This document provides information on the treatment of schizophrenia and related psychotic disorders. It discusses the symptoms and diagnostic criteria for schizophrenia according to the DSM-IV. It describes the positive and negative symptoms as well as functional impairments. The document outlines the challenges in treating schizophrenia, including stigma, impaired insight, substance abuse, and medical comorbidities. It summarizes the evidence for effective treatments like antipsychotic medications and family psychoeducation. The document provides a history of antipsychotic medications, describing their mechanisms of action and side effect profiles. It compares first-generation "typical" antipsychotics to second-generation "atypical" antipsychotics.
antipsychotics history, managment of psychosis,side effect of antipsychotics, mechanism of antipsychotics, atypical antipsychotics,2nd generation antipsychotics.
Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality. Although schizophrenia is not as common as other mental disorders, the symptoms can be very disabling.
This is a presentation done on 4/6/11 for the Grand Rounds at Wayne State university by Pallav Pareek M.D.
This presentation talks about the concept of prdrome as it is(if?) applicable to schizophrenia, and if schizophrenia is becoming more of a preventable illness as science progresses. If so what are the various ways and means in which we can accomplish this prevention.
Amidst so much controversy on the issue , whether there is a prodrome for this illness or not, here I have tried to present the recent advances in this field and the recent scientific literature in this regard.
Antipsychotics and mood stabilizers in pregnancyMohamed Sedky
Objectives:
Background risk of spontaneous congenital anomalies
The impact of mental illness on pregnancy
The impact of pregnancy on mental illness
The impact Antipsychotics and mood stabilizers on pregnancy outcome
Recommendations for prescribing during pregnancy
What to include in discussions with a pregnant women
SCHIZOPHRENIA:
slide 1: A long-term mental disorder of a type involving a breakdown in the relation between thought, emotion, and behavior, leading to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation.
slide 14: Types:
• Paranoid-type schizophrenia is characterized by delusions and auditory hallucinations (hearing voices that don't exist) but relatively normal intellectual functioning and expression of emotions. People with paranoid-type schizophrenia can exhibit anger, aloofness, anxiety, and can be argumentative.
• Disorganized-type schizophrenia is characterized by speech and behavior that are disorganized or difficult to understand, and flattening or inappropriate emotions. People with disorganized-type schizophrenia may laugh inappropriately for no apparent reason, make illogical statements, or seem preoccupied with their own thoughts or perceptions. Their disorganized behavior may disrupt normal activities, such as showering, dressing, and preparing meals.
• Undifferentiated-type schizophrenia is characterized by some symptoms seen in all of the above types, but not enough of any one of them to define it as another particular type of schizophrenia.
• Residual-type schizophrenia is characterized by a past history of at least one episode of schizophrenia, but the person currently has no "positive" symptoms (such as delusions, hallucinations, disorganized speech, or behavior). It may represent a transition between a full-blown episode and complete remission, or it may continue for years without any further psychotic episodes.
Catatonic Schizophrenia
This type of schizophrenia includes extremes of behavior, including:
Catatonic excitement - overexcitement or hyperactivity, in which the patient may mimic sounds (echolalia) or movements (achopraxia) around them.
Catatonic stupor - a dramatic reduction in activity in which the patient cannot speak, move or respond. Virtually all movements stops.
Conclusion
It is clear now, through the use of genetic linkage studies and microbiology, that schizophrenia does indeed have a biological explanation. However, the biological explanation is only part of the story. A yet unknown combination of intense stress, sociocultural situations, and cognitive processes may lead to the actual onset of schizophrenia aided by natural precursors. The most compelling explanation seems to be that a genetically inherited biological abnormality gives rise to hallucinations/delusions as a result of intense stress and eventually leads to other negative symptoms in reaction to the hallucinations/ delusions. At any rate, the current understanding of schizophrenia explains that the symptoms, however easily identifiable, are the result of a complex interaction between nature and nurture that can be treated adequately through the use of atypical anti psychotic drugs and psychotherapy.
antipsychotics history, managment of psychosis,side effect of antipsychotics, mechanism of antipsychotics, atypical antipsychotics,2nd generation antipsychotics.
Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality. Although schizophrenia is not as common as other mental disorders, the symptoms can be very disabling.
This is a presentation done on 4/6/11 for the Grand Rounds at Wayne State university by Pallav Pareek M.D.
This presentation talks about the concept of prdrome as it is(if?) applicable to schizophrenia, and if schizophrenia is becoming more of a preventable illness as science progresses. If so what are the various ways and means in which we can accomplish this prevention.
Amidst so much controversy on the issue , whether there is a prodrome for this illness or not, here I have tried to present the recent advances in this field and the recent scientific literature in this regard.
