Term
| DSM5 Criteria for Schizophrenia |
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Definition
At least 2 symptoms for a significant period of time for at least a one month period.
At least one of the symptoms must be (1), (2), or (3):
1)Delusions- Positive Symptom
2)Hallucinations- Positive Symptom
3)Disorganized Speech- Positive Symptom
4)Grossly Disorganized/Catatonic
5)Negative Symptoms
Social/Occupational Dysfunction: > or = 1 area of functioning below level prior to onset of illness
-Work
-Interpersonal relationships
-Self-care
Duration: Contiunous sign of disturbance for > or = 6 months
** This may include a prodromal phase where they act bizarre or display withdrawal symptoms before psychosis sets in. |
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Term
| DSM5 Criteria for Schizoaffective Disorder |
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Definition
1) Major depressive, manic, or mixed episode concurrent with symptoms of schizophrenia
2) Must have had > or = 2 week period where delusions or hallucinations were present in the absence of prominent mood symptoms
3) Symptoms that meet criteria for major mood episode are present for majority of total duration of illness
**They are always psychotic, even if they are not manic or depressed; they are still having hallucinations or delusions. It is essentially, schizophrenia + bipolar
SAFD Subtypes:
-Bipolar Type: manic or mixed +/- major depressive episode
-Depressive Type: mood disturbances only include depression |
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Term
| Positive Schizophrenic Symptoms |
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Definition
Suspicious
Delusions
Hallucinations
Conceptual disorganization |
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Term
| Negative Schizophrenic Symptoms |
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Definition
Alogia
Avolition
Anhedonia
Affective Flattening |
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Term
| Cognitive Schizophrenic Symptoms |
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Definition
Impaired Attention
Impaired Working Memory
Impaired Executive Function |
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Term
| Effect of D2 receptor Antagonism in the Mesolimbic Tract |
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Definition
| Decrease Positive Symptoms |
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Term
| Effect of D2 receptor Antagonism in the Mesocortical Tract |
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Definition
| Increase Negative Symptoms |
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Term
| Effect of D2 receptor Antagonism in the Nigrostriatal Tract |
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Definition
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Term
| Effect of D2 receptor Antagonism in the Tuberinfundibular Tract |
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Definition
| Increase Hyperprolactinemia |
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Term
| What class of medications is indicated for acute schizophrenia phase? |
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Definition
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Term
| How long is an Adequate antipsychotic therapy trial? |
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Definition
| At least 4 weeks at therapeutic dose |
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Term
| If a partial response occurs during AP treatment (>20% reduction of positive symptoms), what do you do? |
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Definition
| After 4 weeks, continue current dose, or increase dose |
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Term
| If no response is seen after 4 weeks of AP therapy, what do you do? |
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Definition
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Term
| Typical Characteristics of 1st Generation Antipsychotics |
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Definition
-Dopamine (D2) receptor blockade
-Alleviates primarily positive symptoms
-Increases EPS, prolactin, and TDs
-Inexpensive |
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Term
| Typical characteristics of 2nd Generation Antipsychotics |
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Definition
-Increased 5HT2 blockade compared to D2. Indirectly increases dopamine levels in parts of the brain where it is low.
-Thought it would treat neg/cognitive symptoms, but we have not seen this clinically
-Decreases EPS, prolactin, and TDs
-Increases Metabolic Symptoms (BP, glucose, lipids, weight gain)
-More expensive |
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Term
First Generation APs
Lowest Potency ---> Highest Potency |
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Definition
| Chlorpromazine & Thioridazine --> Trifluoperazine, Loxapine, Thiothixene, Perphenazine --> Haloperidol & Fluphenazine |
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Term
APs to cause EPS
Most Likely --> Least Likely |
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Definition
| Haloperidol & Fluphenazine --> Trifluoperazine, Loxapine, Thiothixene, Perphenazine, Risperidone --> Chlorpromazine & Thiorsazine --> olazapine & Zipradisone --> Quetiapine --> Clozapine |
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Term
APs to cause Weight Gain
Most Likely ---> Least Likely |
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Definition
| Clozapine & Olanzapine --> Chlorpromazine & Thioridazine --> Risperidone, Paliperidone, quetiapine --> Trifluoperazine, loxapine, thiothixene, perphenazine --> haloperidol, fluphenazine, aripiprazole, ziprasidone, lurasidone |
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Term
APs to cause TDs
Most Likely ---> Least Likely |
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Definition
| First Generation APs --> Second Generation APs --> clozapine |
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Term
APs to cause QT prolongation
Most Likely ---> Least Likely |
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Definition
| Thioridazine --> Ziprasidone --> Iloperidone --> Quetiapine, risperidone, olanzapine, haloperidol --> clozapine |
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Term
| Extrapyramidal Side Effects |
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Definition
1) Acute Dystonic Reactions
2) Pseudoparkinsonism
3) Akathisia
4) TDs |
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Term
| Neuroleptic Malignant Syndrome (NMS) |
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Definition
-Rare, life-threatening, DOSE RELATED reaction resulting from dopamine blockade of AP treatment
-hyperthermia, muscle rigidity (Creatine kinase >20,000), autonomic instability (HR, BP), altered consciousness (delirious, coma).
