Seeing the Truth About Childhood Schizophrenia
|
|
- Naomi Short
- 6 years ago
- Views:
Transcription
1 Page 1 Seeing the Truth About Childhood Schizophrenia Elizabeth Montagnese, M.D. Adult, Child and Adolescent Psychiatrist Quittie Glen Center for Mental Health in Annville, Pennsylvania This program has been supported by an educational grant from Bristol-Myers Squibb Seeing the Truth About Childhood Schizophrenia Speaker: Dr. Montagnese is board certified in adult, child, and adolescent psychiatry by the American Board of Psychiatry and Neurology. Dr. Montagnese provides comprehensive psychiatric evaluation and treatment for individuals, couples and families. Her primary area of focus is working with children and adolescents but she also treats adults.dr. Montagnese received her medical degree at Wayne State University in Detroit, Michigan. She completed her general psychiatry and child psychiatry training at the Penn State University Milton S. Hershey Medical Center.Dr. Montagnese is the medical director at Family and Children Services of Central Pennsylvania. This is a United Way funded nonprofit agency that serves the greater Harrisburg, York and Lancaster areas. To contact her at this agency please call Speaker Disclosure: Dr. Montagnese has no actual or potential conflicts of interest in relation to this program This program has been supported by an educational grant from Bristol-Myers Squibb PharmCon is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education Legal Disclaimer: The material presented here does not necessarily reflect the views of Pharmaceutical Education Consultants (PharmCon) or the companies that support educational programming. A qualified healthcare professional should always be consulted before using any therapeutic product discussed. Participants should verify all information and data before treating patients or employing any therapies described in this educational activity. PharmCon is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education Legal Disclaimer: The material presented here does not necessarily reflect the views of Pharmaceutical Education Consultants (PharmCon) or the companies that support educational programming. A qualified healthcare professional should always be consulted before using any therapeutic product discussed. Participants should verify all information and data before treating patients or employing any therapies described in this educational activity. Seeing the Truth About Childhood Schizophrenia Accreditation: Pharmacists L01-P Pharmacy Technicians L01-T Target Audience: Pharmacists & Technicians CE Credits: 1.0 Credit hour or 0.1 CEU for pharmacists/technicians Expiration Date: 10/20/2011 Program Overview: This program is designed to assist pharmacists review the facets of childhood schizophrenia, as well as the benefits of managing this disorder with medications. Their knowledge of available treatment options for children with schizophrenia will be enhanced. The program includes information on pharmacologic treatments, drug interactions, patient counseling, and a question/ answer period. Objectives: To state the theories associated with the causes of childhood schizophrenia, as well as detrimental affects that this disorder may have on its victim s lives, incorporating information on the prevalence of this predicament. To list therapeutic agents used in the treatment of childhood schizophrenia, and be able to state an agent s dosage schedule, mechanism of action, and side effects. Review the pharmacist s role in counseling patients on drug treatment strategies and medication adherence to improve quality of life and long-term maintenance of childhood schizophrenia patients. Jani s at the mercy of her mind. LA Times story, June 29, 2009 Jani Schofield, 6 year old Severe symptoms since toddlerhood There is something wrong with her brain.
2 Page 2 Epidemiology of Childhood-Onset Schizophrenia (COS) RARE!!!!! 1 in 40,0000 Adult-onset schizophrenia (AOS): 1% general population M:F ratio: :1 Very rarely diagnosed before age 5 Usually diagnosed between 7-12 years old Schizophrenia Statistics Emil Kraeplin documented cases of COS in 1919 Typical age of onset: males: 18 years of age females: 25 years of age Top 10 causes of disability worldwide Cost of Schizophrenia: 1990-accounted for 2.5% of health care expenditures+ nondirect costs($45 billion) $62.7 billion for direct and nondirect costs Unemployment rate is 70-80% 10% of those permanently disabled What is Childhood Schizophrenia? Neurodevelopmental disorder Fundamental continuity between AOS and COS Differences in Childhood Schizophrenia More severe illness Worse prognosis More insidious onset Harder to treat Misdiagnosis is common
3 Page 3 Diagnostic Difficulties with COS Complex disorder with diverse presentation Diagnosing COS Psychosis and thought disorder are difficult to assess in children Children s concept of reality changes with time Disorganized behavior/speech can be common in nonpsychotic children Symptoms change, emerge, evolve over time Rare disorder: lack of clinical familiarity Devastating illness - Life sentence Clinicians don t want to get it wrong Large overlap with other disorders Mean onset of symptoms: 4.6 years Mean onset of psychosis: 6.9 years Mean onset of diagnosis: 9.5 years 5 year time lag DSM Criteria for Schizophrenia DSM Criteria for Schizophrenia Two or more of following for 1 month: (A Criterion) Delusions Hallucinations Disorganized speech Disorganized behavior Social/occupational dysfunction Disturbance for at least 6 months with at least 1 month with criterion A Not due to substance, medical condition, mood disorder or PDD Negative symptoms: flat affect, avolition, alogia Only 1 if delusions bizarre or voice keeping commentary or 2 voices conversing
