treatment of schizophrenia (329 E1)

Question 1

goals for treatment

Answer 1

-safety in all settings
-physical care
-stabilization on meds
-education to pt & fam
-psychosocial support

Question 2

failure of pt to take prescribed meds can lead to

Answer 2

-risk of relapse
-risk of suicide or self harm
-risk of violence toward others
-increased mortality rates
-potential for hospital readmission
-decline in quality of life
-social and occupational difficulty

Question 3

antipsychotic medications are used to treat

Answer 3

schizophrenia
takes 2 to 6 weeks for meds to become effective

Question 4

antipsychotics

Answer 4

• work better on positive symptoms
• typical have less side effects
• do not have risk for overdose
• are not addictive

Question 5

what type of medication is best for adherence

Answer 5

long term injectable

Question 6

common side effects of antipsychotic medications

Answer 6

-extrapyramidal SE
-anticholinergic SE
-neuroleptic malignant syndrome
-metabolic syndrome

Question 7

extrapyramidal SE (EPS)

Answer 7

-acute dystonic reactions
-akathisia
-pseudoparkinsonism
~the above start w/n a few weeks of starting new med or w/ inc dose
-tardive dyskinesia
worst SE of typical antipsychotics, leads to lack of adherence

Question 8

first gen typical antipsychotics

Answer 8

-chlorpromazine
-haloperidol
-fluphenazine
-thioridazine
-perphenazine

Question 9

typical antipsychotics typically treat

Answer 9

the positive symptoms of schizophrenia & little effect on negative symptoms
used less than atypical d/t lack of effect on negative sx

Question 10

advantages of typical antipsychotics

Answer 10

less expensive than atypical antipsychotics

Question 11

disadvantages of typical antipsychotics

Answer 11

-EPS
-anticholinergic
-sedation, wt gain, metabolic syndrome, neuroleptic malignant syndrome, sexual dysfunction, endocrine disturbances, cardiovascular issues
-increased risk of seizures

Question 12

EPS: acute dystonic reactions

Answer 12

-a sudden, sustained contraction of one or several muscle groups, usually of the head & neck areas
-can be painful, frightening & uncomfy (inc anixety)
-not dangerous unless they involve muscles affecting the airway
-an emergency

Question 13

acute dystonic reactions: torticollis

Answer 13

spasmodic and painful spasm of muscles (head pulled to one side)

Question 14

acute dystonic reactions: oculogyric crisis

Answer 14

eyes roll back toward the head

Question 15

acute dystonic reactions: laryngeal dystonia

Answer 15

spasm of throat impairing breathing and swallowing

Question 16

EPS: akathisia

Answer 16

-motor restlessness manifested as excessive pacing, inability to remain still for any length of time, rocking while seated or shifting from one foot to the other while standing
-can be severe and distressing and can be mistaken for anxiety or agitation (dx correctly bc admin of more of the med will make it worse)
-should go away w/ treatment but can persist despite treatment

Question 17

Akathisia treatment

Answer 17

-a dose reduction or change in medication
-give anticholinergic agent such as benztropine
-provider may add meds such a propranolol, lorazepam or diazepam (short term use only)
-relaxation exercises

Question 18

Pseudoparkinsonism

Answer 18

temporary sx that resemble parkinson’s
-stiff & stooped posture
-shuffling gait
-bradykinesia
-pill rolling
-treumulousness
-dysphagia

Question 19

Pseudoparkinsonism treatments

Answer 19

-ID of the med and slow / safe discontinuation
-dosage reduction
-addition of oral anticholinergic agents such as benztropine or trihexyphenidyl to alleviate sx

Question 20

EPS: tardive dyskinesia

Answer 20

-involuntary rhythmic movement disorder that can occur w/ long term antipsychotic treatment; varies from mild to severe
-usually involves the oral and facial muscles and progresses to include the fingers, toes, neck, trunk or pelvis (tongue protruding)
-changes may be very slow or gradual and dx can be missed

