Pharmacotherapy of schizo

-loss of reality, inability to distinguish what is real/not
-described in terms relating to thoughts/sensations that occur when they shouldn't

-dopaminergic response
-symptoms incl. hallucinations, delusions, paranoia

Disorders associ. w/ psychosis

Schizophrenia

DSM5: two or more of these present for at least 1 mo

1. hallucinations
2. delusions
3. disorganized speech
4. grossly disorganized or catatonic behavior
5. negative sxs
+ cont. disturbance for 6mo, social/occupational dysfun for sig time.

Psychosis vs. Schizo

Psychosis:
-episode where one is detached from reality
-symptom of sleep deprivation, substance use, mental illness, etc.
-signs: hallucinations, delusions, agitation, disorganized thought/behavior

schizo:
-mental illness that impacts thought process/emotion/behavior
-diagnosis: must experience at least 2 of the following sxs for 6 months, incl one of the first 3
Sxs:
-Delusions
-hallucinations
-disorganized speech
-catatonic behavior
-negative symptoms (lessened emotional expression)

Clinical presentation:

Positive:
-hallucinations
-auditory/visual/tactile
-delusions

Negative:
-lack of interest/withdrawal from the world
-emotionless/flat affect
The A's:
-Avolition, Alogia, Anhedonia, Asociality

-Schizoaffective
-Mood disorders
-dementia
-personality disorders
-medical conditions

-meds +/- psychotherapy
-antipsychotics --> GREAT for +
-less role in -
-psychotherapy does NOT have much of a role by itself/used adj

First Gen

-typical
-D2 RA
-block H1/M1/a1
-more specific to dopamine
-effective for (+) sxs

Monitoring:
-movement (AIMS or other scale)
-prolactin lvls
-cognition (MMSE)
-QTc
-Vitals (BP, HR, weight)
-EEG/Seizure

Second Gen

-atypical
-D2 + serotonin (5HT2A) RA
-less specific to dopamine
-effective for (+) sxs

Clozapine: 1st atypical

-low D2/high 5HT2 blockade
-LAST LINE, beneficial in pts w/ EPS, suicidality/treatment resistant schizo.

ADEs
-REMS Program for Agranulocytosis/Neutropenia
-Weight gain, hyperlipidemia, hyperglycemia
-seizures
-anticholinergic effects

Hyperprolactinemia