Schizophrenia and Psychotic Disorders Flashcards Preview

NeuroPsych > Schizophrenia and Psychotic Disorders > Flashcards

Flashcards in Schizophrenia and Psychotic Disorders Deck (36):
1

Epidemiology of Schizo

Onset is early adulthood, usually younger in males than in females
No racial differences
Genetic link
Early brain viruses
Autoimmune comorbidities

2

Affected neurotransmitters

DA
SR
Glu
GABA

3

DSM 4 Dx Criteria

2 or more of the following for at least 6 months: hallucinations, delusions, disorganized speech, negative sx
Not explained by drug or comorbidity

4

Brain abnormalities in Schizo

Larger ventricles due to reduction in brain size
Smaller hippocampus

5

Initial presentation

Positive sx and prodrome of negative sx

6

Schizo and Life Expectancy

Reduced by 20-30 years due to high suicide rate, self-medicating/substance abuse and poor hygeine

7

Positive Sx

Hallucinations
Delusions
Disorganized Speech

8

Negative Sx

Asociality
Alogia - poor speech
Avolition
Anhedonia

9

Cognitive Sx

Impaired speech, memory, learning

10

Therapeutic Goals

Acute Phase
Stabilization Phase
Maintenance Phase

11

General Pathology of Psychosis

Hyperstimulation, especially of dopamine receptors

12

First Antipsychotic

Chlorpromazine

13

Typical Antipsychotic Classes

Phenothiazines
Thioxanthenes
Butyrophenones

14

Side Effects of FGAs

DA2 - EPS
Anti-histamine - alpha 1
Anticholinergic - alpha 1
Weight gain
Cadiac arrhythmias

15

Phenothiazines vs Butyrophenones

Haldol >>> EPS >>>phenothiazenes

16

DA Hypothesis

Too much DA stimulation

17

Antipsychotic and DA receptor block (D1 vs D2)

D1 - cAMP inhibition
D2 - potency and clinical response + EPS

18

Modified DA Hypothesis

Low DA in mesocortical pathway
High DA in mesolimbic pathway

19

Other Neurotransmitter hypotheses

NMDA and Glu
SR

20

SGAs

Block 1+ receptor
Less EPS
Treats + and - sx
>affinity for SR receptors than DA

21

Abilify MOA

Partial DA agonis
Agonist of presynaptic receptors (where DA is low)
Antagonist of postsynaptic receptors (where DA is high)
Partial SR agonist!

22

ADME of Antipsychotics

A: readily, but not completely absorbed
D: High Vd, highly lipophilic and distributed into fat (this affects weaning/transitioning)
M: Extensive first pass (> age = < fx = < dose)
E: Half life 12-2h = QD dosing

23

D2 antagonism

EPS

24

5HT 2a

Attenuate EPS

25

5HT 2c

Attentuate prolactin

26

5HT 3

Anti-emetic

27

Alpha 1

Sedation, hypotension

28

Alpha 2

Depression and negative sx

29

H1

Sedation, anti-histamine

30

m1

Anticholinergic

31

When is sedation most common? With what drugs?

Low potency drugs
Usually due to histamine activity

32

Acute dystonia

Involuntary muscle spasms in neck
High/rapid dose of antipsychotic
Give Benadryl

33

Akathisia

Restless leg
Cogentin or benadryl

34

Parkinsonism

Parkinson-like movements
Cogentin or benadryl

35

Tardive Dyskinesia

Irreversible jerky movements
Reduce or d/c dose

36

Neuroleptic Malignant Syndrome

Rare but occurs more in younger males
Muscular rigidity, fever, SEVERE EPS
Supportive treatment