4 Page 4 Schizophrenia Subtypes Catatonic Paranoid Disorganized What is psychosis? What is real vs. fantasy Think of A Beautiful Mind Undifferentiated Residual Positive Symptoms Negative Symptoms Affective blunting Symptoms associated with distorted reality Delusions Hallucinations Things present in those with schizophrenia as compared to those without. Poverty of speech Thought blocking Adequate grooming Lack of motivation-apathy Things absent from those with schizophrenia as compared to those without. Anhedonia Social withdrawal
5 Page 5 Hallucinations Hallucinations in COS Think of 5 senses: visual, auditory, olfactory, gustatory, tactile Usually frightening, morbid, macabre Can be friendly, company Most common presenting symptom Auditory hallucinations: 80% of COS Visual hallucinations: 30% of COS Tactile/olfactory hallucinations: rare Developmental considerations Hallucinations in isolation = schizophrenia Imaginary friends > 7yrs old: cause for concern Auditory Hallucinations Usually negative Command Conversing Commenting Persecutory May be friendly Visual Hallucinations Almost always accompanied by auditory hallucinations
6 Page 6 Delusions Difficult to assess in children A fixed false belief Bizarre-illogical 50-60% of COS Nonbizarre- can really occur Childhood themes: monsters, animals, family, fantasy figures Persecutory Less complicated in childhood Somatic Ideas of reference Grandiose Religious ideas Thought Disorder is disruption in flow of conscious verbal thought that is inferred from spoken or written language. Flight of ideas Derailment Thought blocking Pressured speech Tangentiality Perseveration Word salad Neologisms Echolalia Illogical Thought Disorder in COS Disturbance of Affect in COS % of COS Difficulty with assessment and definition in children 74% of COS Blunted Flat Inappropriate
7 Page 7 The Prodrome The Prodrome Onset of decline from baseline functioning Latent schizophrenia Don t meet full criteria Nonspecific symptoms Important: early detection is protective cognitive functioning overall functioning social isolation personal hygiene Difficulties with attention Change in emotions Flattening of affect The Prodrome Differential Diagnosis of COS Bizarre preoccupations Change in sleep/appetite Aggression, anxiety Neuromotor or sensory changes Abnormal eye tracking movements Brief, intermittent psychosis Pervasive developmental disorder Affective disorders PTSD Conduct Developmental language disorder Cognitive problems Conduct disorders Personality disorders Dissociative disorder Substance abuse
8 Page 8 Differential Diagnosis of COS Theories of Causation General medical causes: Delirium Seizures CNS lesions Neurodegenerative disorder Toxins No family history: 1% Genetic First degree relative: 10% Identical twin: 50% Gene markers: GAD1 affecting GABA and neureglin Infections Theories of Causation Structural Brain Abnormalities Infection Birth trauma Rh incompatibility Prenatal insults Abnormal protein and NT Synthesis Excessive glutamate release (excito-toxic damage) Hot area of research Lateral ventricular volume Total and regional gray matter volumes Basal ganglia volumes
9 Page 9 Structural Brain Abnormalities in COS Structural Brain Abnormalities in COS Gray matter loss in back to front pattern White matter loss in front to back pattern Exaggerated synaptic pruning Slower brain growth Lopsided brain growth Composite MRI scan data showing areas of gray matter loss over 5 years, comparing 12 normal teens (left) and 12 teens with childhood onset schizophrenia. Red and yellow denotes areas of greater loss. Front of brain is at left. Similar changes as AOS Differs from other neuropsychiatric disorders Not yet diagnostic May predict presymptomatic adolescents Comparison of the Patterns of Cortical Gray Matter (GM) Loss in Childhood-Onset Schizophrenia (COS) (Between Ages 12 and 16 Years) to That Seen in Normal Cortical Maturation (Between Ages 4 and 22 Years) Structural Brain Abnormalities in COS Unaffected family members: early loss of gray matter, normalizes by age 20 Help in finding genetic markers Help in identifying trajectory influences Gogtay, N. Schizophr Bull :sbm103v1-103; doi: /schbul/sbm103 Copyright restrictions may apply.
10 Page 10 Morbidity and Mortality People with schizophrenia that are in the public mental health system die 25 years earlier that the general population!! Schizophrenia can be lethal. Course of Disease 4 phases: prodrome, acute, recuperative, recovery/residual phase Chronic illness No cure Very treatable Without treatment-downhill course Diagnostic Work Up Treatment of COS Comprehensive diagnostic evaluation Labs: complete metabolic panel, thyroid, urinalysis, toxicology screen, HIV, chromosomal analysis, folate, B12, RPR Screen for infections, heavy metals (Wilson s) EEG MRI Cognitive testing Comprehensive, multi-modal Psychological needs Social needs Educational needs Cultural needs Family needs Physical needs
