Schizoprenia Flashcards
What is the gold Standard diagnostic tool for schizophrenia?
What score should an absent symptom receive?
What do you do When the total score is 23?
PANNS positive and negative syndrome scale
1 for absent symptoms
23 is the score for a perfectly normal exam, all symptoms are absent
What factors predict a good prognosis in schizophreniform disorder?
- Acute onset
- No Family history of schizophrenia
- Good pre-morbid social and occupational/cognitive functioning
- Period of confusion and or perplexity at symptoms during symptomatic period
What two things differentiates schizophrenia from schizophreniform disorder?
- Timing. In schizophrenia, symptoms must be persistent for at least six months. Schizophreniform disorder symptoms must be present for at least one month but less than six months.
Diagnosis is always provisional
- Lack of a criterion requiring impaired social and occupational functioning
What percent of patients with schizophreniform disorder will recover and what percent will go on to develop schizophrenia?
1/3 of patients with schizophreniform disorder will fully recover, 2/3 will go on to develop schizophrenia
Which brain area is associated with impaired impulse control and aggressive symptoms?
Orbital frontal cortex
Which brain area is associated with positive symptoms?
Nucleus accumbens
What is wrong with glutamate activity at NMDA receptors in schizophrenia?
Hypo functional
Normally, when glutamate synapses are active, their NMDA receptors trigger an electrical phenomenon known as long-term potentiation which leads to structural and functional changes of the synapse that make neurotransmission more efficient
Big 3 Drug induced parkinsonism symptoms
Tremor, worse at rest
Bradykinesia or Akinesia
Muscle stiffness or rigidity
Mask-like facies
Which class of antipsychotics causes more drug induced parkinsonism?
Name two risk factors for DIP
Occurs more frequently with typical antipsychotics and across the spectrum of atypical antipsychotics
Female gender and age
Dopamine and acetylcholine in movement disorders
DIP low DA, excess ACh
TD excess DA, low ACh
Reducing antipsychotic those and movement disorders
Akathesia —> improves BUT Withdrawal akathisia can occur, allow at least 6 weeks before judging effectiveness of those reduction or medication switch
DIP —-> improves
TD —-> worsens
Drugs used to treat akathisia
Do not use an anti-cholinergic
Beta-adrenergic blockers (propanolol)
Benzodiazepines (clonazepam)
5HT2A agonists (mirtazapine, cyproheptadine)
Treatment of DIP
Withdraw or reduce antipsychotic drug if possible
Switch to antipsychotic with lower D2 affinity
Anticholinergic drugs (Benztropine)
Overuse of anti-cholinergics can lead to excessive tolerability burden
Amantadine may also be helpful, but empirical evidence supporting its use is also limited
TD treatment strategies
Do not stop antipsychotic treatment or reduced dose
VMAT2 inhibitors: valbenazine, deutetrabenazine
Switch to clozapine
Botox injections in face
Deep brain stimulation of the Globus pallidus interna for refractory TD
What drug is 1st line for neuroleptic malignant syndrome
Dantrolene
