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Positive symptoms of schizo
- hallucinations
- delusions (fixed false beliefs)
- disorganized thinking
- catatonia
- First rank symptoms: thought insertion, thought broadcasting, ideas of reference
- thought insertion: pt thinks others are putting thought into their head
- thought broadcasting: pt believes others can hear their thoughts
- ideas of reference: song on radio abouth them, or news is directed toward them or about them
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Negative symptoms of schizo
- affect flattening (having no emotional response)
- alogia (poverty speech)
- asociality (inability to empathise)
- anhedonia (loss to experience pleasure)
- avolition (lack of motivation)
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Cognitive symptoms of Schizo
- impaired attention
- impaired concentration
- impaired working memory
- impaired judgement
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D2 receptor blcokade
- helps manage positive symptoms
- can cause EPS: dystonia, pseudoparkinsonism, akathisia
- treat EPS: with anticholnergic, like benzotropine (or trihyphenidyl, diphenhydramine)
- akathisia: treated w/lorazepam, propranolol or amantadine
- can cause hyperprolactinemia
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5-HT2A receptor blockade
- Decreases EPS
- treatment of negative symptoms
- may also benefit pts with depression or anxiety
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Histamine H1 receptor blockade
- sedation
- drowsiness
- appetite stimulation (weight gain)
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Muscarinic receptor blockade
- blurred vision
- dry mouth
- urinary retention
- constipation
- clozapine: causes sialorrhea (hypersalvation)
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α - Adrenergic receptor blockade
- postural hypotension (orthostasis)
- dizziness
- reflex tachycardia
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Tardative Dyskinesia
- buccal-lingual-masticatory (BLM) - abnomral orofacial movements
- forward, backward or lateral tongue movements
- tongue thrusting, rolling or fly-catching movements
- chewing or lateral jaw movements
- More common in FGA than SGA (risperidone & paliperidone highest occurence)
- do NOT treat TD with anticholinergic
- Treat: w/clozapine or quetiapine (less risk of TD)
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Weight gain and Obesity are caused by what medications
- More common in: SGAs
- olanzapine (more severe)
- clozapine (more severe)
- Less common in: FGAs
- aripiprazole (SGA)
- ziprasidone (SGA)
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Lipid Abnoramilites are caused by what medications
- Phenothiazine (FGA)
- some SGAs
- Less common in: SGAs
- risperidone
- paliperidone
- aripiprazole
- ziprasidone
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QTc interval prolongation caused by what medications
- thiordiazone (greatest risk)
- ziprasidone
- clozapine
- haloperidol
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Thermoregulation
- Poikilothermia: inability to properly adjust to ambient temperature
- can lead to heat stroke
- caused by what medications: low-potency FGA, SGA with potent anticholinergic activity
- chlorpromazine (FGA)
- thioridazine (FGA)
- olanzipine (SGA)
- clozapine (SGA)
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Neuroleptic Malignant Syndrome (NMS) caused by what meds
- high potency FGA
- pts who have EPS
- treat: w/
- stopping antipsychotic
- hydrate and control temp
- muscle relaxant (dantrolene)
- dopamine agonist (bromocriptine)
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Seizures caused by what medications
- clozapine
- chlorpromazine
- Lowest risk for seizures, riperidone, and high potency FGAs
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Agranulozytosis caused by what medications
clozapine
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Thiothixene adverse effects
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Fluphenazine adverse effects
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Haloperidol adverse effects
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Perphenazine adverse effects
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Olanzapine adverse effects
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Chlorpromazine adverse effects
- Orthostasis
- Drowsiness/sedation
- FGA - Low
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Paliperidone adverse effects
Prolactin
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Risperidone adverse effects
Prolactin
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Asenapine adverse effects
Orthostasis
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Clozapine adverse effects
- (WADO)
- Weight gain
- Antichloinergic
- Drowsiness/sedation
- Orthostasis
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Elimination Half-life exceptions
- Risperidone has a relatively short half life but its metabolized to paliperidone which has a half life of a day
- Ziprasidone usually dosed BID
- Quetiapine comes in ER because it too has a relatively short half life
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CYP1A2
- Clozapine
- Olanzapine
- CYP1A2 inhibitors: fluvoxamine, cimetidine, Cipro
- CYP1A2 inducers: omeprazole, nicotine
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CYP2D6
- Perphenazine
- Fluphenazine
- Haloperidol
- Risperidone
- Iloperidone
- CYP2D6 inhibitor: fluoxetine, paroxetine, sertraline (SSRI), bupropion
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CYP3A4
- Haloperidol
- Aripiprazole
- quetiapine
- lurasidone
- olanzapine
- clozapine
- CYP3A4 inhibitors: ketoconazole, itraconazole, clarithromycin, reythromycin, indinavir, nelfinavir, ritonavir, and grapefruit jucie
- CYP3A4 inducer: St. Johns Watr (hypericum perforatum)
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Psychosocial treatment options
- Cognitive Behavioral Therapy: subjecting beliefs and experiences to reality testing
- Individual Psychotherapy: assist pts with managing life stressors, medication compliance, improve self-esteem
- Group Psychotherapy: provides social network for teaching coping and interpersonal skills
- Assertive Community Treatment: Multidisciplinary team delivers services needed
- Electroconvulsive Therapy: recommended in combo w/ antipsychotics meds for pts w/o improvements with meds alone or pregnant
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Clozapine
- 3rd line: used for treatment resistant schizo
- suicidal behavior
- Tardive Dyskinesia
- Clozapine fails then try adjunctive therapies
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Acute Stage Treatment
- Cocktail: haloperidol, benzotropine, and lorazepam
- Severe Syncope: Avoid use of olanzapine and lorazepam together
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Stabilization Stage Treatment
- if nonadherant: Long acting meds
- risperidone
- paliperidone
- haloperidol
- fluphenazine
- olanzapine
- drug containing PLGA polymers
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Clozapine monitoring parameters
- cannot be started if: WBC below 3500 (if below 35 on the left side of cbc chart), or ANC below 2000
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Clozapine Black Box Warnings
- agranulocytosis
- myocarditis
- cariovascular and respiratory reactions
- risk of seizures
- elders pts w/ dementia and the increased risk of death
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Pregnancy Medications of choice
- Haloperidol
- Risperidone
- ECT (electroconvlsive therapy)
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Long-acting (depot) Injections
- haloperidol
- fluphenazine
- respirodone
- paliperidone
- olanzapine
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