11 Page 11 Treatment of COS Now, let s get to the meds Psychopharmacology Psychotherapy: individual and family Case management Educational interventions Social skills training Inpatient/day treatment Neurological/medical services Residential treatment Rarely, ECT Antipsychotics revolutionized treatment Chlorpromazine (Thorazine) st of the Typical antipsychotics First used as an anesthetic How do antipsychotics work? Antipsychotic Use in Children Target dopaminergic neurons Increase dopamine=psychosis Dopamine blockers Atypicals also block serotonin Typical agents affect nigrostriatal tract and mesolimbic tract Nigrostriatal area also affects involuntary movements Most use in children is off label Lack adequate data in children Small sample sizes Need more controlled trials Younger patients are more sensitive to adverse effects of drugs as compared to adults Reason for EPS
12 Page 12 Antipsychotic Use in Children Start low and go slow! Continual monitoring Routine labs Baseline and serial weight, height and BMI Dietary education FDA Approval of Atypical Antipsychotics for COS Risperidone and Aripiprazole are approved for childhood schizophrenia for ages yrs. June, 2009: FDA advisory panel recommended approving Quetiapine and Olanzapine for treatment of childhood schizophrenia for ages yrs. Pre-med workups Atypical Agents Labs ECG Informed consent Newer Affect D2 and 5HT(2A) receptors Reason for increased efficacy Affects positive (D2) and negative (5HT) symptoms Don t effect nigrostriatal tract as much-less EPS Affect mesolimbic and mesocortical tracts
13 Page 13 Side Effects of Atypicals Side Effects of Atypicals Weight gain!!!!! Increased glucose, lipids, triglycerides: Metabolic Syndrome Sedation and anticholinergic symptoms Extra pyramidal symptoms: akathesia, dystonia, Parkinsonism Common reason for medication noncompliance Increased prolactin levels: gynecomastia, galactorhea Can also cause Neuroleptic Malignant Syndrome and Tardive Dyskinesia Thought to cause less EPS and less chance of Tardive Dyskinesia How do we choose an atypical? Side effect profile- make them work for patient Any absolute contraindications or medical risks Other meds: drug-drug interactions Cost!!!! Insurance Patient/family perceptions Doctor s own perceptions about meds Atypical Agents Generic Name Trade Name Daily Dosage (mg) Forms available Aripiprazole Abilify INJ, soln, tabs-d Clozapine Clozaril tabs-d Olanzapine Zyprexa 5-20 INJ, tabs-d Palipaeridone Invega 6-12 tabs Quetiapine Seroquel tabs Risperidone Risperdal 1-12 tabs-d, soln, INJ Ziprasidone Geodon tabs
14 Page 14 Risperidone (Risperdal) Olanzapine (Zyprexa) 1993 Only depot form of atypical-not used in children Depot form q 2 weeks Very sedating Excessive weight gain Metabolic syndrome Weight gain, sedation and high prolactin most common Above 6 mg daily- EPS Quetiapine (Seroquel) Aripiprazole (Abilify) Moderate for weight gain Slit lamp eye exam recommended-cataracts, not often done Very sedating Used in low doses for sleep-off label Not a full DA antagonist Dopamine stabilizer Agonist in areas of low activity More weight neutral Low incidence of metabolic syndrome
15 Page Weight gain Seizures Clozapine (Clozaril) Excessive salivation Agranulocytosis- serious, fatal Weekly biweekly WBC count Specific protocol-complex to manage Used in refractory cases: in children, only after failure of 2 other atypical antipsychotics Ziprasidone (Geodon) 2001 Short acting injectable available Can be used for acute agitation More weight neutral than other atypicals Lower incidence of metabolic syndrome Cardiac side effects In children: 1/3 those started on clozapine discontinue due to severe side effects Typical Antipsychotics Jani s at the mercy of her mind. Still use these Generally more second line in COS Recent debate that risks comparable to atypicals Much cheaper Haloperidol, chlorpromazine, perphenazine
16 Page 16 References Diagnostic and Statistical Manual of Mental Disorders, fourth edition, Text Revision, American Psychiatric Association, 2000 Physicians Desk Reference, 2008 Schizophrenia, A Clinician s Guide, 1995, American Psychiatric Press Lieberman JA, Stroup TS, McEvoy JP, et al, Effectiveness of Antipsychotic Drugs in Patients with Chronic Schizophrenia, N Engl J Med, 2005;353: NIMH, Questions and Answers about the NIMH Clinical Antipsychotic Trials of Intervention Effectiveness Study (CATIE), Wu EQ, Birnbaum HG, et al, The Economic Burden of Schizophrenia in the United States in 2002, JClinPsych, 2005, Sept;66(9): Practice Guidelines for the Treatment of Patients with Schizophrenia, Second Edition, 2002, American Psychiatric Association Practice Parameters for the Assessment and Treatment of Children and Adolescents With Schizophrenia, J.Am.Acad.ChildAdolesc.Psychiatry, 40:7 Supplement, July 2001 References Lieberman, J., Metabolic Changes Associated with Antipsychotic Use, PrimCare Companion J Clin Psychiatry 2004;6(suppl 2):8-13. Battaglia, J., Compliance with Treatment in Schizophrenia, Medscape CME. Narasimhan, M., Bailey, S.B., Schizophrenia, Metabolic Syndrome, and Antipsychotics Challenges, Controversies, and Clinical Management, Medscape CME. Childhood Schizophrenia, Child and Adolescent Psychiatry, 2nd Ed.,Lewis, M., 1996, M., White, T., Afshan, A., Schulz, C., The Schizophrenia Prodrome, Am.J.Psychiatry, 163(3): , March Shari Roan, Jani s at the mercy of her mind, Los Angeles Times, June 29, Russel, A., The Clinical Presentation of Childhood-Onset Schizophrenia, Schizophrenia Bulletin, 20(4): , References Notes Gogtay, N., Rapport, J., Childhood-Onset Schizophrenia: Insights From Neuroimaging Studies, J.Am.Acad.ChildAdolesc.Psychiatry, 47(10) , Oct Greenstein et al, Remission Status and Cortical Thickness in Childhood- Onset Schizophrenia, J.Am.Acad.ChildAdolesc.Psychiatry, 40 (10) , Oct Rapport et al, Autism Spectrum Disorder and Childhood-Onset Schizophrenia: Clinical and Biological Contribution to a Relation Revised, J. Am.Acad.ChildAdolesc.Psychiatry, 48 (1) 10-18, Jan.2009.
