Term
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Definition
| heterogeneous syndrome of disorganized & bizarre thoughts, delusions, hallucinations, inappropriate affect, & impaired social psychosocial function |
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Term
| Positive Symptoms of Schizophrenia |
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Definition
| delusions; hallucinations; disorganized speech & behavior; hostility, agitation, tension, paranoia |
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Term
| Negative Symptoms of Schizophrenia |
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Definition
| alogia; avolition; anhedonia; poor hygiene & grooming; emotional withdrawal; poor social functioning |
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Term
| DSM-IV-TR Diagnostic Criteria for Schizophrenia |
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Definition
A) 2 or more of following present for signigicant portion of time during 1-month period: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms (affective flattening, alogia, or avolition);
B) Social/occupational dysfunction;
C) Duration: continuous signs for at least 6 months;
D) Schizoaffective & Mood Disorder Exclusion: these disorders must be ruled out;
E) Substance/General Medical Condition Exclusion: disturbance is not due to direct physiological effects of a substance or a general medical condition;
F) Relationship to a Pervasive Developmental Disorder: Hx of autistic disorder or antoher pervasive developmental disorder, additional diagnosis of schizo is made only if prominent delusions or hallucinations are also present for at least 1 month |
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Term
| Cognitive Symptoms of Schizophrenia |
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Definition
| impaired attention; impaired memory; impaired executive function |
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Term
| Drugs that Induce Schizophrenia |
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Definition
| cocaine; amphetamines, ketamines, cannabis; ecstasy, phencyclidine (PCP), LSD; various inhalants |
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Term
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Definition
| decrease symptoms of dx; induce remission; minimize adverse effects of medication; prevent hospitalizations; improve quality of life |
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Term
| First Generation Antipsychotics (FGA) - chlorpromazine, thioridazine, perphenazine, thiothixene, haloperidol, fluphenazine |
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Definition
| MoA: blocks D2-receptors in mesolimbic DA pathway --> reduces hyperactivity of + Symptoms; dirty drugs: D2 receptors in other parts of brain (mesocortical, nigrostriatal, tuberoinfundibular), H-1, cholinergic muscarinic, and alpha-1 receptors; Pharm: > affinity for D2 receptors = > potential for EPS, endocrine SEs, > D2 affinity = < EPS, > antiACh & antiH SEs; Equal in efficacy; Dosing: titrate dose when switching from high potency to low potency; Metabolism: CYP450 2D6 & 3A4 |
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Term
| Fluphenazine Decanoate Dosing |
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Definition
depot IM injection;
multiple oral dose by 1.2, round to nearest available dose;
10mg/day ORAL = 12.5 mg IM q2-6 weeks |
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Term
| Haloperidol Decanoate Dosing |
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Definition
IM depot injection;
Loading dose: give 10-20 times oral dose;
Maintenance dose: 10-15 times oral dose;
10 mg/day ORAL = 200 mg IM q4 wks;
In naive pts, use a test dose of less than 100 mg |
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Term
| Side Effects of First Generation Antipsychotics (FGAs) - chlorpromazine, thioridazine, perphenazine, thiothixene, haloperidol, fluphenazine |
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Definition
Antihistaminergic: sedation, weight gain;
Anticholinergic: dry mouth, blurred vision, constipation, urinary retention, tachycardia, erectile dysfunction, cognitive dysfunction;
CV: orthostatic hypotension, dizziness, prolongation of QT interval (BLACK BOX: thioridazine);
Endocrine: elevated prolactin (>60 ng/ml);
EPS: acute dystonia, akathisia, pseudoparkinsonism, tardive dyskinesia, seizures, neuroletpic malignant syndrome |
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Term
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Definition
EPS SE; painful, tense muscle spasm of eyes, face, neck, & throat; occurs EARLY in HIGH DOSE tx;
Treatment: benztropine 1-2 mg IM or diphenhydramine 25-50 mg IM |
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Term
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Definition
EPS SE: motor restlessness - pacing, inability to sit still, anxiety;
Treatment: propanolol 10 mg BID-TID, lorazepam 1 mg daily may also be used |
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Term
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Definition
EPS SE: bradykinesia, akinesia, mask-like face, drooling, decreased eye blinking, monotonous speech, resting tremor, & rigidity of extremities;
Treatment: benztropine 1-2 mg BID, trihexyphenidyl 2-5 mg TID, diphenhydramine 25-50 mg TID, amantadine 100 mg TID |
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Term
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Definition
EPS SE: mouth movements - lip smacking, sucking, puckering, or tongue protrusion, involuntary tongue movements; Early detection & prevention are key - IRREVERSIBLE SE!!!
