NRNP 6635 Final Exam Schizophrenia
- A subset of EPS.
- Associated with long-term treatment with 1st-generation antipsychotics
Movement phenotypes include: torticollis (involuntary contraction of neck muscle,
causing head tilt), dystonia of lips, tongue, oromandibular, or pharynx.
- Treatment includes drugs (valbenazine and deutetrabenazine) that block vesicular
monoamine transporter 2 protein, which then prevents presynaptic dopamine release;
injection of botulinum toxin is also used. - ANSWER-tardive dyskinesia
.- Caused by almost all antipsychotics.
- Can result in irregular menses, galactorrhea, and sexual dysfunction.
- Treatment includes dosage reduction/medication changes. - ANSWER-Elevated
prolactin
.- Idiosyncratic reaction to antipsychotics.
- This is a life-threatening emergency.
- Symptoms include at least 2 of the following cardinal symptoms: fever, altered mental
status, muscle rigidity, and autonomic dysfunction.
- Treatment includes immediate discontinuation of the antipsychotic medication and
aggressive supportive care. - ANSWER-Neuroleptic Malignant Syndrome
.- Obtain laboratory tests: CBC (including differential if clozapine used), electrolytes,
fasting glucose, lipid profile, liver, renal, and thyroid function tests, and a pregnancy test
in females of fertile age.
- ECG if history of heart disease or if using drugs that may prolong the QT interval
(clozapine, thioridazine, iloperidone, ziprasidone).
- Monitor for the 1st few weeks and then regularly for involuntary movement
disorders/EPS, since they may become irreversible.
- The goal is to minimize symptoms, avoid relapses, and promote recovery that allows
integration into society.
- Minimize side effect profile.
- Recommended maintenance treatment is > 5 years.
- May use long-acting injectable antipsychotics for non-compliant patients after checking
for tolerability/efficacy with an oral agent. - ANSWER-treatment of Maintenance phase
in schizophrenia
.- Potentially difficult to recognize because of similarities to depression.
- Flat affect (diminished emotional expression).
- Avolition (lack of initiative).
- Alogia (poverty of speech).
- Poor attention.
- Anhedonia. - ANSWER-Negative (residual phase)
, .- Roughly 40% of treated patients will demonstrate positive symptoms that are resistant
to treatment.
- Assess proper dosage and duration of treatment.
- Do not use 2 antipsychotics at the same time as studies show no benefits.
- Consider the use of clozapine, which can be an effective treatment in persons with
schizophrenia that is resistant to treatment with other antipsychotic drugs. Also reduces
suicide risk. However, clozapine is associated with a risk for agranulocytosis and
requires frequent, intense blood monitoring. - ANSWER-Treatment for individuals with
schizophrenia that are poor responders
.- Usually nonspecific; related to the impact on the patient's quality of life.
- Poor executive functioning, represented by disorganized speech and/or thought that
results in impaired communication.
- Inattention
- Impaired memory - ANSWER-Cognitive
.- Weight gain, hyperlipidemia, hyperglycemia, and hypertension → increased
cardiovascular risk.
- Treatment: Change from high-risk drug (e.g., olanzapine, quetiapine, risperidone) to
an antipsychotic with lower metabolic risk (e.g., aripiprazole or ziprasidone) if possible.
- Monitor and treat each cardiovascular risk factor appropriately. - ANSWER-Metabolic
.1. brief psychotic disorder
2. schizophreniform disorder
3. schizoaffective disorder
4. delusional disorder
5. substance induced psychotic disorder
6. psychotic disorder d/t medical condition
7. mood disorder with psychotic features - ANSWER-Differential Diagnosis (DDx) for
schizophrenia
.1. EPS
2. Tardive dyskinesia
3. elevated prolactin
4. metabolic
5. neuroleptic malignant syndrome - ANSWER-side effects to antipsychotics (both)
.a decline in both cognitive and social functioning that often precedes the development
of florid psychosis. - ANSWER-Schizophrenia is associated with
.a psychological disorder characterized by delusions, hallucinations, disorganized
speech, and/or diminished inappropriate emotional expression. - ANSWER-
Schizophrenia
.Antipsychotic medications form the centerpiece of treatment for schizophrenia,
especially the positive symptoms.