Antipsychotics and mood stabilizers in pregnancyMohamed Sedky
Objectives:
Background risk of spontaneous congenital anomalies
The impact of mental illness on pregnancy
The impact of pregnancy on mental illness
The impact Antipsychotics and mood stabilizers on pregnancy outcome
Recommendations for prescribing during pregnancy
What to include in discussions with a pregnant women
SCHIZOPHRENIA:
slide 1: A long-term mental disorder of a type involving a breakdown in the relation between thought, emotion, and behavior, leading to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation.
slide 14: Types:
• Paranoid-type schizophrenia is characterized by delusions and auditory hallucinations (hearing voices that don't exist) but relatively normal intellectual functioning and expression of emotions. People with paranoid-type schizophrenia can exhibit anger, aloofness, anxiety, and can be argumentative.
• Disorganized-type schizophrenia is characterized by speech and behavior that are disorganized or difficult to understand, and flattening or inappropriate emotions. People with disorganized-type schizophrenia may laugh inappropriately for no apparent reason, make illogical statements, or seem preoccupied with their own thoughts or perceptions. Their disorganized behavior may disrupt normal activities, such as showering, dressing, and preparing meals.
• Undifferentiated-type schizophrenia is characterized by some symptoms seen in all of the above types, but not enough of any one of them to define it as another particular type of schizophrenia.
• Residual-type schizophrenia is characterized by a past history of at least one episode of schizophrenia, but the person currently has no "positive" symptoms (such as delusions, hallucinations, disorganized speech, or behavior). It may represent a transition between a full-blown episode and complete remission, or it may continue for years without any further psychotic episodes.
Catatonic Schizophrenia
This type of schizophrenia includes extremes of behavior, including:
Catatonic excitement - overexcitement or hyperactivity, in which the patient may mimic sounds (echolalia) or movements (achopraxia) around them.
Catatonic stupor - a dramatic reduction in activity in which the patient cannot speak, move or respond. Virtually all movements stops.
Conclusion
It is clear now, through the use of genetic linkage studies and microbiology, that schizophrenia does indeed have a biological explanation. However, the biological explanation is only part of the story. A yet unknown combination of intense stress, sociocultural situations, and cognitive processes may lead to the actual onset of schizophrenia aided by natural precursors. The most compelling explanation seems to be that a genetically inherited biological abnormality gives rise to hallucinations/delusions as a result of intense stress and eventually leads to other negative symptoms in reaction to the hallucinations/ delusions. At any rate, the current understanding of schizophrenia explains that the symptoms, however easily identifiable, are the result of a complex interaction between nature and nurture that can be treated adequately through the use of atypical anti psychotic drugs and psychotherapy.
This is a project for a high school AP Psychology course. This is a fictionalized account of having a psychological ailment. For questions about this blog project or its content please email the teacher Chris Jocham: jocham@fultonschools.org
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. Psychosis
• Generally equated with positive
symptoms and disorganized or bizarre
speech/behavior
• Impaired “reality testing”
• A syndrome present in many illnesses
– remove known cause or treat underlying
illness
– treat symptomatically with antipsychotic
medications
3. Schizophrenia is a
heterogeneous illness
• Defined by a constellation of symptoms,
including psychosis
• Multifactorial etiology, variable course
• Social/occupational dysfunction a
required diagnostic criterion
• Good treatment must address
symptoms and social/occupational
dysfunction
4. DSM-IV Schizophrenia
• 2 or more of the following for most of 1 month:
– Delusions
– Hallucinations
– Disorganized speech
– Grossly disorganized or catatonic behavior
– Negative symptoms
• Social/occupational dysfunction
• Duration of at least 6 months
• Not schizoaffective disorder or a mood disorder
with psychotic features
• Not due to substance abuse or a general
medical disorder
6. Common needs of people with
schizophrenia
• Symptom control
• Housing
• Income
• Work
• Social skills
• Treatment of comorbid conditions
7. Challenges in the Treatment
of Schizophrenia
• Stigma
• Impaired “insight”– no agreement on problem
• Treatment “compliance”
• Substance abuse very common
• Violence risk
• Suicide risk
• Medical problems common, often
unrecognized
8. Schizophrenia Treatment
• Therapeutic Goals
• minimize symptoms
• minimize medication side effects
• prevent relapse
• maximize function
• “recovery”
• Types of Treatment
• pharmacotherapy
• psychosocial/psychotherapeutic
9. Treatments for schizophrenia:
Strong evidence for effectiveness
• Antipsychotic medications
• Family psychoeducation
• Assertive Community Treatment
(ACT teams)
10. The First Modern Antipsychotic
Chlorpromazine (Thorazine)
• Antipsychotic properties discovered in
1952
• Studied originally for usefulness as a
sedative
• Found to be useful in controlling
agitation in patients with schizophrenia
• Introduced in U.S. in 1953
21. Tardive Dyskinesia (TD)
• Involuntary movements, often
choreoathetoid
• Often begins with tongue or digits,
progresses to face, limbs, trunk
• Etiologic mechanism unclear
• Incidence about 3% per year with
typical antipsychotics
– Higher incidence in elderly
22. Tardive Dyskinesia (TD)-2
• Major risk factors:
– high doses, long duration, increased age,
women, history of Parkinsonian side effects,
mood disorder
• Prevention:
– minimum effective dose, atypical meds,
monitor with AIMS test
• Treatment:
– lower dose, switch to atypical, Vitamin E (?)