Treatment: decrease dose of FGA, switch to SGA, Vitamin E 1200-1600 IU/day, benzodiazepines, botulinum toxin, clozapine |
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Term
| Neuroleptic Malignant Syndrome |
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Definition
EPS SE: rare but fatal, fever, extreme rigidity, tachycardia, fluctuating BP, altered mental status, elevated CPK, LFTs, & WBCs;
Treatment: supportive care & D/C antipsychotics, also may use bromocryptine 30 mg/day and dantrolene 400 mg/day adjunctively |
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Term
| chlorpromazine (Thorazine) |
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Definition
low potency FGA used to tx schizophrenia;
Dosing: 100-800 mg, MAX daily dose = 2000 mg/day;
Side Effects:
Anticholinergic: +++
Sedation: ++++
Orthostatic Hypotension: ++++
EPS: +++ |
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Term
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Definition
low potency FGA use to tx schizophrenia;
Dosing: 100-800 mg, MAX dosing: 800 mg/day
Side Effects:
Anticholinergic: ++++
Sedation: ++++
Orthostatic Hypotension: ++++
EPS: +++
BLACK BOX WARNING: Prolongation of QT interval |
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Term
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Definition
intermediate potency FGA used to tx schizophrenia;
Dosing: 10-64 mg, MAX dosing = 64 mg/day
Side Effects:
Anticholinergic: ++
Sedation: ++
Orthostatic Hypotension: +
EPS: ++++ |
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Term
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Definition
high potency FGA for tx of schizophrenia;
Dosing: 4-40 mg, MAX dosing = 60 mg/day
Side Effects:
Anticholinergic: +
Sedation: +
Orthostatic Hypotension: +
EPS: ++++ |
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Term
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Definition
high potenecy FGA for tx of schizophrenia;
Dosing: 2-20 mg, MAX dosing = 100 mg/day
Side Effects:
Anticholinergic: +
Sedation: +
Orthostatic Hypotension: +
EPS: ++++ |
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Term
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Definition
high potency FGA for tx of schizophrenia;
Dosing: 2-20 mg, MAX dose = 40 mg/day
Side Effects:
Anticholinergic: +
Sedation: +
Orthostatic Hypotension: +
EPS: ++++ |
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Term
| clozapine (Clozaril, FazaClo) |
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Definition
SGA for tx-resistant schizophrenia & suicidal behavior;
Dosing: cautious titration, start at 12.5-25 mg/day w/ daily dosing incremenets of 25-50 mg/day, Target dose = 300 mg, if pt stops he MUST be re-titrated;
Monitoring Parameters:
CBCs - weekly for 6 wks, bi-wkly for 6 months, then every 4 wks after; WBC (agranulocytosis), chestpain;
Adverse Effects:
drowsiness, sedation, sialorrhea, tachycardia, hypotension, anticholinergic effects, weight gain, glucose dysregulation, hyperlipidemia;
BLACK BOX WARNINGS:
Agranulocytosis, Seizures, Myocarditis, Orthostasis/respiratory depression
Drug Interactions:
CYP1A2 - smoking, ciprofloxacin; CYP2D6, 3A4 (minor); carbamazepine - increased risk of agranuloctyosis; benzodiazepines - hypotension, respiratory depression, loss of consciousness; Meds that lower seizure threshold (TCAs, bupropion, etc) |
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Term
| risperidone (Risperdal, Risperdal Consta, Risperdal M-Tab) |
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Definition
SGA for schizophrenia (adolescents 13-17 & adults), acute mania associated w/ bipolar (children, adolescents 10-17, & adults), irritability/aggression associated with autism (children, adolescents 5-16), maintenance of bipolar
Doseing:
Initial: 1 mg BID, increase slowly by 1-2 mg/wk - doses >6 mg NOT recommended;
IM depot injection: must be receiving oral first, Initial dose: 25 mg IM q2 wks, Dose can be increased to 37.5 mg or 50 mg IM at slow intervals, takes up to 3 wks for full effect --> continue on ORAL meds for first 3 wks
Adverse Effects:
orthostasis, agitation/anxiety, EPS, prolactin elevation;
Drug Interactions:
HPN meds/trazadone - orthostsis, CYP2D6 inhibitors - fluoxetine, paroxetine increase drug conc., CYP3A4 |