Schizophrenia - The Pharmacist s Role (Diagnosis, Treatment Options, and Outcomes)
Schizophrenia - The Pharmacist s Role (Diagnosis, Treatment Options, and Outcomes) Elizabeth Montagnese, M.D. Adult, Child and Adolescent Psychiatrist Private Practitioner This program has been supported
More informationSchizophrenia and Related Psychotic Disorders
and Related Psychotic Disorders Anand K. Pandurangi, MD Professor & Chair, Div. of Inpatient Psychiatry Director, Program VCU Medical Center 1 Kraeplin 1896 Dementia Praecox. Single, Homogenous Disorder
More informationSchizophrenia and schizophrenia-like disorders
Schizophrenia and schizophrenia-like disorders Dr: Weibo Liu E-mail:liuweibo1020@163.com The Second Affiliated Hospital Zhejiang University College of Medicine Category of psychotic disorders Schizophrenia
More informationChapter 12. Schizophrenia and Other Psychotic Disorders. PSY 440: Abnormal Psychology. Rick Grieve Western Kentucky University
Chapter 12 Schizophrenia and Other Psychotic Disorders PSY 440: Abnormal Psychology Rick Grieve Western Kentucky University psychotic disorders disorders so severe that the person has essentially lost
More informationSchizophrenia. Introduction. Overview and Facts
Introduction is a chronic, severe and disabling brain disease that typically shows its first clear symptoms in late adolescence or early adulthood. It is one of several types of Psychotic Disorders. It
More informationPsychotic Disorders. Schizophrenia. Age Distribution of Onset 2/24/2009. Schizophrenia. Hallmark trait is psychosis
Psychotic Disorders Schizophrenia Schizophrenia Affects people from all walks of life Is about as prevalent as epilepsy Usually begins in late adolescence or early adulthood Hallmark trait is psychosis
More informationObjectives. Epidemiology. Diagnosis 3/27/2013. Identify positive and negative symptoms used for diagnosis of schizophrenia
Objectives Identify positive and negative symptoms used for diagnosis of schizophrenia Mohamed Sallout, Pharm D. Pharmacist Resident St. Luke s Magic Valley Regional Medical Center List medications used
More informationEARLY ONSET SCHIZOPHRENIA
Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences EARLY ONSET SCHIZOPHRENIA JON MCCLELLAN CHILD STUDY AND TREATMENT CENTER GENERAL DISCLOSURES The University of Washington
More informationSchizophrenia FAHAD ALOSAIMI
Schizophrenia FAHAD ALOSAIMI MBBS, SSC - PSYCH C ONSULTATION LIAISON PSYCHIATRIST K ING SAUD UNIVERSITY Schizophrenia - It is not a single disease but a group of disorders with heterogeneous etiologies.
More informationThe psychological disorders
The psychological disorders Defining abnormal Statistical infrequency Normal distribution; the normal curve Violation of norms Culture bound syndromes Personal distress Some disorders do not involve distress
More informationPsychosis. Paula Gibbs, MD Department of Psychiatry University of Utah
Psychosis Paula Gibbs, MD Department of Psychiatry University of Utah Psychotic Symptoms Psychosis in a broad sense, signifies impaired reality testing ability Symptoms include: hallucinations, delusions,
More informationUpdate on First Psychotic Episodes in Childhood and Adolescence. Cheryl Corcoran, MD Assistant Professor of Psychiatry Columbia University
Update on First Psychotic Episodes in Childhood and Adolescence Cheryl Corcoran, MD Assistant Professor of Psychiatry Columbia University Childhood-Onset Psychosis 8% of psychiatrically referred youth
More informationCharles P. Samenow, MD, MPH Department of Psychiatry George Washington University
Charles P. Samenow, MD, MPH Department of Psychiatry George Washington University Objectives Identify the epidemiology, symptomatology, course, causality (including genetic risk) and treatment options
More informationSchizophrenia and the Psychoses
Schizophrenia and the Psychoses Taking leave of one s senses Students of schizophrenia need to study and understand: Clinical presentation via case studies Terms and Definitions Biological features Prognosis
More informationPsychosis & Antipsychotic Medications
Reality Non-reality VS. Psychosis & Antipsychotic Medications Disorganized thinking, hallucinations, delusions, bizarre behaviors What is Psychosis? Psychosis is mental disorganization to such a degree
More informationSCHIZOPHRENIA SPECTRUM DISORDERS Psychiatry 2 Practical # 2
Psychiatrická klinika LFUK a UNB, Bratislava SCHIZOPHRENIA SPECTRUM DISORDERS Psychiatry 2 Practical # 2 Author: MUDr. Ľubomíra Izáková, PhD. Supervisor: doc. MUDr. Ján Pečeňák, CSc. Podporené grantom
More informationCHAPTER 3. Schizophrenia and Antipsychotic Treatment
CHAPTER 3 Schizophrenia and Antipsychotic Treatment What is it? It is a severe, chronic, disabling brain disease Considered to have biological origins but exact unknown 1% of population affected Schizophrenia
More informationSP.236 / ESG.SP236 Exploring Pharmacology Spring 2009
MIT OpenCourseWare http://ocw.mit.edu SP.236 / ESG.SP236 Exploring Pharmacology Spring 2009 For information about citing these materials or our Terms of Use, visit: http://ocw.mit.edu/terms. Atypical (2
More informationDr. Fred Rose. Schizophrenia. Nature of Schizophrenia and Psychosis: An Overview. Prevalence of Schizophrenia 10/20/10. Schizophrenia vs.
Schizophrenia Dr. Fred Rose Nature of Schizophrenia and Psychosis: An Overview Schizophrenia vs. Psychosis Psychosis Cluster of disorders; hallucinations and/or loss of contact with reality Schizophrenia
More informationBehavioral Issues in Dementia. March 27, 2014 Dylan Wint, M.D.