Question 21

treatment for tardive dyskinesia

Answer 21

-reduce or discontinue antipsychotic med (sx will continue)
-switch to 2nd gen med
-give med to help with sx if cannot change med (valbenazine or deutetrabenazine)

Question 22

anticholinergic SE

Answer 22

-dry mouth, blurred vision, dry eyes, constipation, urinary retention/hesitancy, drowsiness, dizziness, confusion, hallucinations, tachycardia, skin flushing

Question 23

neuroleptic Malignant Syndrome (NMS)

Answer 23

-rare
-usually associated w/ antipsychotics
-early detection increases pt’s chance of survival

Question 24

NMS S/s

Answer 24

-severe muscle rigidity
-altered mental status
-inc body temp over 103
-htn
-tachycardia
-tachypnea
-diaphoresis
-incontinence

Question 25

progressive S/s of NMS

Answer 25

-rhado / protein in the blood causing organ failure -acute resp failure (strongest predictor of mortality) -acute kidney injury -sepsis

Question 26

treatment of NMS

Answer 26

-prompt detection -**immediately stop all antipsychotics** -supportive treatment of sx -ICU -meds to treat: dantrolene sodium, bromocriptine mesylate, lorazepam

Question 27

2nd generation atypical antipsychotics

Answer 27

-clozapine -riseridone -olanzapine -questiapine -ziprasidone

Question 28

third generation atypical antipsychotic overview

Answer 28

(subset of 2nd gen) -dopamine system stabilizers -may improve positive & negative sx + cognitive functions -little risk of EPS or tardive dyskinesia

Question 29

third gen drugs

Answer 29

-aripiprazole -brexpiprazole -cariprazine

Question 30

2nd generation overview

Answer 30

-treat both positive and negative sx -less likely to cause TD or EPS -less antipsychotics classic side effects

Question 31

disadvantages of 2nd gen

Answer 31

-tendency to cause significant wt gain -risk of metabolic syndrome -expensive

Question 32

atypical antipsychotics SE

Answer 32

-sedation -major wt gain leading to metabolic/endocrine problems -potential for cardiac dysrhythmias / sudden cardiac death -sexual dysfunction -**less likely** for anti chol SE, orthostatic hypotension, seizures & EPS

Question 33

if pt is at risk for metabolic syndrome

Answer 33

-monitor wt & girth -initial glucose tolerance test -monitor blood glucose -provide nutrition & activity support -consider lifestyle

Question 34

clozapine

Answer 34

-has been effective in treating refractory schizophrenia that doesn't respond to normal treatment **has to have failed success w/ other meds** -results in decreased negative symptoms, inc impulse control, reduced violence to self and others & improved quality of life

Question 35

clozapine SE

Answer 35

potentially fatal SE of agranulocytosis

Question 36

agranulocytosis

Answer 36

-a reduction in the number of circulating granulocytes and decreased production of granulocytes that limit one's ability to fight off infection -life threatening condition -particularly risky w/ clozapine; greater risk during first months of treatment -WBCs drops to dangerous levels -monitor WBC weekly for first 18 wks of treatment and then based on provider thereafter

Question 37

agranulocytosis

Answer 37

-discontinue medicine if pt develops leucopenia or neutropenia -reversible if treated early

Question 38

long acting injectable medications

Answer 38

-pts that are at risk non adherence to prescribed treatments may take medication that is available in injectable form -long acting and require administration only once every 2 to 4 wks or even up to months -must have transportation to receive the injection

Question 39

long acting drugs

Answer 39

haloperidol decanoate risperidone microspheres aripiprazole

Question 40

additional treatment approaches from meds

Answer 40

-ECT -cognitive behavioral therapy -group therapy -family therapy -social skills training -case mgt -support groups

Question 41

prognostic consideration of schizophrenia

Answer 41

-meds improve sx -good quality of life -some do not fully response to treatment leaving mild to severe residual sx & varying degree of disability -few require repeated or lengthy inpatient care

Question 42

factors contributing to repeated or lengthy inpatient care

Answer 42

-slow onset of the disease -younger age at onset -longer duration between first sx and first treatment -longer periods of untreated illness -more negative sx