Schizophrenia Spectrum and Other Psychotic Disorders; Medication-Induced Movement Disorders

Two groups of symptoms found with schizophrenia spectrum and related psychotic disorders are “positive” and “negative” symptoms. Positive symptoms generally “add” and include things such as delusions, hallucinations, and repetitive movements. Negative symptoms generally “detract” and may include difficulty showing emotions, withdraw from social relationships, or apathy.

While many disorders result in the development of “positive” symptoms, not all of these conditions represent schizophrenia. When treating schizophrenia spectrum and other psychotic disorders, place emphasis not only on treating the positive symptoms but the negative and residual symptoms as well.

Medication-induced movement disorders, one example of which is tremors, can stem from both recreational and therapeutic drugs, with dopamine receptor blocking drugs, such as antipsychotic and antiemetics, being common causes. These types of disorders can range from subtle to lethal.

This week, you will explore a wide variety of disorders along the schizophrenia spectrum as well as medication-induced movement disorders.

Students will:

Assess patients with schizophrenia, other psychotic, and medication-induced movement disorders
Develop differential diagnoses for patients with schizophrenia, other psychotic, and medication-induced movement disorders
Develop appropriate treatment plans for patients with schizophrenia, other psychotic, and medication-induced movement disorders
Advocate health promotion and patient education strategies for patients with schizophrenia, other psychotic, and medication-induced movement disorders.

Learning Resources

Required Readings (click to expand/reduce)

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer. (For review as needed)

• Chapter 7, “Schizophrenia Spectrum and Other Psychotic Disorders”
• Chapter 29.2, “Medication-Induced Movement Disorders”
• Chapter 29.3, “α₂-Adrenergic Receptor Agonists, α₁-Adrenergic Receptor Antagonists: Clonidine, Guanfacine, Prazosin, and Yohimbine”

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (Eds.). (2015). Rutter’s child and adolescent psychiatry (6th ed.). Wiley Blackwell.  

• Chapter 43, “Pharmacological, Medically-Led and Related Disorders”
• Chapter 57, “Schizophrenia and Psychosis”

Zakhari, R. (2021). The psychiatric-mental health nurse practitioner certification review manual. Springer Publishing Company.

• Chapter 9, “Psychotic Disorders and Delusions”

Document: Focused SOAP Note TemplateDocument: Focused SOAP Note ExemplarRequired Media (click to expand/reduce)PsychScene Hub. (2017, April 24). Movement disorders with antipsychotic medication – Conversations with Dr. Stephen Stahl [Video]. YouTube. https://www.youtube.com/watch?v=ipW5AcbFzzEVallejo, E. (2020). Realistic schizophrenia simulation [Video]. YouTube. https://www.youtube.com/watch?v=63lHuGMbscU

Walden University. (2021). Case study: Sherman Tremaine. Walden University Blackboard. https://class.waldenu.eduAccessible player –Downloads–Download Video w/CCDownload AudioDownload Transcript

Medication Review

Review the FDA-approved use of the following medicines related to treating schizophrenia-spectrum and other psychotic disorders:

Psychosis	Schizoaffective disorder
alprazolam (adjunct) amisulpride aripiprazole asenapine blonanserin carbamazepine (adjunct) chlorpromazine clonazepam (adjunct) clozapine cyamemazine flupenthixol fluphenazine haloperidol iloperidone lamotrigine (adjunct) lorazepam (adjunct) loxapine lurasidone	mesoridazine molindone olanzapine paliperidone perospirone perphenazine pimozide pipothiazine quetiapine risperidone sertindole sulpiride thioridazine thiothixene trifluoperazine valproate (divalproex) (adjunct) ziprasidone zotepine zuclopenthixol	amisulpride aripiprazole asenapine carbamazepine (adjunct) chlorpromazine clozapine cyamemazine flupenthixol haloperidol iloperidone lamotrigine (adjunct) l-methylfolate (adjunct) loxapine lurasidone mesoridazine molindone olanzapine paliperidone	perospirone perphenazine pipothiazine quetiapine risperidone sertindole sulpiride thioridazine thiothixene trifluoperazine valproate (divalproex) (adjunct) ziprasidone zotepine zuclopenthixol

Schizophrenia	Cataplexy syndrome	Catatonia	Extrapyramidal side effects
amisulpride aripiprazole asenapine carbamazepine (adjunct) chlorpromazine clozapine cyamemazine flupenthixol haloperidol iloperidone lamotrigine (adjunct) l-methylfolate (adjunct) loxapine lurasidone mesoridazine molindone olanzapine paliperidone perospirone	perphenazine pipothiazine quetiapine risperidone sertindole sulpiride thioridazine thiothixene trifluoperazine valproate (divalproex) (adjunct) ziprasidone zotepine zuclopenthixol Seasonal affective disorder bupropion Sedation-induction hydroxyzine midazolam	clomipramine imipramine sodium oxybate	alprazolam chlordiazepoxide clonazepam clorazepate diazepam estazolam flunitrazepam flurazepam loflazepate lorazepam midazolam oxazepam quazepam temazepam triazolam