Behavioral Issues in Dementia March 27, 2014 Dylan Wint, M.D. OVERVIEW Key points Depression Definitions and detection Treatment Psychosis Definitions and detection Treatment Agitation SOME KEY POINTS
More informationSchizophrenia. Psychology 372 Physiological Psychology. Overview. Characterized by. Disorganized Thoughts Hallucinations Delusions Bizarre behaviors
Overview Schizophrenia Psychology 372 Physiological Psychology Steven E. Meier, Ph.D. Listen to the audio lecture while viewing these slides Probably consists of more than one disorder Is the most devastating
More informationENTITLEMENT ELIGIBILITY GUIDELINE SCHIZOPHRENIA
Entitlement Eligibility Guideline SCHIZOPHRENIA Page 1 of 8 ENTITLEMENT ELIGIBILITY GUIDELINE SCHIZOPHRENIA MPC 00607 ICD-9 295 ICD-10 F20 DEFINITION SCHIZOPHRENIA Characteristic symptoms of Schizophrenia
More informationThe alternate reality of schizophrenia
The alternate reality of schizophrenia MICHAEL TRINSEY SCHIZOPHRENIA IS A GROUP of chronic, disabling psychiatric disorders characterized by disturbed thinking and disorganized speech. Patients with schizophrenia
More informationSchizophrenia Pharmacology UNIVERSITY OF HAWAI I HILO PRE -NURSING PROGRAM
Schizophrenia Pharmacology UNIVERSITY OF HAWAI I HILO PRE -NURSING PROGRAM NURS 203 GENERAL PHARMACOLOGY DANITA NARCISO PHARM D Learning Objectives Understand the result of dopamine binding to D2 receptors
More informationGoal: To recognize and differentiate different forms of psychopathology that involve disordered thinking and reasoning and distorted perception
Goal: To recognize and differentiate different forms of psychopathology that involve disordered thinking and reasoning and distorted perception Psychotic disorders, or psychoses, are among the most serious
More informationMajor Depressive Disorder: Diagnosis, Treatment & Impact on Rural Communities
Page 1 Major Depressive Disorder: Diagnosis, Treatment & Impact on Rural Communities Elizabeth Montagnese, M.D. Adult, Child and Adolescent Psychiatrist This program has been supported by an educational
More informationPsychotic disorders Dr. Sarah DeLeon, MD PGYIV, Psychiatry ConceptsInPsychiatry.com
Psychotic disorders Dr. Sarah DeLeon, MD PGYIV, Psychiatry ConceptsInPsychiatry.com Introduction Psychotic spectrum disorders include schizotypal personality disorder, delusional disorder, brief psychotic
More informationAntipsychotic Medication
Antipsychotic Medication Mary Knutson, RN 3-7-12 Mosby items and derived items 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 1 Clinical Uses of Antipsychotics Short-term: in severe depression and
More information9/3/2014. Contemporary Psychiatric-Mental Health Nursing Third Edition. Features of Schizophrenia. Features of Schizophrenia (cont'd)
Contemporary Psychiatric-Mental Health Nursing Third Edition CHAPTER 16 Schizophrenia Features of Schizophrenia Prevalence in U.S. is 1.1%. Average onset is late teens to early twenties, but can be as
More information25 Things To Know. disorders
Biological Psych 25 Things To Know Schizo phrenia disorders Schizophrenia Psychotic disorders The Schizophrenias 1% incidence More likely in US & Europe 10 to 100 times Schizophrenia Demographic Data Slightly
More informationBiological Psych Schizophrenia
Biological Psych Schizophrenia Psychotic disorders The Schizophrenias 1% incidence More likely in US & Europe 10 to 100 times Slightly more common in men Earlier onset, more severe Originally: dementia
More informationSchizophrenia and Other Psychotic Disorders
Schizophrenia and Other Psychotic Disorders Chapter 14 This multimedia product and its contents are protected under copyright law. The following are prohibited by law: any public performance or display,
More informationIs Lurasidone more safe and effective in the treatment ofschizoaffective disorder and schizophrenia than other commonanti-psychotic medications?
Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 2015 Is Lurasidone more safe and effective
More informationSchizophrenia. Psychotic Disorders. Schizophrenia. Chapter 13
Schizophrenia Chapter 13 Psychotic Disorders Symptoms Alternations in perceptions, thoughts, or consciousness (delusions and hallucination) DSM-IV categories Schizophrenia Schizophreniform disorder Schizoaffective
More informationChapter 12 1/29/2018. Schizophrenia and Schizophrenia Spectrum Disorders. Epidemiology. Comorbidity. Lifetime prevalence of schizophrenia is 1%
Chapter 12 Schizophrenia and Schizophrenia Spectrum Disorders Epidemiology Lifetime prevalence of schizophrenia is 1% No difference related to 2 Comorbidity Substance abuse disorders Anxiety, depression,
More informationSCHIZOPHRENIA AN OVERVIEW
SCHIZOPHRENIA AN OVERVIEW Compiled by Campbell M Gold (2004) CMG Archives http://campbellmgold.com IMPORTANT The health information contained herein is not meant as a substitute for advice from your physician,
More information8/22/2016. Contemporary Psychiatric-Mental Health Nursing Third Edition. Features of Schizophrenia. Features of Schizophrenia (cont'd)
Contemporary Psychiatric-Mental Health Nursing Third Edition CHAPTER 16 Schizophrenia Features of Schizophrenia Prevalence in U.S. is 1.1%. Average onset is late teens to early twenties, but can be as
More informationContemporary Psychiatric-Mental Health Nursing. Features of Schizophrenia. Features of Schizophrenia - continued
Contemporary Psychiatric-Mental Health Nursing Chapter 16 Schizophrenia and Other Psychotic Disorders Features of Schizophrenia Prevalence in U.S. is 1.1%. Average onset is late teens to early twenties,
More informationAntidepressants. Dr Malek Zihlif
Antidepressants The optimal use of antidepressant required a clear understanding of their mechanism of action, pharmacokinetics, potential drug interaction and the deferential diagnosis of psychiatric
More informationSchizophrenia. Positive Symptoms. Course of Schizophrenia. Psychotic Disorder
Schizophrenia Kimberley Clow kclow2@uwo.ca http://instruct.uwo.ca/psychology/155b/ Outline What is Schizophrenia? Positive Symptoms Negative Symptoms Subtypes Phases Development Causes Treatment What Is
More information4/12/2014. Early-Onset Schizophrenia
Early-Onset Schizophrenia 1 Overview History: Conceptualizations Past and Present DSM Model, Symptoms & Subtypes Epidemiology: Prevalence/Onset/Course/Duration Comorbidity Neurobiology Genetic Underpinnings
More informationMental Health Rotation Educational Goals & Objectives
Mental Health Rotation Educational Goals & Objectives Mental illness is prevalent in the general population and is commonly seen and treated in the office of the primary care provider. Educational experiences
More informationD. Exclusion of schizoaffective disorder and mood disorder with psychotic features.
