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Pathophysiology
Anxiety Drugs
Schizophrenia
Schizophrenia Drugs
RANDOM
100
Serotonin System in GAD
Decreased serotonin = anxiety
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3 General Drug Classes used for Anxiety
Benzodiazepines, Antidepressants, Buspirone
100
What is the treatment cornerstone for Schizophrenia?
Antipsychotic medication with psychosocial support
100
What is the best approach for duration of therapy for Schizophrenia patients?
maintaining the antipsychotic at the minimal effective dose continuously
100
Difference between obsession and compulsion
Obsession= intrusive or recurrent thought, image, or impulse Compulsion= behavior or ritual that is performed in a repetitive or stereotypic way
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Noradrenergic Model in GAD
if stimulated, provokes anxiety --> increase HR, tremor, sweating
200
General Anxiety Disorder Treatment
If you need rapid relief, give BZDs then add on AD and taper off BZDs If you don't need rapid relief, give anti-depressant, if that doesn't work switch to different anti-depressant (TCA) (you can add a BZD for two weeks), if that doesn't work use buspirone, and if that doesn't work use atypical antipsychotic
200
Positive vs. Negative Symptoms of Schizophrenia
Positive= Ideation/Reality, Cognition, Behavior, Perception Negative= Judgement, Attention, Motivation, Emotions
200
Clozapine (Clozaril)
Less potent dopamine blocker Serotonin and dopamine antagonist Superior improvement of negative symptoms The only drug with enough data that is effective for patients whom typical drugs have failed Affects brain region that control cognitive and affective states but not the A9 tract that modulates movement Second line because of agranulocytosis risk!!! Must do weekly CBC for 6 months, then every 2 weeks for 6 months, then monthly after 1 year if the WBC >3500 and ANC >2000
200
Definition of diagnosing panic disorder
A period of intense fear or discomfort, in which 4 or more of the following symptoms develop abruptly and reach a peak within 10 minutes Example of some symptoms: palpitations, chest pain or discomfort, sweating, chills, trembling, shaking, shortness of breath, nausea, etc..
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GABA- Benzodiazepine System in GAD
If you increase GABA, you break the anxiety attack BZD binds to brain receptors to increase GABA
300
What BZD would you give for someone with liver problems?
Oxaezepam (Serax)
300
4 phases of Schizophrenia
Prodromal Phase= gradual development of symptoms that may go unnoticed: isolation, deterioration of hygiene, loss of interest at work or school, and dysphoria Acute: full-blown episode of psychotic behavior Stabilization= acute symptoms decrease, this phase may last for several months Stable= symptoms markedly declined and may not be present
300
Risperidone (Risperdal)
A potent dopamine (D2) and serotonin antagonist Low anticholinergic activity Efficacy in treatment-resistant patients remains to be seen Depot parenteral form tolerated better than typical depots Incidence of EPS= placebo (doses up to 6mg/day) EPS may be seen at usual doses though Usual dose= 3-6mg (max dose= 6-8mg) Adverse effects= sedation, orthostatic hypotension, weight gain, hyperprolactinemia as often as FGA
300
What drug is not effective in PTSD?
Benzodiazepine
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Bottom line of Pathophysiology for Schizophrenia
Dopamine regulation is required for an antipsychotic agent's effectiveness especially for positive symptoms of schizophrenia
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OCD Treatment
SSRI if that doesn't work try Clomipramine (TCA) If you fail 3 anti-depressants, try atypical antipsychotic like Risperidone, Quetiapine, Olanzapine
400
what are the extrapyramidal symptoms?
Parkinsonism, Dyskinesia, Akathesia, Tardive dyskinesia
400
Olanzapine (Zyprexa)
Similar to clozapine but not associated with agranulocytosis Less potent dopamine blocker Its a greater serotonin antagonist than dopamine blocker Negative symptoms responded better than with haloperidol EPS is not higher than placebo New role in treatment= resistant depression Available in parenteral formulation (IM)for rapid treatment of agitation Adverse effects= transient, slight prolactin elevation, hypotension, common weight gain, glucose, triglyceride abnormalities
400
Social Anxiety Disorder
1st line= SSRIs/SNRIs (can add on BZD if needed) 2nd line= Pregabalin or Gabapentin (anti-convulsants) 3rd line= beta blockers
500
What does Ziprasidone (Geodon) cause?
Increased QT interval!! Use caution if combined with other drugs and conditions associated with prolonged QT **Note- low incidence of weight gain, lipid, and EPS than other atypical antipsychotic drugs - Available in a parenteral formulation for acute agitation
500
Treatment for Panic Disorder
If you need fast relief, first do a BZD then add on anti-depressant and taper off of the BZD If you don't need fast relief, start with SSRI/SNRI, if that doesn't work, 2nd line= TCA (can add BZD for 2 weeks) If all that doesn't work, try MAOI *you can use beta blocker also to alleviate panic symptoms*
500
Adverse Effects of Antipsychotic Medications (6)
1. Neuroleptic Malignant Syndrome- agitation, confusion, fever, tachycardia, bp, sweating, HIGH MORTALITY 2. Endocrine effects- galactorrhea and menstrual changes 3. New-onset DM 4. Sexual dysfunction (erectile problem, loss of libido and anorgasmia) 5. Pigmentary deposits on the retina (also corneal opacity) 6. QT interval prolongation
500
Quetiapine (Seroquel)
Structurally related to clozapine and olanzapine Less potent dopamine blocker Higher serotonin antagonist than dopamine Less anticholinergic effects Low incidence of EPS and prolactin elevation More effective for anxiety and depressive symptoms DOC for psychotic Parkinson's disease patients!! Adverse effects: prolongs QT interval, transient sedation, mild weight gain, mild triglyceride elevation
500
Aripiprazole (Abilify)
Newer of the typical antipsychotics D2/5-HT2 agonist and 5-HT2 antagonist Dopamine-serotonin stabilizing drug (agonist AND antagonist) Low risk of EPS and tardive dyskinesia No titration of dose required- metabolized by CYP2D6 Adverse effects- sedation, n/v, akathesia, constipation, weight gain, lipid and glucose abnormalities, *Usually does NOT cause hyper-prolactinemia!