- A subset of EPS.
- Associated with long-term treatment with 1st-generation antipsychotics
Movement phenotypes include: torticollis (involuntary contraction of neck muscle,
causing head tilt), dystonia of lips, tongue, oromandibular, or pharynx.
- Treatment includes drugs (valbenazine and deutetrabenazine) that block vesicular
monoamine transporter 2 protein, which then prevents presynaptic dopamine release;
injection of botulinum toxin is also used. - ANSWER-tardive dyskinesia
.- Caused by almost all antipsychotics.
- Can result in irregular menses, galactorrhea, and sexual dysfunction.
- Treatment includes dosage reduction/medication changes. - ANSWER-Elevated
prolactin
.- Idiosyncratic reaction to antipsychotics.
- This is a life-threatening emergency.
- Symptoms include at least 2 of the following cardinal symptoms: fever, altered mental
status, muscle rigidity, and autonomic dysfunction.
- Treatment includes immediate discontinuation of the antipsychotic medication and
aggressive supportive care. - ANSWER-Neuroleptic Malignant Syndrome
.- Obtain laboratory tests: CBC (including differential if clozapine used), electrolytes,
fasting glucose, lipid profile, liver, renal, and thyroid function tests, and a pregnancy test
in females of fertile age.
- ECG if history of heart disease or if using drugs that may prolong the QT interval
(clozapine, thioridazine, iloperidone, ziprasidone).
- Monitor for the 1st few weeks and then regularly for involuntary movement
disorders/EPS, since they may become irreversible.
- The goal is to minimize symptoms, avoid relapses, and promote recovery that allows
integration into society.
- Minimize side effect profile.
- Recommended maintenance treatment is > 5 years.
- May use long-acting injectable antipsychotics for non-compliant patients after checking
for tolerability/efficacy with an oral agent. - ANSWER-treatment of Maintenance phase
in schizophrenia
.- Potentially difficult to recognize because of similarities to depression.
- Flat affect (diminished emotional expression).
- Avolition (lack of initiative).
- Alogia (poverty of speech).
- Poor attention.
- Anhedonia. - ANSWER-Negative (residual phase)
, .- Roughly 40% of treated patients will demonstrate positive symptoms that are resistant
to treatment.
- Assess proper dosage and duration of treatment.
- Do not use 2 antipsychotics at the same time as studies show no benefits.
- Consider the use of clozapine, which can be an effective treatment in persons with
schizophrenia that is resistant to treatment with other antipsychotic drugs. Also reduces
suicide risk. However, clozapine is associated with a risk for agranulocytosis and
requires frequent, intense blood monitoring. - ANSWER-Treatment for individuals with
schizophrenia that are poor responders
.- Usually nonspecific; related to the impact on the patient's quality of life.
- Poor executive functioning, represented by disorganized speech and/or thought that
results in impaired communication.
- Inattention
- Impaired memory - ANSWER-Cognitive
.- Weight gain, hyperlipidemia, hyperglycemia, and hypertension → increased
cardiovascular risk.
- Treatment: Change from high-risk drug (e.g., olanzapine, quetiapine, risperidone) to
an antipsychotic with lower metabolic risk (e.g., aripiprazole or ziprasidone) if possible.
- Monitor and treat each cardiovascular risk factor appropriately. - ANSWER-Metabolic
.1. brief psychotic disorder
2. schizophreniform disorder
3. schizoaffective disorder
4. delusional disorder
5. substance induced psychotic disorder
6. psychotic disorder d/t medical condition
7. mood disorder with psychotic features - ANSWER-Differential Diagnosis (DDx) for
schizophrenia
.1. EPS
2. Tardive dyskinesia
3. elevated prolactin
4. metabolic
5. neuroleptic malignant syndrome - ANSWER-side effects to antipsychotics (both)
.a decline in both cognitive and social functioning that often precedes the development
of florid psychosis. - ANSWER-Schizophrenia is associated with
.a psychological disorder characterized by delusions, hallucinations, disorganized
speech, and/or diminished inappropriate emotional expression. - ANSWER-
Schizophrenia
.Antipsychotic medications form the centerpiece of treatment for schizophrenia,
especially the positive symptoms.