65 CHAPTER 8: APPENDIX. ADDENDUM A DSM-IV diagnostic criteria for schizophrenia A. Characteristic symptoms: Two or more of the following, each present for a significant portion of time during a one-month
More informationPromoting and Monitoring Evidenced-Based Antipsychotic Prescribing Practices in Children and Adolescents: Florida Medicaid Initiatives
Promoting and Monitoring Evidenced-Based Antipsychotic Prescribing Practices in Children and Adolescents: Florida Medicaid Initiatives Mary Elizabeth Jones, Pharm BSc, RPh Senior Pharmacist AHCA Pharmacy
More informationAutism. Childhood Autism and Schizophrenia. Autism, Part 1 Diagnostic Criteria (DSM-IV-TR) Behavioral Characteristics of Autism
Autism Childhood Autism and Dr. K. A. Korb University of Jos Autism comes from the Latin within oneself Autism: Severe developmental disorder characterized by abnormalities in: Social functioning Language
More informationAntipsychotic Use in the Elderly
Antipsychotic Use in the Elderly Presented by: Fatima M. Ali, PharmD, RPh, BCPS Clinical Consultant Pharmacist MediSystem Pharmacy, Kingston Originally Prepared by: Nicole Tisi BScPhm, RPh ACPR Disclosure
More informationChapter 17. Psychoses. Classifications of Psychoses. Schizophrenia. Factors Attributed to Development of Psychoses
Chapter 17 Psychoses Drugs for Psychoses Delusions Hallucinations Illusions Paranoia Upper Saddle River, New Jersey 07458 All rights reserved. Classifications of Psychoses Acute episode Chronic episode
More informationNational Center for Mental Health
National Center for Mental Health 9 de Febrero St., Mandaluyong City Telephone No.: 531-9001 (c/o Dr. Vinluan) Organizational Structure Medical Center Chief II Chief, Medical and Professional Staff (Hospital
More information3/9/2017. A module within the 8 hour Responding to Crisis Course. Our purpose
A module within the 8 hour Responding to Crisis Course Our purpose 1 What is mental Illness Definition of Mental Illness A syndrome characterized by clinically significant disturbance in an individual
More informationRole of Clozapine in Treatment-Resistant Schizophrenia
Disease Management and Treatment Strategies Elkis H, Meltzer HY (eds): Therapy-Resistant Schizophrenia. Adv Biol Psychiatry. Basel, Karger, 2010, vol 26, pp 114 128 Role of Clozapine in Treatment-Resistant
More informationSCHIZOPHRENIA AND PSYCHOSIS MODULE III RNSG 2213
SCHIZOPHRENIA AND PSYCHOSIS MODULE III RNSG 2213 SCHIZOPHRENIA: OVERVIEW Major Axis I disorder Characterized by disturbances in: Perception Thought processes and reality testing Affect (feelings) Behavior
More informationStudy Guide Unit 3 Psych 2022, Fall 2003
Psychological Disorders: General Study Guide Unit 3 Psych 2022, Fall 2003 1. What are psychological disorders? 2. What was the main treatment for some psychological disorders prior to the 1950 s? 3. What
More informationSchizophrenia & Psychotic Disorders
Schizophrenia & Psychotic Disorders The Misunderstood Disorder Speak the word schizophrenia and you ll likely receive reactions ranging from misunderstanding to fear. The disorder is largely shrouded in
More informationMichael J. Bailey, M.D. OptumHealth Public Sector
Michael J. Bailey, M.D. OptumHealth Public Sector LIHP Quality Charter To ensure the quality of care delivered to enrollees in San Diego County Assistance Programs, such as County Medical Services (CMS)
More informationAnswers for Psychotic Disorder Cases Neuroscience and Behavior Block 1/29/16
Answers for Psychotic Disorder Cases Neuroscience and Behavior Block 1/29/16 1) Psychosis is a loss of reality testing, in which the patient is unable to distinguish between his or her own thoughts and
More informationPharmacotherapy of psychosis and schizophrenia in youth
Pharmacotherapy of psychosis and schizophrenia in youth Benedetto Vitiello Pavia, 2 December 2017 Disclosure Benedetto Vitiello, M.D. Professor of Child and Adolescent Neuropsychiatry University of Turin,
More informationThe routine use of Intramuscular anticholinergics and depot antipsychotics BY DR. CHANTELLE MAGRI FOUNDATION YEAR 1
The routine use of Intramuscular anticholinergics and depot antipsychotics BY DR. CHANTELLE MAGRI FOUNDATION YEAR 1 Contributors Dr. Francesca Falzon Aquilina; BST psychiatry Dr Claire Axiaq; Resident
More informationThe National Institute of Mental Health:
The National Institute of Mental Health: http://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml Schizophrenia What Is Schizophrenia? Schizophrenia is a chronic, severe, and disabling brain disorder
More informationWhat Team Members Other Than Prescribers Need To Know About Antipsychotics
What Team Members Other Than Prescribers Need To Know About Antipsychotics The Care Transitions Network National Council for Behavioral Health Montefiore Medical Center Northwell Health New York State
More informationHope FIRST: An Innovative Treatment for First Episode Psychosis PRESENTATION BY REBECCA FLATTERY, LCSW AND BRIAN ROHLOFF, LPC
Hope FIRST: An Innovative Treatment for First Episode Psychosis PRESENTATION BY REBECCA FLATTERY, LCSW AND BRIAN ROHLOFF, LPC What is a first episode of psychosis? The word psychosis is used to describe
More informationANTIPSYCHOTICS/ NEUROLEPTICS
Pharmacological Interventions Tutorial Antipsychotic medications First Generation (Typicals) Includes phenothiazines, thioxanthenes, butyrophenones ANTIPSYCHOTICS/ NEUROLEPTICS Second Generation (Atypicals)
More informationKelly E. Williams, Pharm.D. PGY2 Psychiatric Pharmacy Resident April 16,2009
Kelly E. Williams, Pharm.D. PGY2 Psychiatric Pharmacy Resident April 16,2009 List the antipsychotics most often prescribed Compare and contrast the use and adverse effects experienced in the pediatric
More informationAPPROACH TO PSYCHOSIS IN PRIMARY CARE
APPROACH TO PSYCHOSIS IN PRIMARY CARE Family Medicine Forum 2015 Annual Meeting Toronto, Ontario November 12-14, 2015 Jon Davine, MD, CCFP, FRCP(C) Associate Professor, McMaster University Objectives
