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In what areas are there a disruption in patients with schizophrenia?
- 1) perception
- 2) emotion
- 3) cognition
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What are the different classifications of schizophrenia?
- 1) disorganized
- 2) catatonic
- 3) paranoid
- 4) undifferentiated
- 5) residual
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List some positive symptoms.
- 1) hallucinations
- 2) delusions
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List some negative symptoms.
- 1) flat affect
- 2) poverty of thought
- 3) avolition
- 4) anhedonia
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What criteria must be met before being able to diagnose a patient with schizophrenia?
- Two or more of the following symptoms for at least one month:
- 1) hallucinations
- 2) delusions
- 3) disorganized speech
- 4) grossly disorganized or catatonic behavior
- 5) negative symptoms, anhedonia, flat affect, avolition
- 6) significant social dysfunction (signs must persist for at least six months)
- 7) mental retardation, schizoaffective disorders, mood disorders, substance abuse, and other causative medical disorders have been ruled out
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Which agent is the only one proven to be effective in the treatment of refractory schizophrenia?
clozapine (Clozaril, FazaClo)
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What are some atypical antipsychotics used in the treatment of schizophrenia?
- 1) clozapine (Clozaril)
- 2) respiradone (Risperdal)
- 3) olanzepine (Zyprexa)
- 4) quetiapine (Seroquel)
- 5) ziprasidone (Geodon)
- 6) Arpripazole (Abilify)
- 7) Paliperidone (Invega)
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Which atypical antipsychotic is the only one approved in the treatment of schizophrenia in patients ages 13-17?
risperidone (Risperdal)
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What are some side effects associated with typical antipsychotics?
- 1) sedation
- 2) orthostatic hypotension
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What are some side effects associated with atypical antipsychotics?
- 1) weight gain
- 2) anticholinergic side effects
- 3) EPS
- a. dystonic reactions
- 4) akathisia
- 5) psuedo-parkinsonism
- 6) irreversible drug-induced movement disorders
- 7) choreoathetosis
- 8) oral/buccal movements
- 9) NMS
- 10) endocrine/metabolic effects
- a. amenorrhea
- b. galactorrhea
- c. gynaecomastia
- d. hyperprolactinemia
- e. decreased glucose tolerance
- 11) dermatologic
- a. photosensitivity
- b. allergic
- c. pigmentation problems
- 12) temperature disregulation
- 13) QT prolongation
- 14) opthalmologic effects
- a. pigmentary retinopathy associated with thioridazine at doses > 800 mg.
- b. melanin deposits on cornea possibly leading to blindness
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What are some treatments given for patients experiencing dystonia of EPS as an adverse effect?
- 1) benztropine (Cogentin) 1-2 mg IM
- 2) diphenhydramine (Benadryl) 25-50 mg q 30 minutes until relieved
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What are some treatments given for patients experiencing akathisia associated with atypical antipsychotics?
- 1) benzodiazepines
- 2) lipophilic beta blockers
- a. propanolol
- 3) clonidine
- 4) anticholinergics
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What are some treatments give for patients experiencing pseudo-parkinsonism associated with atypical antipsychotics?
- 1) amantadine (Symmetrel) 100 mg BID
- 2) anticholinergics
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What are some strategies that can be incorporated for patients on an atypical antipsychotics to prevent adverse effects?
- 1) lowest effective dose
- 2) vitamin E
- 3) vitamin B6
- 4) lecithin
- 5) monitor by adminstering AIMS
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What are some symptoms of NMS?
- 1) BT > 104o F
- 2) lead-pipe rigidity
- 3) HTN
- 4) diaphoresis (sweating)
- 5) increased HR
- 6) incontinence
- 7) increased LFTs
- 8) increased CPK
- 9) increased WBCs
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How would you treat patients with NMS?
- 1) d/c atypical antipsychotic
- 2) hydrate patient
- 3) cooling blankets
- 4) bromocriptine
- 5) dantrolene sodium
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What are some treatments for acute schizophrenia?
- 1) haloperidol (Haldol-D) 5-10 mg IM/fluphenazine (Prolixin-D) 5-10 mg IM and
- lorazepam (Ativan) 2 mg IM q 4 hrs and anticholinergics
- 2) olanzepine (Zyprexa) 10 mg IM
- a. second dose in 2 hrs
- b. third dose in another 4 hrs
- c. maximum dose: 30 mg QD
- 3) ziprasidone (Geodon) 10 mg IM q 2 hrs or 20 mg IM q 4 hrs
- a. maximum dose: 40 mg QD
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What parameters must be monitored in patients taking atypical antipsychotics?
- 1) fasting blood glucose
- a. baseline
- b. after 12 weeks
- 2) lipids
- a. baseline
- b. after 12 weeks
- 3) BMI
- a. 4 weeks
- b. 8 weeks
- c. 12 weeks
- d. quarterly
- 4) waist circumference
- a. baseline
- b. annually
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What are two alternative drugs that can be used in patients who are non-compiant to PO dosing?
- 1) haloperidol decanoate (Haldol-D)
- 2) fluphenazine decanoate (Prolixin-D)
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How is the dosing converted for a patient who was taking haloperidol PO to Haldol-D?
PO daily dose x 10 equals the IM dose every 4 weeks
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How is the dosing converted for a patient who was taking fluphenazine PO to Prolixin-D?
1 mg po = 1.25 mg IM every 2 weeks
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What is contraindicated in the use of the depot forms of fluphenazine and haloperidol?
allergies to sesame seed oil
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How is fluphenazine and haloperidol administered?
IM into the gluteal or deltoid muscle with a 16 or 18 gauge needle
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How is the long-acting injection form of respiridone (Risperdal Consta) administered?
It is administered with a 3 week overlap of risperidone (Risperdal) PO.
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