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Module 1 – Schizophrenia Spectrum and Other Psychotic Disorders This will provide a more detailed summary of pharmacological treatment guidelines and 1.The prevailing hypothesis for schizophrenia implicates the neurotransmitter dopamine as playing a key role in the development of the disease. Dopamine acts on several areas of the brain with differing effects. Please outline the key dopamine pathways and the implications of antipsychotic use on each pathway. 2. PA is a 18 yo male college student brought in by police after being found running on the highway. He is extremely paranoid and reports that the mafia is coming for him. When asked, he does admit to auditory hallucinations, mostly a commanding male voice telling him to hurt himself and his family. All pertinent labs and vitals are WNL, urine drug screen is negative. He is admitted to acute inpatient psychiatric unit for his first psychotic episode. He still lives with his parents and his father reports that over the past several months he has secluded himself to his room and can hear him talking “with someone” every once in a while. His father denies any previous medical or psychiatric history for PA and he is not currently taking any medications. He does report the following family history: DM2, dyslipidemia (father, paternal grandfather), schizophrenia (maternal aunt). What treatment do you recommend for PA’s first psychotic episode? Be specific in your answer and support your choice with neurobiologic rationale. Please also consider the pros and cons of each medication. Post your initial response by Wednesday at midnight. Response must be a minimum of 275 words, scholarly written, APA formatted, and referenced. A minimum of 2 references are required (other than your text). Refer to the Grading Rubric for Online Discussion in the Course Resource section. important information about medications (adverse effects, interactions, monitoring, etc

Module I: Schizophrenia Spectrum and Other Psychotic Disorders

Introduction

Schizophrenia affects around 1% of the U.S. population. Patients usually present with symptoms of schizophrenia during young adulthood, with males presenting earlier in life than females (21 years of age vs. 27 years of age, respectively). (Centers for Disease Control and Prevention 2013) Patients with schizophrenia have a shortened life expectancy compared to the general population, attributed mostly to medical comorbidities such as cardiovascular and cerebrovascular disease. (Gabbard 2014 pg.198) Patients with early-onset schizophrenia (first episode at 13 – 18 years of age) have been found to have poorer outcomes. Early identification of schizophrenia is key to maximize treatment response and to optimize long-term outcomes.

Antipsychotics are the mainstay in the pharmacological treatment of schizophrenia and other psychotic disorders. Although the largest body of evidence for the use of antipsychotics is for psychotic disorders, many antipsychotics have gained FDA-approved and non approved indications for various mood disorders and behavioral disorders. You will learn about the utility of antipsychotics for the treatment of these other mental health illnesses throughout this semester.

The choice of antipsychotic is generally based on various patient specific factors: history of response/nonresponse/intolerability, comorbid medical/psychiatric illnesses and sensitivity to potential adverse effects, concurrent medications and potential for drug interactions, cost, and personal preference. Adolescents and young adults are sensitive to the adverse effects of antipsychotics, especially extrapyramidal symptoms and metabolic changes, and generally respond better to smaller doses.

Each time a patient relapses their risk of having persistent psychotic symptomatology increases. (Gabbard 2014, pg 152) Treatment adherence is a crucial part of preventing relapse in schizophrenia. Being upfront about side effects and treatment expectations and involving caregivers in discussions are important in building trusting relationships with patients, which can help improve adherence. Switching to a long-acting injectable medications is a useful treatment consideration for patients who have difficulty remembering to take their medication.

In addition to the antipsychotics listed in Table 11-1 there are two new second-generation antipsychotics that have been recently approved for the treatment of schizophrenia: brexpiprazole (Rexulti) and cariprazine (Vraylar). Another second-generation, pimavanserin (Nuplazid), was approved for the treatment of Parkinson Disease psychosis in early 2016.

Objectives

By the end of this module the student should be able to:

• Choose an appropriate first line treatment for first episode psychosis based on patient specific factors.
• Choose an appropriate modification to therapy in the event of nonadherence, partial response, nonresponse, or intolerability.
• Manage common and serious adverse effects of first and second generation antipsychotics.

Read It 

Required

Gabbard’s Treatments of Psychiatric Disorders

• Part II: Schizophrenia Spectrum and Other Psychotic Disorders
  • Introduction; pg 127 – 129
  • Chapter 8: Early-Stage Schizophrenia; pg 131 – 156
  • Chapter 9: Toward a Dimensional Understanding of Psychosis and Its Treatment; pg 157 – 167
  • Chapter 11: Pharmacological Treatment of Psychosis; pg 187 – 205

Stahl’s Essential Psychopharmacology

• Chapters 1-3
  • These chapters will provide a review of the necessary neurobiology and neurochemistry that will be required for adequate comprehension of course concepts and material
• Chapters 4 & 5
  • Psychosis & Schizophrenia
  • Antipsychotic agents

DynaMed summaries

Module 1 – Schizophrenia Spectrum and Other Psychotic Disorders

This will provide a more detailed summary of pharmacological treatment guidelines and 1.The prevailing hypothesis for schizophrenia implicates the neurotransmitter dopamine as playing a key role in the development of the disease. Dopamine acts on several areas of the brain with differing effects. Please outline the key dopamine pathways and the implications of antipsychotic use on each pathway.

2. PA is a 18 yo male college student brought in by police after being found running on the highway. He is extremely paranoid and reports that the mafia is coming for him. When asked, he does admit to auditory hallucinations, mostly a commanding male voice telling him to hurt himself and his family. All pertinent labs and vitals are WNL, urine drug screen is negative. He is admitted to acute inpatient psychiatric unit for his first psychotic episode. He still lives with his parents and his father reports that over the past several months he has secluded himself to his room and can hear him talking “with someone” every once in a while. His father denies any previous medical or psychiatric history for PA and he is not currently taking any medications. He does report the following family history: DM2, dyslipidemia (father, paternal grandfather), schizophrenia (maternal aunt).

What treatment do you recommend for PA’s first psychotic episode? Be specific in your answer and support your choice with neurobiologic rationale. Please also consider the pros and cons of each medication.

Post your initial response by Wednesday at midnight. Response must be a minimum of 275 words, scholarly written, APA formatted, and referenced. A minimum of 2 references are required (other than your text). Refer to the Grading Rubric for Online Discussion in the Course Resource section.

important information about medications (adverse effects, interactions, monitoring, etc.)