Neurotransmitters
what is the dopamine hypothesis of schizophrenia
excess dopamine in the mesolimbic tract has been hypothesized to cause positive psychotic symptoms
what is criterion A
2+ symptoms are present for a significant portion of time during at least 1 month or less if successfully treated (delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, negative symptoms)
what is the prodromal period
period that can start a month to a year before first psychotic break (acute phase)-slow onset of either positive or negative symptoms
what are common side effects associated with FGAs
EPS, sedation, hyperprolactinemia, decreased seizure threshold, orthostatic hypotension, anticholinergic symptoms, weight gain, NMS, cardiotoxicity
what is a delusion
fixed beliefs that are not amenable to change
what glutamate receptor has been hypothesized to contribute to the pathology of schizophrenia
NMDA
what is criterion B
social/occupational dysfunction-since onset of disturbance, one or more areas of functioning are markedly below level achieved prior to onset
what is the acute phase
presents with symptoms and can be characterized as “floridly psychotic”
what is the major thing to monitor for with Clozapine
agranulocytosis
what are hallucinations
sensory experience without any stimuli in one’s environment
what is the major CNS inhibitory neurotransmitter
GABA
what is criterion C
duration-disturbance persist for at least 6 months
what is the maintenance phase
acute symptoms decrease in severity
what are biologic approaches to treatment?
Pharmacological Therapies
Brain Stimulation Therapy
ECT
Deep brain stimulation → negative symptoms
Repetitive transcranial magnetic stimulation → both positive and negative symptoms, particularly auditory hallucinations
what are EPS
acute dystonia, akathisia, pseudoparkinsonism, tardive dyskinesia
which dopamine receptor do most antipsychotic properties block
dopaminergic D2 receptors
what is criterion D
schizoaffective and major mood disorder exclusion-schizoaffective, bipolar or depressive disorder with psychotic features are rules out
what is the stabilization phase
remission period though some symptoms can mildly persist
-optimize functioning individual
-this is where you want to guide individuals to and where you want them to stay
what are psychotherapeutic approaches to treatment
Individual therapy
Family intervention
Group therapy
what is MTS
cluster of conditions: abdominal obesity, insulin resistance, DLP, HTN & patients are at an increased risk for premature cardiovascular disease, diabetes mellitus, and death
what is GABA interneurons important for
the regulation of prefrontal cortical function
what is criterion E
the disturbance is not attributable to the physiological effects of a substance or another medical condition
what is the goal of care during the acute phase
SAFETY:risk of violence to self/others, explore their fears expressed about hallucinations, provide reassurance, remove dangerous objects from the room, verbal de-escalation, assess level of self-care, discuss any behavior changes, orient to being in the hospital
what is the most serious complication with antipsychotics?
Neuroleptic Malignant Syndrome (NMS)
what are some factors that are believed to increase the incidence of schizophrenia
season of birth, urban environment, some minority ethnic groups, pregnancy and birth complications