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Term
| olanzapine (Zyprexa, Zyprexa Zydis, Zyprexa Intramuscular, Zyprexa Relprevv) |
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Definition
SGA for: schizophrenia, acute mania or mixed episodes associated w/ bipolar, bipolar disorder maintenance, agitation associated with schizo or bipolar, depression associated with bipolar in combo with fluoxetine
Dose:
Initial antipsychotic dose: 5-10 mg/day HS
Inital antimanic dose: 10-15 mg
MAX daily dose = 20 mg (more potent)
Short-acting IM injection for agitation: 10 mg with max of 3 IM injections given 2-4 hrs apart;
ADRs:
anticholinergic SEs, highly sedating, metabolic side effects (diabetes, wt gain);
BLACK BOX WARNINGS:
post injection delirium/sedation syndrome;
Monitoring Parameters:
Monitor pts w/ IM injection for 3 hrs after dose given
Drug Interactions:
CYP1A2 metabolism, smoking increases clearance by 20-40%, DA agonists |
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Term
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Definition
SGA for: schizophrenia, acute mania, maintenance of bipolar disorder, depressive episodes of bipolar;
Dose:
Initial: 25-50 mg BID to Target: 300-400 mg/day, titrate slowly by 25-50 mg BID, Best antipsychotic effect at 600-800 mg/day
Adverse Effects:
sedation (take at night), dry mouth, dizziness, constipation, cataracts
Drug Interactions:
CYP3A4 - affected by inducers, inhbiitors; DA agonists |
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Term
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Definition
SGA for: schizophrenia, agitation associated w/ schizophrenia, acute mania or mixed episodes of bipolar
Dose:
Initial: 20 mg BID WITH FOOD
Doses >80 mg BID NOT RECOMMENDED
Short-acting IM injection - acute agitation only: 10 mg q2 hrs or 20 mg q4 hrs (MAX = 40 mg/day)
Adverse Effects:
nausea, constipation, somnolence, dizziness, akathisia, EPS effects
Warnings: QTC prolongation - avoid in pts w/ significant CV dx, Monitor: baseline ECG, K, Mg, Ca
Drug INteractions:
CYP3A4 inducers & inhibitors, other agents that prolong QTC interval (amiodarone, quinidine, thioridazine, quinolone antibiotics) |
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Term
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Definition
SGA for: schizophrenia, maintenance of bipolar, acute agitation, adjunctive tx to antidepressants in major depressive disorder
MoA: partial D2 and 5HT1A receptor agonists, 5-HT2a antagonist
Dose:
Initial: 10 mg/day
Target: 30 mg/day
IM injection: 9.75 mg for acute agitation, repeated every 2 hrs PRN, up to 30 mg/day
Adverse Effects:
akathisia, anxiety, sedation, insomnia, HA, N/V, dizziness
Drug Interactions:
metabolized by CYP3A4, CYP2D6; increase dose by 50% w/ inducers, reduce dose with inhibitors |
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Term
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Definition
SGA for: schizophrenia
Dose:
Initial: 1 mg BID
Target: 12-24 mg/day, divided BID
ADRs:
QTC prolongation
Drug Interactions:
CYP2D6, 3A4 inhibitors - requires 50% dose reduction; alpha-1 receptor antagonists |
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Term
| Baseline Monitoring Parameters for SGAs |
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Definition
| Personal/family hx, weight (BMI), waist circumference, BP, fasting plasma glucose, fasting lipid panel |
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Term
| Monitoring Parameters for SGAs after 4 & 8 wks, & Quarterly (3 months) |
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Definition
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Term
| Monitoring Parameters for SGAs after 12 wks |
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Definition
| weight (BMI), BP, fasting plasma glucose, fasting lipid panel |
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Term
| Monitoring Parameters for SGAs Annually |
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Definition
| waist circumference, BP, fasting blood glucose |
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Term
| Monitoring Parameters for SGAs every 5 years |
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Definition
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