Schizophrenia Lecture Notes PDF

SCHIZOPHRENIA  Objectives At the end of this lecture, students should be able to: 1. Understand the definition, pathophysiology and symptoms (negative and positive) 2. Understand the risk factors, diagnosis, complications and non- pharmacological treatment of Schizophrenia 3. Differentiate...

SCHIZOPHRENIA  Objectives At the end of this lecture, students should be able to: 1. Understand the definition, pathophysiology and symptoms (negative and positive) 2. Understand the risk factors, diagnosis, complications and non- pharmacological treatment of Schizophrenia 3. Differentiate the drugs used for Schizophrenia (classifications, mechanism of actions) 4. List the examples, side-effects, generic and trade names of antipsychotic drugs used in schizophrenia. 5. Understand the general information regarding antipsychotic drugs  Objectives At the end of this lecture, students should be able to: 1. Understand the definition, pathophysiology and symptoms (negative and positive) 2. Understand the risk factors, diagnosis, complications and non- pharmacological treatment of Schizophrenia 3. Differentiate the drugs used for Schizophrenia (classifications, mechanism of actions, 4. List the examples, side-effects, generic and trade names of antipsychotic drugs used in schizophrenia. 5. Understand the general information regarding antipsychotic drugs  Schizophrenia is a brain disorder that affects one’s ability to Definition differentiate reality and imagination. Pathophysiology Theory: Dysregulations/abundance of dopamine and serotonin Evidence: Antipsychotics are D2 and 5HT antagonists Symptoms Negative (loss of ability) Positive (in addition to reality) Lack of motivation Hallucinations (hear, feel things Lose of interest in life that don’t exist) Impaired memory Delusions (false belief) Not talking much Disorganised thinking, jumbled Social withdrawal speech  Objectives At the end of this lecture, students should be able to: 1. Understand the definition, pathophysiology and symptoms (negative and positive) 2. Understand the risk factors, diagnosis, complications and non- pharmacological treatment of Schizophrenia 3. Differentiate the drugs used for Schizophrenia (classifications, mechanism of actions, 4. List the examples, side-effects, generic and trade names of antipsychotic drugs used in schizophrenia. 5. Understand the general information regarding antipsychotic drugs Risk factors Stress, genetics, brain damage, drugs & alcohol, difficult childhood (genetics and environment) Full psychiatric assessments. Also, screenings to rule out Diagnosis other diseases Develop during early adulthood 30-45 yo, negative symptoms usually appear first! Complications Shorter life expectancy, depression, thoughts of suicide, overweight, heart diseases and diabetes Non- Cognitive behavioural therapy (CBT), Art therapy, social and pharmacological community support, encouraging physical health treatment  Objectives At the end of this lecture, students should be able to: 1. Understand the definition, pathophysiology and symptoms (negative and positive) 2. Understand the risk factors, diagnosis, complications and non- pharmacological treatment of Schizophrenia 3. Differentiate the drugs used for Schizophrenia (classifications, mechanism of actions) 4. List the examples, side-effects, generic and trade names of antipsychotic drugs used in schizophrenia. 5. Understand the general information regarding antipsychotic drugs  Typical/First/Conventional Atypical/Second/Non-conventional More effective towards +ve symptoms Effective towards +ve and –ve symptoms to some extent MOA: Mainly block D2 receptors MOA: Mainly antagonise 5-HT (dopamine) and to other receptors receptors (serotonin) and D2 to some extent  Objectives At the end of this lecture, students should be able to: 1. Understand the definition, pathophysiology and symptoms (negative and positive) 2. Understand the risk factors, diagnosis, complications and non- pharmacological treatment of Schizophrenia 3. Differentiate the drugs used for Schizophrenia (classifications, mechanism of actions, 4. List the examples, side-effects, generic and trade names of antipsychotic drugs used in schizophrenia. 5. Understand the general information regarding antipsychotic drugs  Typical/First/Conventional Atypical/Second/Non-conventional May cause extrapyramidal effects Less likely to cause extrapyramidal (Excessive muscle movements) effects but likely to cause metabolic More prominent in elderly abnormalities such as: So, to avoid this, must use smallest dose and prefer atypical Excessive weight gain Hyperglycaemia Hyperlipidaemia Other side effects: Blurred vison, dry mouth, constipation, drowsiness, hypotension, sexual dysfunction  Typical/First/Conventional Atypical/Second/Non-conventional Chlorpromazine,haloperidol, Amisulpiride, aripiprazole, clozapine, prochlorperazine, sulpiride, risperidone, olanzapine, quetiapine zuclopenthixol, asenapine, Paliperidone  Objectives At the end of this lecture, students should be able to: 1. Understand the definition, pathophysiology and symptoms (negative and positive) 2. Understand the risk factors, diagnosis, complications and non- pharmacological treatment of Schizophrenia 3. Differentiate the drugs used for Schizophrenia (classifications, mechanism of actions, 4. List the examples, side-effects, generic and trade names of antipsychotic drugs used in schizophrenia. 5. Understand the general information regarding antipsychotic drugs  General Information All are equally effective. Only to control, they don’t cure Choice based on desired outcomes and ability to tolerate side effects Atypical is started first (less EPS, better tolerability, cover +ve and –ve symptoms) Clozapine is often used as a last resort, when other antipsy failed – those who don’t respond to at least 2 antipsy. But it can cause agranulocytosis (low WBC) and induce seizures Some are used as antiemetics; Haloperidol, Prochlorperazine  General Information When to start: Once diagnosed, start low, and taper up according to response, only change drug after 4-6w if no response When to stop: Stop slowly and gradually to avoid rebound psychosis. Antipsychotics aren’t addictive but difficult to stop since the body get used to it.  General Information Drug interactions: Antipsychotics and sedative drugs increase sedation Pregnancy and breastfeeding: Atypical is preferred Formulations: Tablets, capsules, liquids, depot injection (Provide sustained medication up to 3 months! 1) Reduce the need for daily oral dosing hence increase adherence 2) More stable treatment outcomes/fewer relapses 3) Helpful for those with swallowing difficulties 4) Reduce possibility of missed doses Depot injection to increase adherence/compliance