Treatment:
-Discontiune AP
-Begin supportive and symptomatice treatment (fluids, antipyretic, O2)
-DO NOT RETRIAL WITH SAME AP
-Must wait 2 weeks to try different AP |
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Term
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Definition
(b) Abilify
PARTIAL D2 agonist
once daily with or without food
Long t1/2
Interactions: CYP3A4 Inhibitors increase concentration (azoles, PIs, macrolides) & Inducers will decrease concentration (Rifampin, phenytoin, phenobarbital, carbamazepine), CYP2D6 Inhibitors increase concentration (Paroxetine, Fluoxetine, Buproprion), |
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Term
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Definition
(b) Saphris
SUBLINGUAL
Must not eat or drink 10 mins after dose!
Interactions: CYP1A2 inhibitors |
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Term
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Definition
(b) Fanapt
Requires daily dose titration due to orthostasis risk
If miss > or = 3 days, must restart titration
Interactions: CYP2D6 Inhibitors increase concentration (Fluoxetine & Paroxetine), CYP3A4 inhibitors increase concentration (Ketoconazole) |
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Term
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Definition
(b) Latuda
Must take with 350 calories
Interactions: CYP3A4 Inibitors & inducers |
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Term
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Definition
(b) Zyprexa
Has long acting injectible
BLACK BOX WARNING: Post-injection delirium & sedation syndrome
Part of a resticted distribution program
Interactions: CYP1A2 inhibitors increase concentrations (fluvoxamine), inducers decrease concentrations (Carbamazepine)
Do NOT give olazapine SA injections and parenteral BZDs (w/in 1 hour of ativan IM) due to risk of excessive sedation and cardiorespiratory depression |
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Term
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Definition
(b) Risperdal
Most typical of the atypicals
has an active metabolite
Interactions: CYP2D6 inhibitors increase levels (fluoxetine & paroxetine), inducers decrease levels (carbamazepine, phenytoin, rifampin) |
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Term
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Definition
(b) Invega
Active metabolite of Risperidone
Shell is visible in stool!! |
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Term
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Definition
(b) Seroquel
Interactions: CYP3A4 inducers and inhibitors |
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Term
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Definition
(b) Geodon
Must take with >500 calories |
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Term
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Definition
(b) Clozaril
Restricted Drug Program
BLACK BOX WARNING: Myocarditis, agranulocytosis, CV & respiratory effects, increased mortality in the elderly, seizures (DOSE RELATED)
Interactions: CYP1A2 inhibitors (fluvoxamine & Cipro) and inducers (tobacco smoke, rifamin, phenytoin) |
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Term
| Low Potency First Generation Antiosychotics |
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Definition
| Chlorpromazine & Thioridazine |
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Term
| Mid Potency First Generation Antipsychotics |
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Definition
| Lozapine < Perphenazine < Trifluoperazine < Thiothixene |
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Term
| High Potency First Generation AntiPsychotics |
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Definition
| Haloperidol & Fluphenazine |
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Term
| Haloperidol PO to IM conversions |
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Definition
Standard: 10-15x maintenance PO dose (overlap for 1 month then taper)
Loading dose: 20x PO dose(No overlap)
Recommended: 50-200mg IM q4week |
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Term
| Fluphenazine PO to IM conversions |
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Definition
1.25x maintenance PO dose (Overlap PO for 1 week)
Recommended dose: 6.25-25mg IM Q2 weeks |
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Term
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Definition
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Term
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Definition
| Once monthly (loading dose) |
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Term
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Definition
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Term
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Definition
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Term
| Stage 1 of Schizophrenia Therapy |
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Definition
1st episode psychosis (delusion, hallucinations)
Second Generations Antipsychotics
DO NOT use olanzapine because of metabolic SEs
DO NOT use clozapine because of metabolic SEs and agranulocytosis UNLESS patient is extremely suicidal or hostile |
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Term
| Stage 2 of Schizophrenia Therapy |
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Definition
Second Generation Antipsychotic (NOT CLOZAPINE) not tried in Stage 1
Or, First Generation Antipsychotic |
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Term
| Stage 3 of Schizophrenia Therapy |
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Definition
| Clozapine (for refractory patients) |
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Term
| Stage 4 of Schizophrenia Therapy |
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Definition
Clozapine + First Generation Antipsychotic
Or, Clozapine + Second Generation Antipsychotic
Or, Clozapine + Electroconvulsive Therapy |
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Term
| Stage 5 of Schizophrenia Therapy |
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Definition
Trial of First Generation Antipsychotic
Or, Second Generation Antipsychotic
(not tried in stages 1 or 2) |
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Term
| Stage 6 of Schizophrenia Therapy |
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Definition
Combination Therapy (Stage 4)
Second Generation Antipsychotic PLUS First Generation Antipsychotic, combo of SGAs, FGA or SGA + ECT, FGA or SGA + other agent (mood stabilizer) |
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