What are the two main symptoms of paranoid schizophrenia?
- Persecutory Delusions
* Auditory Hallucinations
At least one of which symptoms must be present for a month in a paranoid schizophrenic?
At least one present most of the time for a month
• Thought echo - A form of auditory hallucination, associated with schizophrenia, in which the patient hears his/herthoughtsspoken aloud
• Thought insertion or withdrawal - the idea that another thinks through the mind of the person
• Thought broadcast - thought broadcastingis the belief that others can hear or are aware of an individual’sthoughts
• Delusions of control referred to body parts, actions, or sensations
• Delusional perception
• Hallucinatory voices giving a running commentary, discussing the patient, or coming from some part of the patient’s body
Persistent bizarre or culturally inappropriate delusions
At least two of which symptoms must be present for a month in a paranoid schizophrenic?
- Persistent daily hallucinations accompanied by delusions
- Incoherent or irrelevant speech
- Catatonic behaviour such as stupor or posturing
- Negative symptoms such as marked apathy, blunted or incongruous mood
How are anti-psychotic drugs prescribed?
- As per BNF
- Baseline tests – weight, waist size,BP, pulse, bloods ( Glucose / HbA1C, Prolactin, Lipids), ? ECG
- Start low dose and titrate up
- Trial at optimal dose 4-6 weeks ( or less time if no response at all)
- Usually use single antipsychotic
How is anti-psychotic treatment monitored?
- Response to treatment
- Side effects
- EPSE
- Weight, Waist, Pulse and BP
- Fasting blood glucose, HbA1c and blood lipid levels at 12 weeks, at 1 year and then annually
- Adherence
What are the side effects of Haloperidrol?
- Extrapyramidal side effects seen in approx. 20% of typical antipsychotics
- Tremor
- Bradykinesia
- Rigidity
- Up to 10% can develop acute dystonia ( oculogyric crisis, Torticollis)
What factors should you consider when choosing an antipsychotic?
- Involve patient / carer
- Metabolic (including weight gain and diabetes)
- Extrapyramidal (including akathisia, dyskinesia and dystonia)
- Cardiovascular (including prolonging the QT interval)
- Hormonal (including increasing plasma prolactin)
- Other (including unpleasant subjective experiences)
What could cause ‘none’ response?
- Review diagnosis.
- Establish adherence to antipsychotic medication
- ? adequate dose
- ? correct duration.
- Switch antipsychotic
- Trial Clozapine if no response to 2 different antipsychotic drugs
When would you consider drug treatment for depression?
- Anticipated adverse events – for example, side effects and discontinuation symptoms
- Person’s perception of the efficacy and tolerability of any antidepressants they have previously taken.
- Potential interactions
- Normally choose an SSRI.
- Take into account toxicity in overdose for people at risk
- The greatest risk in overdose is with TCAs, except for lofepramine.
- SSRIs have least side effects
- Consider potential interactions eg NSAIDS and SSRIs
What has to be done when stopping or reducing medication?
- Antipsychotic
- Risk of relapse if discontinued within 2 years
- Antidepressant
- Discontinuation symptoms may occur on stopping
- Normally, gradually reduce the dose over 4 weeks
- Advise to continue 6 months after remission
- Or for at least 2 years if recurrent depression or high risks
What are some impacts of a psychotic illness?
- Education
- Finances
- Health
- Relationships
- Social contact
- Work
- Confidence
- Suicide 5%
- Substance misuse
- Debts
- Homelessness
- Social isolation
- Violence (14 x at risk of being victim!)
- Life expectancy
- Physical Health – Exercise/ Smoking/ Drug side effect
