General info

Question 1

Negative symptoms

Answer 1

Underactivity in the mesocortical pathway.
- Social withdrawal
- Poor hygiene
- Apathy
- Catatonia

Question 2

Positive symptoms

Answer 2

Overactivity in the mesolimbic pathway.
- Hallucinations
- Delusions
- Disorganised speech/thoughts

Question 3

Extrapyramidal symptoms

Answer 3

D2 antagonism in the nigrostriatal pathway.
- Parkinsonism
- Tardive dyskinesia
- Akathisia
- Dystonia
- Dyskinesia

Question 4

RCofP - advice on doses of antipsychotic drugs above the BNF upper limit

Answer 4

1. Alternatives (adjuvants/newer 2nd gen e.g. clozapine)
2. Consider risk factors (obesity, elderly)
3. Potential drug interactions?
4. ECG (exclude QT prolongation/other abnormalities).
5. Increase dose slowly (once weekly)
6. Regular pulse, BP + temp checks (adequate fluid intake)
7. High therapy for LIMITED time only. Review regularly + stop if no improvement after 3 months.

Question 5

Antipsychotics in the elderly - risks

Answer 5

Elderly patients + dementia = increased risk of death and stroke/TIA

Susceptible to postural hypotension and hyper/hypothermia

Question 6

Antipsychotics in the elderly - prescribing

Answer 6

1. Do NOT treat mild-moderate psychotic symptoms.
2. Initial dose = half adult dose
   - Take into account pt factors e.g. weight, other meds and co-morbidities
3. Review treatment regularly

Question 7

Antipsychotics in patients with learning disabilities who are not experiencing symptoms

Answer 7

• Reduce dose/stop long-term treatment
• Review after dose reduced/stopped.
• Refer to psychiatrist specialist in treating MH in people with learning disabilities.
• Annual documentation of reason for continuing treatment if dose not reduced/stopped.

Question 8

Emergency administration of antipsychotics

Answer 8

IM route
IM dose lower than oral dose (avoids first pass)
- Especially in very active patients (due to increased blood flow)
Rx must specify dose for each route.
Review dose daily