Psy Newton 1
Terms
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- Indications for antipsychotics (7)
-
schizophrenia
schizoaffective disorder
dementia
drug-induced psychosis
acute mania
psychotic depression
alcohol withdrawl - Major brain site of disorder in psychosis
- limbic system
- Onset of schizophrenia?
- early adolescence - early adult
- Birth complications that may contribute?
-
viral infection in 2nd semester
hypoxia - Schizophrenia Diagnosis
-
2 or more sx present for 1 month:
delusions
hallucinations
disorganized speech
disorganized/catatonic behavior
negative symptoms - When do you only need 1 sx present?
- if bizarre delusions or running-commentary hallucinations
- Types of schizophrenia
- paranoid, disorganized, catatonic, undifferentiated, residual, schizoaffective
- Positive target sx?
- hallucinations, delusions, agitation, paranoia, combativeness, loose associations
- Negative target sx?
- flat affect, social withdrawl, amotivation, mutism, poverty of speech, catatonia
- Cognitive target sx?
- memory, attention, judgement
- Schizophrenia work-up
-
Hx & diagnosis assessment
Drug history
Alcohol, caffeine, nicotine, herbals
Past psych meds
Labs: CBC, electrolytes, FBG, LFT, lipid profile, Thyroid, renal, EKG if >50yo - Neuropsych tests that should be performed
- GAF, brief psychiatric rating scale, QOL scale, AIMS, positive & negative syndrome scale items
- What is an adequate trial for APs?
- 4-6 weeks
-
D2 receptor occupancy for:
efficacy?
hyperprolactinemia?
EPS? -
65%
72%
78% - How long treated for first break? For multiple breaks?
-
1 yr
5 yr - AP effects at 1-3 days?
- improved eating & sleeping; reduced agitation, hostility, and anxiety
- AP effects at 1-2 weeks?
- increases socialization & ADL
- AP effects at 3-6 weeks?
- decreased hallucinations and delusions; improved thinking and appropriate talk
- Effects of atypicals at nigrostriatial pathway?
- 5HT2-a antagonists promote dopamine release and less DA receptor block, therefore reduced EPS
- Effects of atypicals at mesocortical pathway?
- reverses dopamine antagonism & blocks 5HT2-a receptors, therefore dopamine release and reduced negative sx
- Effects of atypicals at tuberofundibular pathway?
- doapmine inhibits prolactin levels and 5HT2-a increases release, therefore no lactation
- Effects of atypicals at mesolimbic pathway?
- D2 block is NOT reversed so positive sx are reduced