Positive Symptoms of Pychosis

Negative Symptoms of Psychosis

Blunted affect

emotional withdrawal

poor rapport

passivity

apathetic

difficulty in abstract thinking

lack of spontaneity

social withdrawl

alogia (restrictions in productivity of thought speech)

anhedonia

attenional impairment

DSM-IV Classification

Psychotic Classifications

delusional disorder (middle age)

shared psychotic (husband/wife)

due to a general medical condition

substance induced

NOS

Biological Bisis of Shizophrenia

antithesis of parkinsons disease which is love levels of dopamine, shizophrenia levels of dopamine are too high

durgs for parkinsons have been kow to cause druge induced physhosis

Thorazine

chlorpormazine

Prolizin

fluphenazine

Haldol

haloperidol

Orap

pimozide

(tourettes)

Phenothiazines Antipsychotics

least expensive druges for teating sychosis

alcholoh induced hallucinasis

manage halluciantions and delusions cased by phychedelic agents

mangae halllucinations related to acute mania

teatment of nausea

pre-op

premature ejaculation

relieve severe itching

Four dopamine pathways

involved with untreated shizophrenia

Mesolimbic dopamine pathway: hyper dopamanergic activity, causes positive symptoms

Mesocortical pathway: lower levels of dopamine, casing cognitive dysfunciton and negative symptoms

Nigrostriatal Pathway: normal levels

Turberoinfundibular Pathway: normal levels

Four Dopamine Pathways when blocked by neuroleptic AP's (older anti-phsycotic)

mesolimbic pathway: blocking dopamine, relieves delusions and hallucianations (Positive symptoms)

mesocortical pathway: block dopamine, increases cognitive dysfunction and negative symptoms

nigrostriatal pathway: blocking dopamine, produces EPS (extra privital side effects)

Tuberoinfundibular pathway: produces proclactin secretion when dopamine is blocked and prolactin level rises

Parkinsonism

group of nervous system disorders marked by:

 muscular rigidity, tremors, lack of facial expression known as facial mask(not flat affect), akinesia (lack of or slow movement), postural abnormalities and gait posture

Acute drug-induced akathisia

subjective complaints of restlessness and at least one of the following:

figety movements, swinging of the legs while seated, rocking from foot to foot (walkin on the spot), pacing to relieve the restlessness, inability to sit or stand still for at least several minutes.

Drug-induced acute dystonia

sustaind abnormal postures or muscle spasms include:

abnormal positioning of the head and neck in relation to the body, spasms of the jaw muscles(grimacing), impaird swallowing (dysphagia), impaird speaking or breathing, thickened or slurred speech due to hpertonic tongue, oculogyric crisis (eyes deviate up, down or sideways), abnormal positioning of limbs and trunk

Drug-induced Tardive Dyskinesia

abnormal involuntary movements of the tongy, jaw trunk or extremities.

Clozaril

(clozapine)

first molecule to come out of the a-typical: the most effective antipsychotice espessally for severe schizopphrenia, helps with both the negative and positive symptoms, later research has shown it to be effective with disorganized, life treting side effect agranulocystosis (decrese of white blood cells), need weekly blood tests in first months, sedation, weight gain, constipation, if discontinued too fast: delusions, halucinations, hostility, paronaoid reaction - zyprexa has been used to block the withdrawl

Risperdal

risperidone

risperdal consta (slow release)

Invega

paliperidone

Risperdal side effect

sleepy

agitation

insomia

headaches

EPS

Zyprexa

olanizapine

side effects: wight gain, dedation, orthostatic hypotension, EPS is rare

Seroquel

quetiapine

side effects: as effective as hldol reducing positive symptoms, the reduction of negative symptoms have not been consisten according to studies, short half-life, useful for byi, shizoaffective

Geodon

ziprosidone

low risk of EPS, lower risk of weight gain, effect as haldo, may help with depression, increase energy

Abilify

aripiprazole

most effective anti-psycotic, partial dopamine agonist, dopamine system stabilizer (DSS), lower rate of sedation, lower rate of wight gain, may be stimulation, treats both positive and negative symptoms

Invega

paliperdone

Saphris

asenapine

sublingual tablets (under the tongue)

Fanapt

iloperiodone