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Neuro Quiz 4 > Treatment of Schizophrenia > Flashcards

Treatment of Schizophrenia Flashcards

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1
Q

Clinical Presentation

A 
Difficult to live independently
Withdrawn socially
Poor self-care
Poor insight into illness
Substance abuse
Intermittent acute psychotic episodes
Social deterioration during first 5 years
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2
Q

Late life Schizo

A

Less acute psychotic episodes but residual negative symptoms presist

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3
Q

***DSM5 Criteria for Schizo

A
  • 2+ following persisting for at least 1 month (at least 1 must be 1/2/3)
    1. Delusions
    2. Hallucinations
    3. Disorganized speech
    4. Disorganized or catatonic behavior
    5. Negative symptoms
  • Level of social and/or occupational function has significantly declined
  • Continuous signs for at least 6 months (prodromal or residual symptoms)
  • Schizoaffective or mood disorder has been excluded
  • Disorder not due to medical disorder or substance abuse
  • If a development disorder is present, there must be symptoms of hallucination/delusions for at least 1 month
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4
Q

Treatment of Schizo

A

ECT
Assertive Community Treatment
Cognitive Behavioral Therapy
Pharmacological (antipsychotics)

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5
Q

Assertive Community Treatment (ACT)

A

Multidisciplinary team
Provides home vistis several times a week
Training for activities of daily living, grocery shopping, med management, public transportation
- Shown to reduce hospitalization and homelessness

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6
Q

Cognitive Behavioral Therapy (CBT)

A

Develop strategies for coping

- 4 to 9 months

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7
Q

Acute Stabilization Treatment

A

Initiate antipsychotic treatment and titrate dose every few days to a moderate dose
Severely agitated = fast acting antipsychotic by IM injection
- If cheeking, use oral disintegrating tablet or liquid
- Chemical not physical restraining

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8
Q

Define Cheeking

A

Appear to be taking medications but really just put in in cheek and spit it out later

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9
Q

First 7 days of acute treatment?

A

Decreased agitation, hostility, anxiety and aggression

Improved Sleep and appetite

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10
Q

What is typically used with IM anti-psychotics and wht?

A

Lorazepam and benztropine IM
L: aids in calming
B: prevents dystonia

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11
Q

Lorazepam shouldn’t be combined with:

A

Olanzapine due to hypotension, respiratory depression and CNS depression

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12
Q

2-3 weeks with treatment

A

Increased socialization
Improved self care and mood
Decreased hallucinations

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13
Q

6-8 weeks with treatment

A

Improvement in formal thought process

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14
Q

No improvement in 3-4 weeks or partial decrease in (+) symptoms within 12 weeks =

A

Next treatment algorithm stage

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15
Q

Increase dose?

A

Continuously and gradually for more symptom control

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16
Q

Treatment goal:

A

No or minimal (+) symptoms

(-) or cognitive symptoms are less likely to remit

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17
Q

Maintenance Treatment

A

Continued antipsychotic for at least 5 years or lifetime for chronically ill

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18
Q

Relapse rate

A

18-32% with maintenance

60-80% without

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19
Q

Dosing points to consider:

A

First episode = lower dose (start low and titrate)

Use 1/2 life to determine how fast to titration or taper

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20
Q

First Psychotic Episode Treatment

A

Antipsychotic not cloza/olnzapine

Not effective – switch to a different one (not clozapine)

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21
Q

More than 1 psychotic episode but successful treatment in past Treatment

A

Antipsychotic not clozapine

Not effective – switch to a different one (not clozapine)

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22
Q

For treatment resistant patients or violet behaviors or suicidalitytreatment

A

See definition

Clozapine

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23
Q

Common side effects in 1st Generation Antipsychotics

A

EPS and hyperprolactinemia (D2)
Anticholinergic (M1)
Sedation/weight gain (H1)
Orthostasis (alpha1)