23. Neuroleptic Malignant Syndrome
(NMS)
• Fever, muscle rigidity, autonomic instability,
delirium
• Muscle breakdown indicated by increased CK
• Rare, but life threatening
• Risk factors include:
– High doses, high potency drugs, parenteral
administration
• Management:
– stop antipsychotic, supportive measures (IV fluids,
cooling blankets, bromocriptine, dantrolene)
24. Typical Antipsychotic limitation:
Other common side effects
• Anticholinergic side effects: dry mouth,
constipation, blurry vision, tachycardia
• Orthostatic hypotension (adrenergic)
• Sedation (antihistamine effect)
• Weight gain
• “Neuroleptic dysphoria”
25. Typical Antipsychotic limitation:
Treatment Resistance
• Poor treatment response in 30% of
treated patients
• Incomplete treatment response in
an additional 30% or more
26. The First “Atypical” Antipsychotic:
Clozapine (Clozaril)
• FDA approved 1990
• For treatment-resistant schizophrenia
• 30% response rate in severely ill,
treatment-resistant patients (vs. 4%
with chlorpromazine/Thorazine)
• Receptor differences: Less D2 affinity,
more 5-HT
10
30. Defining “atypical” antipsychotic
Relative to conventional drugs:
• Lower ratio of D2 and 5-HT2A receptor
antagonism
• Lower propensity to cause EPS
(extrapyramidal side effects)
31. Atypical Antipsychotics:
Efficacy
• Effective for positive symptoms
• (equal or better than typical antipsychotics)
• Clozapine is more effective than
conventional antipsychotics in treatment-
resistant patients
• Atypicals may be better than
conventionals for negative symptoms
32. New Antipsychotics and Haloperidol vs
Placebo: ‘Pooled’ Data
Mean BPRS Changes
Olanzapine pooled
r=.23*; n=574
(2 studies)
Quetiapine pooled
r=.23*; n=991
(4 studies)
Risperidone pooled
r=.28*; n=686
(3 studies)
Haloperidol pooled
r=.28*; n=814
(6 studies)
-0.4 -0.3 0.2 0.1 0 0.1 0.2 0.3 0.4 0.5 r (95% CI)
*Statistically significant.
Modified from Leucht S, et al. Schizophr Res. 1999;35:51-68.
33. New Antipsychotics and Haloperidol
vs Placebo: ‘Pooled’ Data
Change in Negative Symptoms
Olanzapine pooled
r=.21*; n=582
(2 studies)
Quetiapine pooled
r=.19*; n=823
(4 studies)
Risperidone pooled
r=.20*; n=686
(2 studies)
Haloperidol pooled
r=.17*; n=796
(5 studies)
-0.4 -0.3 0.2 -0.1 0 0.1 0.2 0.3 0.4 0.5 r (95% CI)
*Statistically significant.
Modified from Leucht S, et al. Schizophr Res. 1999;35:51-68.
34. Relapse Rates in 1 Year Studies:
Atypical vs. Typical Antipsychotics
NA
CA Risk Difference (95% CI fixed)
Marder, 2002 (risperidone) n/N
2/33 %
6% n/N
3/30
%
Csernansky, 2002 (risperidone) 10%
Risperidone pooled 41/177 23 65/188
Daniel, 1998 (sertindole) 35
Speller, 1997 (amisulpride) 43/210 21 68/218
31
Tamminga, 1993 (clozapine) 2/94 2 12/109
Essock, 1996 (clozapine) 11
Rosenheck, 1999 (clozapine) 5/29 17 9/31
Clozapine pooledd 29
Tran, 1998a (olanzapine)
Tran, 1998b (olanzapine) 1/25 4 0/14
Tran, 1998c (olanzapine) 0
Olanzapine pooled 13/76 17 15/48
31
10/35 29 4/14
Total 29
24/136 18 19/76
p=0.0001 in favor of atypical drugs; -0.5 Favors 0 Favors 0.5
25
Leucht S et al. Am J Psychiatry. 2003 Atypical Antipsychotic Conventional Drug
10/45 22 2/10
35. Atypical Antipsychotics:
Efficacy for Cognitive and Mood
Symptoms
• Atypical antipsychotics may improve
cognitive and mood symptoms
(Typical antipsychotics tend to worsen
cognitive function)
• Dysphoric mood may be more
common with typical antipsychotics
36. Atypical Antipsychotics:
Side Effects
• Atypical antipsychotics tend to have
better subjective tolerability (except
clozapine)
• Atypical antipsychotics much less likely
to cause EPS and TD, but may cause
more:
• Weight gain
• Metabolic problems (lipids, glucose)
