CPTP 3.2 Case 38 Launch Flashcards
What are the symptoms of paranoid schizophrenia?
Auditory hallucinations (which discuss the patient in a derogatory way)
Disorders of thought:
• Delusional perception (e.g. “I’m king of the world because that red car drove past me”)
• Idea that thoughts are being controlled or broadcast
• Persecutory delusions
Catatonic behaviour (stupor):
• Apathy
• Social withdrawal
• Blunted emotions
What makes prescribing difficult with paranoid schizophrenic patients?
Lack of insight (knowledge or understanding that a disease is present)
Compliance
How is dose decided with treatment for paranoid schizophrenics?
Start with minimum effective dose for 4-6 weeks then titrate up.
Use a single antipsychotic
What is monitored during antipsychotic treatment?
Response
Adherence
Side effects:
• Extrapyrimidal side effects (EPSEs)
• Weight, pulse, BP
• Glucose and lipid levels
When are glucose and lipid levels tested for patients undergoing antipsychotic treatment?
at 12 weeks and then annually
Which antipsychotic has the most evidence for effective use against schizophrenia?
Haloperidol
What are the extrapyrimidal side effects?
Parkinson-like symptoms:
Tremor at rest
Bradykinesia
Rigidity
What are the non-extrapyrimidal (normal) side effects of antipsychotics?
Weight gain & diabetes
Cardiovascular (Prolonging QT interval)
Hormonal
What are the causes of non response to antipsychotics?
Inadequate dose
Incorrect diagnosis
Noncompliance
Need to switch antipsychotic
What is depot medication and why is it used?
Injectable forms of slow release medication (that is usually also available as a tablet).
The idea is that in an injectable form, it only needs to be administered fortnightly (due to the slow release), so it can be used for antipsychotics to combat noncompliance long enough for the patient to gain insight into their condition.
List the antipsychotics in the student formulary
What are the routes of administration for these, and which are available in depot form?
Oral Route Allows Calm And Quiet Humans
- HALOPERIDOL
- OLANZAPINE
- Risperidone
- Quetiapine
- Clozapine
Alternatives:
• Aripiprazole
• Amisulpiride
All oral, the following are available as DEPOTS:
• Haloperidol
• Risperidone
When is drug treatment considered for depression?
When moderate to severe
Subthreshold for more than 2 years
Subthreshold that persists after other interventions
When subthreshold depression complicated care of physical health problem
What is the greatest risk with prescribing TCAs for depression?
Overdose, causing death through cardiotoxicity
Which antidepressive class of drugs has the least side-effects?
SSRIs
Name the SSRIs in the student formulary
FLUOXETINE
Sertraline
Citalopram
Name the classes of antidepressants
TCAs
SSRIs
Monoamine oxidase inhibitors
Noradrenergic/Serotonin-related ones
Name the TCAs
AMITRIPTYLINE
Trazodone
Name a monoamine oxidase inhibitor
Phenelzine
Name the NaSSA & SNRI (ATYPICAL) antidepressants (which affect norepinephrine and serotonin)
Mirtazapine NaSSA
Venlafaxine SNRI
Outline how you would review antidepressant treatment
Review after 4 weeks
If there is no response, change antidepressant
If there is minimal response, increase dose
If there is improvement continue treatment for another 4 weeks
How long must antipsychotic treatment be continued for and what is the risk if this isn’t met?
2 years otherwise there is a risk of relapse
How long must antidepressant treatment be continued for?
Stay on antidepressants for 6 months after patient is well, to avoid relapse. After this, reduce dose over a period of 4 weeks to avoid withdrawal effects.
How long must antidepressant treatment be continued for if the patient is experiences recurrent depression or is at high risk?
2 years
What proportion of paranoid schizophrenics recover after their first episode?
80%
What proportion of recovered paranoid schizophrenics never experience another episode?
20%
