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September 7, 2010



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Appropriate and Safe Dosing of
Atypical Antipsychotics


Published: November 1, 2002
ACPE Lesson Expires: November 1, 2005



Provided through an unrestricted educational grant from


 


 

TABLE 1. SYMPTOM DESCRIPTIONS RELATED TO SCHIZOPHRENIA
POSITIVE NEGATIVE COGNITIVE
Hallucinations
Auditory hallucinations are the most common, followed by visual hallucinations

Delusions
Usually due to distorted reasoning or misinterpretations  

Grossly disorganized behaviors
Distinguished from delusional behaviors by their apparent purposelessness

Disorganized speech/thinking
(loosening of associations)
Effective communication is impaired

Catatonic behaviors
Includes aimless excess motor activity, in addition to motionlessness

Depersonalization
Relates to person's sense of self

Derealization
Relates to person's sense of their
surroundings

Apathy
(affective flattening)

Relative to the individual patient's normal range/intensity of emotional expression

Alogia
(poverty of speech)
Thought to reflect a slowed or blocked
thinking process

Avolition
(lack of drive or initiative)
Relative to the individual patient's normal
ability to initiate and persist in goal-directed behavior
 

Anhedonia
(lack of pleasure)

Impaired attention/vigilance
(for executive functioning)

Impaired memory
Working memory deficit could explain impaired attention and positive symptom of
disorganized speech/thinking
Verbal memory

Impaired verbal fluency
Inability to produce spontaneous speech

Impaired abstract thinking

Impaired visual processing

Neologisms
(meaningless words)

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TABLE 2. EFFECT OF ATYPICALS ON COGNITIVE SYMPTOMS
OF SCHIZOPHRENIA*18
Cognitive Symptoms Clozapine Risperidone Olanzapine Quetiapine
Attention
Verbal fluency
Executive functioning
Working memory
Verbal learning/memory
Visual learning/memory
         

* Further evaluation of ziprasidone is needed in order to assess its effect on cognitive symptoms.
Key: improves, no change.

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FIGURE 1. Dopamine pathways (modified from Stahl, 1999).13

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A total of 54% (20 of 37) and 41% (15 of 37) of patients treated with clozapine and olanzapine, respectively, were reported to have treatment-emergent hyperglycemia, type II diabetes, or diabetic ketoacidosis, while all other available atypical antipsychotics comprised the remaining 5% of published case reports.
 
FIGURE 2. Incidence of treatment-emergent metabolic disturbances by antipsychotics.

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