• ECG changes
37. Weight gain at 10 weeks
6
5
4
Kg 3
2
1
0
-1
HAL
OLZ
CPZ
CLOZ
PLB
ZIP
RISP
Allison et al 1999
39. Why worry about side effects?
• May cause secondary symptoms,
illnesses
• Contribute to “noncompliance” and thus
relapse
40. Current consensus on
antipsychotics
• Atypical antipsychotics (other than clozapine)
are first choice drugs:
-superiority on EPS and TD
-at least equal efficacy on + and – symptoms
-possible advantages on mood and cognition
• BUT:
-long-term consequences of weight gain and
metabolic effects may alter recommendation
-atypicals are very expensive
41. Real and Projected Global Sales of
Antipsychotics 1990-2009 ($ millions)
42. Common factors associated
with psychotic relapse
•antipsychotics not completely effective
•“noncompliance”—inconsistent
antipsychotic medication use
•stressful life events/home
environment (Expressed Emotion—EE—
hostility, criticism, overinvolvement)
•alcohol use
•drug use
43. Antipsychotic medication
reduces relapse rates
Risk of relapse in one year:
Consistently taking medications: 20-30%
Not taking medications consistently: 65-80%
44. Relapse in Schizophrenia
Hogarty et al., N = 374
Prien et al., N ≈ 630
100
90 Caffey et al., N = 259
80
70 Neuroleptics
% Not Relapsed
60
50
40
Placebo
30
20
10
0 3 6 9 12 15 18 21 24 27 30
Months
Baldessarini RJ et al: Tardive Dyskinesia: APA Task Force Report 18, 1980
45. Consequences of relapse
• Disruptive to patients lives
(hospitalizations, lost jobs, lost apartments,
estranged family and friends)
• Risk of dangerous behaviors
• May worsen course of illness
• Increased costs
46. Long-acting injectable (depot)
antipsychotics
• Until late 2003, only haloperidol and
fluphenazine available in the U.S.
• Long-acting risperidone introduced late 2003
• Injections approximately every 2 weeks
(fluphenazine and risperidone) or 4 weeks
(haloperidol)
• Goal is to decrease “noncompliance” and
thus relapse--widely used but less commonly
in last 10 years
• Not yet clear if long-acting risperidone will
reverse the trend
47. Schizophrenia Treatment
Assertive Community Treatment
• Multidisciplinary teams: MDs, RNs,
social workers, psychologists,
occupational therapists, case managers
• Staff:patient ratio about 1:10
• Outreach, contact as needed
• Effective at reducing hospitalizations
• Cost-effective when targeted at high
hospital users
48. Schizophrenia Treatment
Family Psychoeducation
• Provides information about
schizophrenia: course, symptoms,
treatments, coping strategies
• Supportive
• One aim is to decrease expressed
emotion (hostility, criticism, etc.)
• Not blaming
49. Other interventions for schizophrenia:
Some evidence for effectiveness
• Some types of psychotherapy
• Case management
• Vocational rehabilitation
• Outpatient commitment
• ECT (for catatonia)
51. Schizophrenia Treatment
Psychosocial Remedial Therapies
• To improve social and vocational skills
• Clubhouse model offers opportunities to
socialize, transitional employment
• Vocational rehabilitation—especially
supported employment
52. Schizophrenia Treatment:
Case management
• Case manager helps coordinate
treatments, provides support
• Help navigating life, such as managing
every day activities, transportation, etc.
• Helps broker access to available services
• Benefits:
improves compliance, reduces stressors,
helps identify and treat problems with
substance use
53. Course of Schizophrenia
Stages of Illness
premorbid prodromal onset/ residual/
deterioration stable
More symptoms
Higher Function
Gestation/Birth 10 20 30 40 50
54. “Deinstitutionalization”
• Mid-1950s: >500,000 people in state
psychiatric hospitals
• Now: <<100,000
• Antispychotic medications
• Civil (patients) rights movement
• Community Mental Health Acts (1963-64)
• Medicaid (1965-allows states to share costs
with federal government)
• Still an active issue in N.C.—adequacy of
community-based services remain in doubt
55. Recommended books on
schizophrenia
• Is there no place on earth for me?,
Susan Sheehan
• Imagining Robert,
Jay Neugeboren
• Nightmare: a schizophrenia narrative,
Wendell Williamson
• The Quiet Room, Lori Schiller