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Este Cmap, tiene informaciĆ³n relacionada con: Grant-Young_3_score, Schizophrenia Features Negative SX -Affective flattening -Alogia -Avoliation -Anhedonia -Social withdrawl, Schizophrenia Treatment Atypical Antipsychotics -Clozapine (clozaril)-1990 -Risperidone (risperdal)-1994 -Quetiapine (seroquel)-1997 -Ziprasidone (Geodon)-2001, Patho 3 ???? Schizophrenia, Schizophrenia type Dementia, Schizophrenia A Psychiatric disorder, Atypical Antipsychotics -Clozapine (clozaril)-1990 -Risperidone (risperdal)-1994 -Quetiapine (seroquel)-1997 -Ziprasidone (Geodon)-2001 Therapeutic Monitoring Risperidone and Olanzapine -baseline and maintenance-weight, chem 7, lipid profie lipid profile more impt. with olan Quetiapine -baseline-lense exam, weight, (chem 7, lipid profile-suggested) -maintenance-lens exam every 6months, weight Ziprasidone -baseline-ECG (controversial) -maintenance-weight, chem 7 (hypokalemia and hypomagnesemia inc risk of TORSADES), lipid profile, Atypical Antipsychotics -Clozapine (clozaril)-1990 -Risperidone (risperdal)-1994 -Quetiapine (seroquel)-1997 -Ziprasidone (Geodon)-2001 AND CYP CLOZAPINE-1A2 RISPIEIDONE-2D6 OLANZAPINE-1A2 QUETIAPINE-3A4 ZIPRASIDONE-2/3 aldehyde oxidase; 1/3 CYP (less likely affected by CYP450 process) *isoenzyme primarily resp for metabolizing a particular drug shown, Typical Antipsychotics -Low potency-chlorpromazine (thorazine), thioridazine (mellaril) -Intermediate potency-molindone (moban), loxapine (loxitane) -High potency-haloperidol (haldol), fluphenazine (prolixin) SE Dermatologic: allergic photosensitivity long term skin changes- pigmentation of skin, Atypical Antipsychotics -Clozapine (clozaril)-1990 -Risperidone (risperdal)-1994 -Quetiapine (seroquel)-1997 -Ziprasidone (Geodon)-2001 Treatment Considerations: -Tx refactory-then drug of choice is cloz -Diabetes-avoid cloz and olan -Hyperlipidemia-min use of cloz and olan -Smoker-if you use olan, must use higher doses b/c of the hydrocarbon in the smoke can inc isoenzyme 1A2 and cloz and olan are substrates for this isoenzyme -Obesity-do not use cloz, olan, use another atypical -Cognitive impairment-if you look at muscurenic activity, do not use cloz, olan, consider another atypical -Epilepsy-do not use cloz, because it has a increased dose dependent risk of seizures -Parkinson DZ-rispirodone produces dose dependent EPS, use quet or cloz instead-best with least EPS, Schizophrenia Treatment Typical Antipsychotics -Low potency-chlorpromazine (thorazine), thioridazine (mellaril) -Intermediate potency-molindone (moban), loxapine (loxitane) -High potency-haloperidol (haldol), fluphenazine (prolixin), Schizophrenia Features Positive SX -Delusions -Hallucinations -Disorganized seech, Schizophrenia Features Comorbid Conditons -Depresson -Anxiety -Agression -Substance abuse, Schizophrenia DX Symptoms > or equal 2 of the following for a time period > or equal to 1 month: -Delusions -Hallucinations -Disorganized spech -Grossly disorganized catatonic behaivor -Negative SX ie. affective flattening, alogia, or avolition -Social/occupational dysfunction -Continuous for 6 months -Not mania or depression -One SX required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary, or greater or equal to 2 voices conversing, Schizophrenia Measuring BPRS The Brief Psychiatric Rating Scale -Rate the degree of unusualness, not thedegree of disorganization of speech Usual Thought Content Anchors 2, very mild 3, mild 4, moderate 5, moderately severe 6, severe 7, extremely severe note:if somatic concern, guilt, suspiciousness, or grandiosity are rated 6 or 7 then unusual thought content must be rated a 4 or above, Typical Antipsychotics -Low potency-chlorpromazine (thorazine), thioridazine (mellaril) -Intermediate potency-molindone (moban), loxapine (loxitane) -High potency-haloperidol (haldol), fluphenazine (prolixin) Movement Disorders Acute dystonic reaciton-rx with diphenhhydramine or benztropine Pseudoparkinsonism-rx, dec. dose or change to atypical, antiparkinsonian agents eg cogentin, artane, diphen. Akathisia-rx, beta blockers, benzodiazepines,anticholinergics, or change drug Tardive Dyskinesia-rx-minimize risk,eg restrict use of APDs to treat psychosis, use atypical APD etc., Typical Antipsychotics -Low potency-chlorpromazine (thorazine), thioridazine (mellaril) -Intermediate potency-molindone (moban), loxapine (loxitane) -High potency-haloperidol (haldol), fluphenazine (prolixin) SE Other: metabolic-wt gain hypothalamic-amenorrhea convulsant-lowered seizure threshold opthalmologic-retinitis pigmentosa (Mellaril) thioridazine), Schizophrenia Statistics -1.8 million Americans suffer from schizophrenia -1% of population will expperience an episode in lifetime -mortality is 2X higher than general population -20% attempt suicide-4% succeed -20-50% of homeless are mentaly ill/many have schiz. -150,000 new cases/yr in U.S., Dementia type Alzheimers Disease, Schizophrenia Features Cognitive Deficits -Attention -Memory -Executive funnction, Schizophrenia Epidemiology Onset-late teens to mid 30's No gender or racial differences Lifetime prevalence 0.5-1% Women>onset than men Older indiv. present with delusion & hallucinations More common in lower socioeconomic class