Schizophrenia and Drugs

• Positive Symptoms of Schizophrenia

  • Exaggeration or distortion of normal function
  • Hallucinations
  • Delusions
  • Agitation
  • Tension
  • Paranoria
• Negative symptoms of Schizophrenia

  • Lack of normal function
  • Lack of motivation
  • Poverty of speech
  • Blunted affect
  • Poor self care
  • Social withdrawal
• Cognitive symptoms of Schizophrenia

  • Disordered thinking
  • Reduced ability to focus attention
  • Prominent learning and memory difficulty
  • Subtle changes may appear years before symptoms become florid (thinking and speech may become incomprehensible
• First Generation Antipsychotic agents

  • Phenothiazine - Chlorpromazine
  • Butyrophenone - Haloperidol
• FGAS (conventional) antipsychotics stop symptoms of psychosis by blocking dopamine 2 receptors in brain
• FGA side effects

  • Extrapyramidal symptoms (EPS)
  • Parkinsonism
  • Acute dystonia
  • Akathisia
  • Tardive dyskinesia
  • Neuroleptic Malignant Syndrome
• Acute dystonia

  • involuntary muscle contractions
  • twisting of body parts
  • repetitive movements
• Acute dystonia treatment

  • Removal of drug
  • Anticholinergic
• Parkinsonism

  • Mask like face
  • shuffling gate
  • stooped posture
  • Bradykinesia
• Parkinsonism Treatment

  • Anticholinergics
• Akathsia

  • Intolerance of inactivity
  • Motor restlessness
• Akathsia Treatment

  • Beta blocker
  • Benzodiazepine
  • Anticholinergic
  • Or switch to low potency FGA
• Tardive Dyskinesia

  • Tongue flicks out
  • Worm like movement of tongue
  • Inteferes with chewing, swallowing, speaking
  • Leads to malnutrition and weight loss
• Tardive Dyskinesia Treatment

  • Reduce drug or drug withdrawal
  • Switch to SGA
• Neuroleptic Malignant Syndrome

  • Lead pipe muscle rigidity
  • Sudden high fever
  • Altered levels of conciousness
  • Sweating
  • Autonomic instability
  • Seizures and coma may develop
  • Rhamdomyolysis
• Neuroleptic Malignant Syndrome Treatment

  • Immediate withdrawal of antipsychotic meds
  • Dantrolene : muscle relaxant, reduces rigidity and hyperthermia (fever)
  • Bromocriptine: Dopamine receptor agonist relieves CNS toxicity
• FGAs also cause anticholinergic effects

  • Cant pee
  • Cant see
  • Cant spit
  • Cant shit
  • Photophobia and Tachycardia
• FGAs also cause orthostatic hypotension

  • Instruct client to sit or lie down slowly
• Haloperidol and Chlorpromazine

  • First generation antipsychotic
  • NOT recommened in older adults with dementia related psychosis
  • Contraindicated in glaucoma, cardiovascular disease
• Second Generation Antipsychotic agents

  • Clazepine
  • Risperidone
  • Olanzapine
  • Ziprasidone
  • Quetiapine
  • Aripiprazole
  • Depot Preperations
• Clazepine

  • SGA
  • Blocks dopamine and serotonin; low affinity for dopamine = fewer EPS
  • Improves postive, negative and cognitive symptoms
• Clazepine adverse effects

  • Metabolic syndrome
  • Diabetes
  • Dyslipidemia
  • Weight gain
  • Sedation
  • Agranulocytes
• Risperidone

  • SGA
  • blocks dopamine and seratonin
  • SE: Metabolic syndrome, prolones QT interval, agranulocytosis
• Olanzpine

  • Approved for schizophrenia
  • SE: Metabolic syndrome, no QT interval changes
• Ziprasidone

  • Blockes dopamine, seratonin, and histamine
  • SE: metabolic syndrome, angranulocytosis, rash (SJS)
• Quetiapine

  • Blocks dopamine and seratonin
  • SE: Metabolic syndrome, agranulocytosis, Prolonged QT interval
• Aripiprazole

  • Dopamine system stabilizer
  • SE: metabolic syndrome, Prolonged QT interval
• Depot Preparations

  • SGA
  • Long acting injectable formula used for long term
  • Viscous liquid = Large needle (21 gauge) Z track method in deep muscle
• FGAs and SGAs are equally effective BUT

  Clazepine is MOST effective