Schizophrenia — Comprehensive Study Materials Flashcards

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Schizophrenia

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A chronic psychiatric disorder characterized by recurrent or persistent psychosis, functional impairment, and symptoms across positive, negative, and cognitive domains. Diagnosis is clinical and requires exclusion of other causes.

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Positive symptoms

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Symptoms that represent an exaggeration or distortion of normal functions, including hallucinations, delusions, disorganized speech, and grossly disorganized behavior. They are typically responsive to antipsychotic treatment.

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Negative symptoms

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Loss or diminution of normal functions such as apathy, social withdrawal, paucity of speech, and loss of motivation. They are core features of schizophrenia and are less responsive to many antipsychotics.

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DSM-V criteria

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Requires at least two core symptoms (delusions, hallucinations, disorganized speech, grossly disorganized behavior, negative symptoms) for a significant portion of one month, with continuous signs for at least six months and functional impairment. Rule out schizoaffective disorder, substance-induced psychosis, and medical causes.

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Dopamine hypothesis

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Posits excess dopamine activity in the mesolimbic pathway causing positive symptoms and reduced dopamine in the mesocortical pathway contributing to negative and cognitive symptoms. Forms the pharmacologic rationale for D2-targeted antipsychotics.

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Glutamate hypothesis

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Suggests NMDA receptor hypofunction leads to abnormal excitatory signaling and contributes to schizophrenia symptoms. It offers alternative therapeutic targets beyond dopamine.

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First-generation antipsychotics

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Also called typical antipsychotics; strong D2 antagonists effective for positive symptoms but with higher rates of EPS and tardive dyskinesia. They may worsen negative and cognitive symptoms.

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Second-generation antipsychotics

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Atypical agents that combine D2 and 5-HT2A antagonism, generally with lower EPS risk but greater metabolic adverse effects. Choice among SGAs is guided by side-effect profiles and individual patient factors.

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Clozapine

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The most effective antipsychotic for treatment-resistant schizophrenia and suicidality but requires strict monitoring for agranulocytosis and myocarditis. It has significant metabolic and hematologic risks.

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LAI antipsychotics

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Long-acting injectable formulations that improve adherence and reduce relapse risk in patients with poor adherence. They are not recommended for initial acute management due to slow attainment of steady state.

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Akathisia

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A subjective sense of inner restlessness often accompanied by an inability to sit still; frequently caused by D2 blockade or activating agents. Management includes dose reduction, β-blockers (propranolol), benzodiazepines, or switching agent.

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Parkinsonism (drug-induced)

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Extrapyramidal symptoms resembling Parkinson disease (rigidity, bradykinesia, tremor) caused by dopamine blockade. Treated with dose reduction, anticholinergics, amantadine, or switching to lower-EPS agents.

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Tardive dyskinesia

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A late-onset, potentially irreversible movement disorder characterized by orofacial and limb dyskinesias, typically from long-term D2 blockade. Management includes switching to clozapine or quetiapine and symptomatic measures.

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Neuroleptic malignant syndrome

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A rare but life-threatening reaction to antipsychotics marked by hyperthermia, severe rigidity, mental status changes, autonomic instability, and elevated CPK. Immediate withdrawal of the antipsychotic and supportive care with dantrolene or bromocriptine is required.

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Ziprasidone

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An SGA with a favorable metabolic profile that requires administration with food to ensure adequate absorption and may cause mild QT prolongation. EKG monitoring may be indicated for at-risk patients.

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Aripiprazole

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A partial D2 and 5-HT1A agonist (a 'dopamine stabilizer') associated with lower prolactin and metabolic effects but can be activating and cause akathisia. Available in oral and long-acting injectable formulations.

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Cariprazine

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A partial D3-preferring agonist (also D2 and 5-HT1A partial agonist) with clinical benefit for negative symptoms. It may cause akathisia and is useful across acute and maintenance phases.

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First psychotic episode

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Patients often respond well but are more sensitive to adverse effects; SGAs at limited doses are preferred and clozapine is not first-line. Improvement may take 6–12 weeks; reassess after 3–4 weeks at therapeutic doses for partial response.

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Clozapine monitoring

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Requires weekly CBC for the first 6 months, then less frequently, with immediate action if WBC/ANC fall below safety thresholds. Early monitoring for myocarditis (CRP/troponin) and ongoing metabolic surveillance are also mandatory.

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Pharmacist role

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Pharmacists educate patients and families, simplify and coordinate regimens, monitor drug interactions and adverse effects, and help select agents to minimize harm while maximizing adherence and efficacy. They play a key role in continuity of care.