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Schizohrenia is not:
- a distinct disease
- due to flaws in personality
- a multiple personality
- from poverty
- a split personality
- demonic
- contagious
- a socipathic behavior
- from bad parenting
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Lifetime prevelance of schizophrenia
1%
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epidemiology of schizophrenia
- no sex or racial differences
- women late 20s
- men early to mid 20s
- more frequent in lower socioeconomic class
- older people present with delusions and hallucinations and less disorganized and negative symptoms
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Life expectancy of a patient with schizophrenia
- 20-30 years shorter
- due to suicide, premature CV disease, genetics, AP drugs, lifestyle choices
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Environmental factors that can cause schizophrenia
- low birth weight
- hypoxia
- fetal distress/prematurity
- malnutrition
- infectious disease (flu in 2nd trimester)
- autoimmune causes
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Positive signs of schizophrenia
- delussions
- hallucinations
- disorganized speech
- unusual behavior
- psychomotor agitation
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Negative symptoms of schizophrenia
- blunted affect
- alogia- inability to speak
- avolition- lack of initiative or motivation
- anhedonia- absence of pleasure or ability to experience it
- poverty of speech
- psychomotor retardation
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Cognitive symptoms of schizophrenia
- attention
- memory
- executive functions
- skill acquistion
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mood symptoms of schizophrenia
- depression
- dysphoria
- hopelessness
- demoralization
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social and occupational symptoms of schizophrenia
- social isolation
- emplyment difficulties
- self-care
- family relationships
- social relationships
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5 subtypes of schizophrenia
- paranoid
- disorganized
- catatonic
- undifferentiated
- resdiual
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Standardized rating scales
- Brief Psychiatric Rating Scale (BPRS)
- Positive and Negative Symptom Scale (PANSS)
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List some tradition antipsycotics
- chlorpromazine (Thorazine)
- fluphenazine (Prolixin)
- haloperidol (Haldol)
- loxapine (Loxitane)
- molindone (Moban)
- perphenazine (Trilafon)
- thioridazine (Mellaril)
- thiothixene (Navane)
- trifluoperazine (Stelazine)
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Pathophysiology of schizophrenia
- dopamine hyper/hypoactivitiy
- serotonin blockade???
- excitatory amino acids
- decreased glutamate
- NMDA receptor dysfunction
- increased glutamate receptors
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Therapeutic goals of schizophrenia
- acute stabilization: reduced threat to self or others, reduct acute symptoms, improve role functioning, identify types of psychosocial interventions, collaborate with family members and caregivers
- stabilization: minimize/prevent relapse, medication compliance, optimize dose vs. adverse effects
- Stable phase/maintenance: improve functionand QOL, maintain base line functioning, optimize dose and limit AE, monitor for prodromal symptoms of relapse, monitor for ADR
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Non-pharmacologic interventions for schizophrenia
- supportive/counseling
- personal thearpy
- social skills therapy
- vocational sheltered employment rehabilitation therapies
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Atypical antipsycotics (2nd generation)
- aripiprazole (Abilify)
- clozapine (Cozaril)
- olanzapine (Zyprexa)
- paliperidone (Invega)
- quetiapine (Seroquel)
- risperidone (Risperdal)
- ziprasidone (Geodon)
- iloperidone (Fanapt)
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SE of chlopromazine (Throazine)
- EPS not as prominant
- anticholinergic delirium in elderly patients
- QT prolongation
- orthostasis
- photosensitivity
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SE of clozapine (Clozaril)
- agranulocytosis
- weight gain
- seizures
- drooling
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SE of risperidone (Risperdal)
orthostasis
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SE of olanzapine (Zyprexa)
weight gain
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SE of quetiapine (Seroquel)
- sedation
- weight gain
- anxiety
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SE of ziprasidone (Geodon)
- orthostatic hypotension
- increase QT interval
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Agents used to treat EPS
- Antimuscarinics: benztropine, biperiden, trihexyphenidyl
- Antihistamine: diphenhydramine
- Dopamine agonist: amantadine
- Bzds: lorazepam, diazepam, clonazepm
- Beta blockers- propranolol
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How often should you monitor hyperprolactemia?
screen for symptoms at each visit and then yearly
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How often should you assess EPS?
every 2 weeks during acute phase of treatment and at each visit during the stable phase
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How often should you assess tardive dyskinesia?
complete every 6 months with typical APs and every 12 months with atypical APs. if at an increased risk then every 3-6 months
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How often you you assess cataracts?
ocular exam every 2 years for patients <40 and yearly >40
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Neuroleptic Malignant Syndrome
- characterized by muscular rigidity, hyperthermia, altered conschiousness, and autonomic disturbances
- most develop withing 10 days of starting therapy with AP
- occure more in males
- last 5-10 days after D/C medicaiton
- incidence is rare (0.5-2.4%)
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NMS treatment
- bromocriptine
- Dantrolene
- Amantadine
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