More information4/7/2016. Auditory Hallucinations in Youth: The Good, the Bad, and the Reassuring. Objectives. Disclosures
Auditory Hallucinations in Youth: The Good, the Bad, and the Reassuring Nick Weiss, MD April 30, 2016 Objectives Participants will learn about the prevalence and patterns of auditory hallucinations in
More informationDisclosure. Speaker Bureaus. Grant Support. Pfizer Forest Norvartis. Pan American Health Organization/WHO NIA HRSA
Disclosure Speaker Bureaus Pfizer Forest Norvartis Grant Support Pan American Health Organization/WHO NIA HRSA How Common is Psychosis in Alzheimer s Disease? Review of 55 studies 41% of those with Alzheimer
More informationMENTAL HEALTH DISEASE CLASSIFICATIONS
MENTAL HEALTH DISEASE CLASSIFICATIONS DIAGNOSIS OF MENTAL DISORDERS DSM-IV-TR Published by APA ( 2000 ) Multiaxial system 5 categories called axes Facilitate holistic assessment for care Is a great resource
More informationPSY/NEU338: Animal learning and decision making: Psychological, computational and neural perspectives
Too much dopamine can be bad for you: 1I. Latent inhibition and schizophrenia PSY/NEU338: Animal learning and decision making: Psychological, computational and neural perspectives thanks to Ina Weiner
More informationSchizophrenia: A Lifelong Illness
Schizophrenia: A Lifelong Illness Medical Director Brain Health Exeter, NH Objectives Appreciate the historical perspectives of schizophrenia Describe our current understanding of the etiology of schizophrenia
More informationPsychosis and Agitation in Dementia
Psychosis and Agitation in Dementia Dilip V. Jeste, MD Estelle & Edgar Levi Chair in Aging, Director, Stein Institute for Research on Aging, Distinguished Professor of Psychiatry & Neurosciences, University
More informationSCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDERS
1 SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDERS OBJECTIVES 2 Know and understand: How to evaluate a person with psychotic symptoms The epidemiology and clinical characteristics of lateonset schizophrenia
More informationAntipsychotics. Neuroleptics/ Major Tranquilizers. Hiwa K. Saaed, PhD Pharmacology & Toxicology /5/18 1
Antipsychotics Neuroleptics/ Major Tranquilizers Hiwa K. Saaed, PhD Pharmacology & Toxicology hiwa.saaed@univsul.edu.iq 2018-2019 12/5/18 1 Learning objectives Pharmacy students should: be familiar with
More informationPharmacy Medical Necessity Guidelines: Antipsychotic Medications
Pharmacy Medical Necessity Guidelines: Antipsychotic Medications Effective: July. 1, 2016 Prior Authorization Required Type of Review Care Management Not Covered Type of Review Clinical Review Pharmacy
More informationFamily Medicine Forum November 10, 2017 Montreal. Quebec. Jon Davine, CCFP, FRCP(C) McMaster University
APPROACH TO PSYCHOSIS IN PRIMARY CARE Family Medicine Forum November 10, 2017 Montreal. Quebec. Jon Davine, CCFP, FRCP(C) McMaster University DISCLOSURE Speaker/Presenter Disclosure Not applicable Disclosure
More informationDEMENTIA and BPSD in PARKINSON'S DISEASE. DR. T. JOHNSON. NOVEMBER 2017.
DEMENTIA and BPSD in PARKINSON'S DISEASE. DR. T. JOHNSON. NOVEMBER 2017. Introduction. Parkinson's disease (PD) has been considered largely as a motor disorder. It has been increasingly recognized that
More informationChoosing Wisely Psychiatry s Top Priorities for Appropriate Primary Care
Choosing Wisely Psychiatry s Top Priorities for Appropriate Primary Care JASON BEAMAN D.O., M.S., FAPA ASSISTANT CLINICAL PROFESSOR CHAIR, DEPARTMENT OF PSYCHIATRY AND BEHAVIORAL SCIENCES OKLAHOMA STATE
More informationPsychotic Disorders in Children and Adolescents
Psychotic Disorders in Children and Adolescents Dr. Marcelo Rodriguez-Chevres, M.D. Emergence Health Network Learning Objectives Audience will be able to: 1. Distinguish developmentally normal experiences
More informationSlide 1. Slide 2. Slide 3. About this module. About this module. Antipsychotics: The Essentials Module 5 A Primer on Selected Antipsychotics
Slide 1 Antipsychotics: The Essentials Module 5 A Primer on Selected Antipsychotics Flavio Guzmán, MD Slide 2 About this module 13 antipsychotics will be studied 3 first generation antipsychotics 10 second
More informationChapter 161 Antipsychotics
Chapter 161 Antipsychotics Episode Overview Extrapyramidal syndromes are a common complication of antipsychotic medications. First line treatment is benztropine or diphenhydramine. Lorazepam is used in
More informationConfronting Adolescent Bipolar Disorder
Page 1 Confronting Adolescent Bipolar Disorder Confronting Adolescent Bipolar Disorder Elizabeth Montagnese, M.D. Adult, Child and Adolescent Psychiatrist Quittie Glen Center for Mental Health Annville,
More informationConfronting Adolescent Bipolar Disorder
Confronting Adolescent Bipolar Disorder Elizabeth Montagnese, M.D. Adult, Child and Adolescent Psychiatrist Quittie Glen Center for Mental Health Annville, Pennsylvania This program has been supported
More informationAntipsychotic Medications
TRAIL: Team Review of EVIDENCE REVIEW & RECOMMENDATIONS FOR LTC Behavioural and psychological symptoms of dementia (BPSD) refer to the non-cognitive symptoms of disturbed perception, thought content, mood
More informationIn 2020 mental and substance use disorders will surpass all physical diseases as a major cause of disability worldwide
1 In 2020 mental and substance use disorders will surpass all physical diseases as a major cause of disability worldwide 2 Incidence of Mental Illness 10-25% of general population 6% experience serious
More informationClass Update: Oral Antipsychotics
Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35 Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119
More informationFinal Exam PSYC2022. Fall (1 point) True or False. The DSM-IV describes the symptoms of acute intoxication with cannabis.
