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Neuro Symposia > Aetiology and biological treatment of psychosis > Flashcards

Aetiology and biological treatment of psychosis Flashcards

1
Q

Genetics

A

Relatives of affected subjects have increased risk of psychosis

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2
Q

Environmental/ biological stress

A

Obstetric complications increase risk

  • premature birth
  • low birth weight
  • perinatal hypoxia

Intrauterine infection

Antepartum bleeding

Immune activation

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3
Q

Macro neurodevelopmental abnormalities reported in schizophrenia

A

Ventricular enlargement

Widening cortical sulci

Cortical grey matter loss

Loss of asymmetry

Decreased limbic structure and thalamic volume

Progressive deficits in some

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4
Q

Micro neurodevelopmental abnormalities reported in schizophrenia

A

Cortical glial loss

Increased neurone density

Aberrant neurone migration

Synaptic loss

Decreased dendritic complexity

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5
Q

Neuropsychology abnormalities: deficits

A

Attention

Arousal

Working memory

Executive function

Eye movement

Social cognition

Theory of mind

Loss of functional asymmetry

Receptive language function

Subtle motor function

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6
Q

Drugs associated with psychosis influence

A

L-Dopa

Amphetamines

LSD

Cannabis

Cocaine

Ketamine

MDMA

PCP

Other novel psychoactives

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7
Q

Affective psychosis

A

Bipolar disorder

Depressive psychosis

Schizoaffective disorder

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8
Q

Organic psychosis

A

Epilepsy

Infections

Cerebral trauma

Cerebrovascular disease

Demyelination

Neurodevelopmental disorders

Endocrine

Metabolic

Immunological

Drugs

Toxins

Dementias

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9
Q

Differential diagnosis of psychosis

A

Affective psychosis

Organic psychosis

Personality disorder§

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10
Q

Physical treatments

A

Drugs

  • clozapine has greatest efficacy in resistant cases
  • treatment benefit usually clinically evident by 2 weeks
  • side effects predicted by receptor affinity for drug
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11
Q

D2 receptor adverse effect

A

Dopamine

Parkinsoism

Tardive dyskinesia

Raised prolactin

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12
Q

5-HT2 receptor adverse effect

A

Serotonin

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13
Q

Alpha-1 receptor adverse effect

A

Norepinephrine

Postural hypotension

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14
Q

H1 receptor adverse effect

A

Histamine

Sedation

Weight gain

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15
Q

M1 receptor adverse effect

A

Cholinergic

Antagonism

  • constipation
  • urinary retention
  • blurred vision
  • confusion

Agonism
- saliva overproduction

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16
Q

Typical antipsychotics

A

Haloperidol

Chlorpromazine

17
Q

Atypical antipsychotics

A

Amisulpride

Aripiprazole

Clozapine

Risperidone

Olanzapine

Quetiapine

Lurasidone

18
Q

Long acting injections

A

Depixol

Clopixol

Piportil

Paloperidone

Aripiprazole

19
Q

Typical antipsychotic side effects

A

Sedation

Extrapyramidal symptoms

Cardiac (hypotenesion, arrhythmias)

Temperature dysregulation

Neuroepileptic malignant syndrome

Anticholinergic side effects

Weight gain

Raised prolactin

20
Q

Extrapyramidal symptoms

A

Parkinsonian symptoms

Dystonia

Akathisia

Tardive dyskinesia

21
Q

Atypical antipsychotic side effects

A

Sedation

Metabolic (weight gain, glucose intolerance, increase triglycerides)

Raised prolactin (galatorrhoea, decrease sexual function, osteoporosis)

Cardiac (hypotension, arrhythmias)

Neutropaenia with clozapine

22
Q

NICE guidelines for antipsychotic use

A

Joint choice of drug with patient/ carer/ Dr

use clozapine if no response to 2 others

Long acting injections useful in those who prefer, or help to convert non adherence

Develop advance directives

Avoid high dose or prescription of two antipsychotics together

23
Q

Clozapine

A

Oral medication taken daily

Licensed with regular neutrophil monitoring

Neutropaenia in approx 1% of cases

Slow titration to optimal dose with monitoring of pulse, BP and neutrophil count necessary

Little parkinsonian effects or tardive dyskinesia

Sedation, weight gain, dribbling common

24
Q

Electroconvulsive treatment

A

Not a primary treatment of psychosis

Very effective in psychosis associated with depression or with catatonia

25
Q

Metabolic syndrome

A

Exacerbated by atypical antipsychotic drugs

Appears more prevalent in schizophrenia pre treatment than general population

Associated with higher rates of CHD, cerebrovascular pathology and earlier death

Neuro Symposia (10 decks)

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