigine

94

Amount of time the continuation phase lasts in bipolar depression treatment

full response for 4-6 months

95

6 medications that have FDA approval for prevention of recurrence of bipolar disorder

1. Lithium
2. Lamotrigine
3. Olanzapine
4. Aripiprazole
5. Risperdal consta
6. ziprasidone (adjunct)

96

5 medications that are not recommended for monotherapy in bipolar depression

1. Gabapentin
2. Aripiprazole
3. Ziprasidone
4. Parozetine
5. Levetiracitam

97

Drug class that tends to be best for disphoric mania

AEDs

100

Hypomania + major depressive episode

Bipolar II disorder

101

How often a patient on antipsychotic therapy should get an AIMS (abnormal involuntary movement scale) assessment

At baseline and every 6 months

102

How often a patient on anti psychotic therapy needs to get a lipid panel and glucose checked

every 3 months