Final Exam PSYC2022 Fall 1998 (2 points) Give 2 reasons why it is important for psychological disorders to be accurately diagnosed. (1 point) True or False. The DSM-IV describes the symptoms of acute intoxication
More informationFirst Steps: Considering Clozapine for your Patients
First Steps: Considering Clozapine for your Patients The Care Transitions Network National Council for Behavioral Health Montefiore Medical Center Northwell Health New York State Office of Mental Health
More informationSchizophrenia and other psychotic disorders
Schizophrenia and other psychotic disorders Psychosis, schizophrenia What does psychosis mean? What does schizophrenia mean? Is there any difference between them? Psychosis, schizophrenia Psychosis: -
More informationTreat mood, cognition, and behavioral disturbances associated with psychological disorders. Most are not used recreationally or abused
Psychiatric Drugs Psychiatric Drugs Treat mood, cognition, and behavioral disturbances associated with psychological disorders Psychotropic in nature Most are not used recreationally or abused Benzodiazepines
More informationPositive and Negative Symptoms of Psychosis The Care Transitions Network
Positive and Negative Symptoms of Psychosis The Care Transitions Network National Council for Behavioral Health Montefiore Medical Center Northwell Health New York State Office of Mental Health Netsmart
More informationTable of Contents. 1.0 Policy Statement...1
Division of Medical Assistance General Clinical Policy No. A-6 Table of Contents 1.0 Policy Statement...1 2.0 Policy Guidelines...1 2.1 Eligible Recipients...1 2.1.1 General Provisions...1 2.1.2 EPSDT
More informationFirst-Generation Versus Second-Generation Antipsychotics in Adults: Comparative Effectiveness
1 First-Generation Versus Second-Generation Antipsychotics in Adults: Comparative Effectiveness This continuing education monograph examines the results of a comparative effectiveness review to compare
More informationAbnormal Psychology Notes
Abnormal Psychology Notes Abnormal Behaviors Psychological Disorder a harmful dysfunction in which behavior is judged to be: atypical not enough in itself disturbing varies with time/culture maladaptive
More informationBy Jason H. King DECONSTRUCTING THE DSM-5 ASSESSMENT AND DIAGNOSIS OF SCHIZOPHRENIA SPECTRUM DISORDERS THE NEW LANDSCAPE
DECONSTRUCTING THE DSM-5 By Jason H. King ASSESSMENT AND DIAGNOSIS OF SCHIZOPHRENIA SPECTRUM DISORDERS Happy New Year as you engage in your counseling, research, supervision or educational endeavors. I
More informationPharmacy Medical Necessity Guidelines: Atypical Antipsychotic Medications. Effective: February 20, 2017
Pharmacy Medical Necessity Guidelines: Effective: February 20, 2017 Prior Authorization Required Type of Review Care Management Not Covered Type of Review Clinical Review Pharmacy (RX) or Medical (MED)
More informationErotomanic type- central theme of the delusion is that another person is in love with the individual. Grandiose type- central theme of the delusion
A. Presence of one or more non-bizarre delusions that persist for at least one month B. Diagnosis of Delusional Disorder is not given if person has had symptom presentation that met criterion A for Schizophrenia
More informationAntipsychotics Prior Authorization Criteria for Louisiana Fee for Service and MCO Medicaid Recipients
Antipsychotics Prior Authorization Criteria for Louisiana Fee for Service and MCO Medicaid Recipients Preferred Agents (Oral) a Amitriptyline/Perphenazine (Generic) Aripiprazole Tablet (Generic) b Chlorpromazine
More informationCognitive Symptoms of Schizophrenia
Cognitive Symptoms of Schizophrenia In other information sheets we have discussed the two major types of symptoms traditionally thought to characterise schizophrenia: first of all the positive symptoms
More informationSchizophrenia. Nikita Verma 2017 Page 1
Schizophrenia It is a severe psychiatric disorder with symptoms of emotional instability, detachment from reality and withdrawal into self. It is an umbrella term used to outline a range of different psychiatric
More informationPSYCHIATRIC DRUGS. Mr. D.Raju, M.pharm, Lecturer
PSYCHIATRIC DRUGS Mr. D.Raju, M.pharm, Lecturer PSYCHIATRIC DRUGS Treat mood, cognition, and behavioral disturbances associated with psychological disorders Psychotropic in nature Most are not used recreationally
More informationTreat Schizophrenia Schizoaffective disorder Bipolar disorder Psychotic depression Off-label uses Insomnia Tics Delirium Stuttering
Robert M. Millay RN MSN Ed Professor, Napa Valley College Psychiatric Technician Programs Copyright 2015, 2011, 2007, 2003, 1999, 1995, 1991 by Mosby, an imprint of Elsevier Inc. Treat Schizophrenia Schizoaffective
More informationSiGMA/ MMHSCT GUIDELINES FOR ANTIPSYCHOTIC DRUG TREATMENT OF SCHIZOPHRENIA. [compatible with NICE guidance]
SiGMA/ MMHSCT GUIDELINES FOR ANTIPSYCHOTIC DRUG TREATMENT OF SCHIZOPHRENIA [compatible with NICE guidance] Medicines Management Committee August 2002 For review August 2003 Rationale The SiGMA algorithm
More information