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24
Q

Chlorpromazine and Thioridazine Side Effects

A 
Anticholinergic
Sedation/weight gain
Lower BP
M1, H1, alpha1
***Low EPS (D2)
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25
Loxapine Side Effects
Some anticholinergic, sedation weight gain, EPS/hyperprolactin
26
Perphenazine Side Effects
Low anticholinergic, sedation weight gain, alpha 1 | ***HIGH EPS/hyperprolactin
27
Thiothixene Side Effects
Low anticholinergic, sedation weight gain, alpha 1 | ***HIGH EPS/hyperprolactin
28
Haloperidol and Fluphenazine Side effects
Low anticholinergic, sedation weight gain, alpha 1 | ****SUPER HIGH EPS/hyperprolactin
29
Most common AE with 2nd Generation
Weight gain Dyslipidemia Hyperglycemia - Anticholinergic, H1, alpha 1, some EPS/hyperprolactin
30
"PINES"
Clozapine Olanzapine Quetiapin Asenapine
31
Clozapine Side effects
High everything except EPS/hyperprolactin
32
Olanzapine Side effects
High everything except EPS/hyperprolactin and alpha 1
33
Quetiapine Side Effects
High sedation, low BP and metabolic | - H1, alpha 1, 5HT
34
Asenapine Side Effects
High sedation | Everything else is low
35
"DONES"
``` Risperidone Paliperidone Ziprasidone Iloperidone Lurasidone ```
36
Risperidone Side effects
High EPS/Hyperprolactin | High alpha 1 (low BP)
37
Paliperidone Side Effects
High EPS/Hyperprotlactin | Everything else is low
38
Ziprasidone Side effects
Low across the board
39
Iloperidone Side effects
High alpha 1 (low BP)
40
Lurasidone Side Effects
High EPS/hyperprolactin
41
"PIPS"
Partial D2 agonists Aripiprazole Brexipiprazole
42
Aripiprazole & Brexipiprazole Side effects
Low across the board A: has akathisia B: less akathisia
43
Define akathisia
State of agitation, restlessness, distress
44
High risk of metabolic side effects:
Clozapine | Olanzapine
45
Low risk of metabolic side effects
Ziprasidone Aripiprazole Lurasidone Brexipiprazole
46
Monitoring for 2nd gen antipsychotics
``` BMI Q3 months Waist annually BP 12 weeks -- annually FPG 12 weeks -- annually FLP 12 weeks -- 1-5 years ```
47
Agranulocytosis as a side effect in what drugs
Clozapine ---- phenothiazines ---- olanzapine
48
Seizures as a side effect in what drugs
Clozapine --- phenothiazine
49
QT prolongation as a side effect in what drugs
Phenothizines, haloperidol IV, ziprasidone
50
Sexual dysfunction as a side effect in what drugs
High potency first gen
51
Neuroleptic Malignant Syndrome (NMS) as a side effect in what drugs
High potency first generation
52
What is Neuroleptic Malignant Syndrome (NMS)
``` Symptoms develop in 24-72 hours Temp greater than 100.4 Alter consciousness Vital fluctuations Muscle rigidity Leukocytosis Elevated CPK Rhabdo Elevates AST/ALT ```
53
Define Parkinsonism
Experience muscle rigidity, tremor, bradykinesia, postural instability Develops over 1-2 weeks
54
Treatment of parkinsonism
Anticholinergics (benztropine, diphenhydramine and trihexyphenidyl)
55
Define Dystonia
Muscle contractions Neck and shoulders usually Develops 1-4 days
56
Treatment of parkinsonism
Anticholinergics (benztropine, diphenhydramine and trihexyphenidyl)
57
Define Akathsia
Inner restlessness: pace back and forth, shift, tapping feet
58
Treatment of akathsia
Reduce antipsychotic dose or use a different agent | - Propranolol
59
Define Tardive Dyskinesia
Involuntary movements of the muscles (sticking out tongue, puckering lips, lip smacking, grimacing) IRREVERSIBLE
60
Treatment of tardive dyskinesia
Decrease or d/c antipsychotic and switch to an agent with less DA antagonism
61
Define AIMS
Abnormal Involuntary Movement Scale | - If you have a higher score, you will probably never be below that score again
62
Long Acting Antipsychotics Given IM
``` Haloperidol Fluphenazine Risperidone Paliperidone Olanzapine Aripiprazole ```
63
Haloperidol IM Aripiprazole IM Paliperidone IM
Once monthly
64
Fluphenazine IM
Q3-6 weeks
65
Risperidone IM
Q 2 wks
66
Olanzapine IM
Once or twice monthly
67
Oral therapy to IM, how long for overlap?
Stabilze on oral therapy first or at least 3-7 days of oral therapy to see if pt tolerates
68
Risperidone Overlap
Reconsituted before given Continue oral for 3 weeks before first depot shot IN THE BUTT
69
Fluphenazine (prolixin D)
1.2 X the oral dose Weekly for first 4-6 weeks then Q3-6 wks Deep Ztract IM method
70
Fluphenazine (prolixin D) overlap
Oral overlapped by 1 week
71
Haloperidol (Haldol D)
10-15 times the oral dose | Deep Ztract IM method
72
Haloperidol (Haldol D) overlap
Oral overlap by 1 month
73
Paliperidone (Invega Sustenna)
Deltoid or gluteal muscle 234 mg initially then 156 mg given 1 week later as loading doses Then 39-234 mg
74
Paliperidone (Invega Sustenna) overlap
Not necessary
75
Aripiprazole (Abilify Maintena)
IN THE BUTT | 400 mg loading dose
76
Aripiprazole (Abilify Maintena) overlap
14 days overlap with oral
77
Olanzapine (zyprexa relprevv)
LD: 210-300 mg Q 2 weeks X 4 MD: 150-300 Q2wks OR 300-405 Q 4 wks IN THE BUTT
78
Olanzapine (zyprexa relprevv) Black Box Warning
Sedation and delirium have been observed after use
79
CATIE and CUtLASS showed
No difference between first and second generation antipsychotics when comparing clinical outcomes (time to d/c and QofL

Neuro Quiz 4 (4 decks)

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