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Question 1

What are the two main symptoms of paranoid schizophrenia?

Answer 1

• Persecutory Delusions

* Auditory Hallucinations

Question 2

At least one of which symptoms must be present for a month in a paranoid schizophrenic?

Answer 2

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

Question 3

At least two of which symptoms must be present for a month in a paranoid schizophrenic?

Answer 3

• 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

Question 4

How are anti-psychotic drugs prescribed?

Answer 4

• 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

Question 5

How is anti-psychotic treatment monitored?

Answer 5

• 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

Question 6

What are the side effects of Haloperidrol?

Answer 6

• Extrapyramidal side effects seen in approx. 20% of typical antipsychotics
• Tremor
• Bradykinesia
• Rigidity
• Up to 10% can develop acute dystonia ( oculogyric crisis, Torticollis)

Question 7

What factors should you consider when choosing an antipsychotic?

Answer 7

• 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)

Question 8

What could cause ‘none’ response?

Answer 8

• Review diagnosis.
• Establish adherence to antipsychotic medication
• ? adequate dose
• ? correct duration.
• Switch antipsychotic
• Trial Clozapine if no response to 2 different antipsychotic drugs

Question 9

When would you consider drug treatment for depression?

Answer 9

• 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

Question 10

What has to be done when stopping or reducing medication?

Answer 10

• 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

Question 11

What are some impacts of a psychotic illness?

Answer 11

• 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