8 - Clinical Management of SZ Flashcards
how does substance misuse relate to SZ?
(except tobacco)
- have great chance of persistant low grade psychotic symptoms
- have worse outcomes in every respect
how does cannabis use relate to SZ?
- moderae use lfrom 18 doubles risk os SZ
- high use from age 15 increases risk by x10
how does the global function of SZ pts differ from non SZ peers?
- gradual decline in global function
- slower development - walking, talking, potty training
when is the most common onset of SZ?
20-25
what is the ratio of male:female for SZ?
2:1
when is the 2nd peak of SZ?
40-50s
what is the correlation between severity of psychosis at presentation and age & sex?
no correlation
what is the correlation between negative symptom severity at presentation and age & sex?
- more severe at a younger age
- men are worse than women
what is the correlation between disorganisation severity at presentation and age & sex?
- less severe in older pts
- no difference in men and women
how does commencement of treatment correlate to response to treatment?
- longer that pt is ill with no treatment, the harder the symptoms are to treat
- not linear
- most profound in the first year
what % of SZ pts commit suicide?
- almost 1% per year initially
- eventually 4-6%
what is the mechanism of action of all antipsychotic drugs?
D2 receptor antagonists
what is the optimum % occupancy of D2 for antipsychotic effects?
- > 60% occupancy in associative striatum has antipsychotic effect
- > 75% occupancy causes motor SE & hyperprolactinaemia
what other medication can SZ pts be given for agitation?
benzodiazepines
what other medication can SZ pts be given for motor side effects?
- anticholinergics - parkinsonisms
- propranolol - akathisia
which type of symptom is least effected by antipsychotic medication?
negative symptoms
when is clozapine prescribed?
when two or more first line antipsychotics have been used and failed to adequately control symptoms
clozapine reduces symptoms by what %?
30-50%
clozapine is used for what ype of SZ?
Treatment resistant SZ
what is the issue with clozapine if it is so effective?
it has lots of side effects
