lectures - schizophrenia

Question 1

what is the prognosis of schizo?

Answer 1

Reduced life expectancy (by 19 years) due to cardiovascular disease! very important.

25% recover completely

40% have recovery periods but relapse

10% have sustained deterioration

5-10% die by suicide

the longer it goes without treatment - the worse the prognosis. worse if earlier onset

Question 2

some extra important factors in aetiology of schiizo?

Answer 2

paternal age

genetics: genes implicated all affect dopamine metabolism

Question 3

list some differentials for schizo?

Answer 3

affective psychosis - eg from mania or depressive psychosis

drug induced psychosis - cannabisi khat and ketamine can cause paranoia and thought disorder

delirium

personality disorder

Question 4

list some differentials for schizo?

Answer 4

affective psychosis - eg from mania or depressive psychosis

drug induced psychosis - cannabisi khat and ketamine can cause paranoia and thought disorder

delirium

personality disorder

physical health eg porphyria

Question 5

ivx for schiizo?

Answer 5

hx and mse

physical exam - any cvs symptoms?

urine drug screen

bloods - lipids, hba1c

EEG - if suspecting Temporal lobe epilepsy or post octal

Question 6

ivx for schizo?

Answer 6

hx and mse

physical exam - any cvs symptoms?

urine drug screen

bloods - lipids, hba1c

EEG - if suspecting Temporal lobe epilepsy or post octal

Question 7

ivx for schizo?

Answer 7

hx and mse

physical exam - any cvs symptoms?

urine drug screen

bloods - lipids, hba1c

EEG - if suspecting Temporal lobe epilepsy or post octal

Question 8

what can present very similarly to severe depression?

Answer 8

‘residual schizophrenia’

Prominent negative symptoms are all that remain after
delusions and hallucinations subside

Question 9

what is the difference between aripiprazole and other atypical?

Answer 9

it is a PARTIAL dopamine agonist

the rest are antagonists

Question 10

which is the most effective antipsychotic?

Answer 10

clozapine

the rest have equal efficacy

Question 11

issues with atypiical antipsychotics?

Answer 11

metabolic syndrome increasinig risk of cardio/cvs risk

Question 12

excess dopamine in the 4 dopaminergic pathways are responsible for which sx?

Answer 12

mesoliimbic - positive sx

mesocortiical - negativie sx

nigrostriatal - epse

tuberoinfundibular - antipsychotics can led to hyperprolactinaemia

Question 13

liist some sx of hyperprolactinaemia

Answer 13

galactorrhea
oligo/amennorheoa
gynaecomastia
sexual dysfunction

osteoporosis and incresed breast cancer risk

YOU HAVE TO PROBE FOR THIS IF PATIENTS ARE ON ANTIPSYCHOTIICS because they usually won’t mention it and it affects compliance.

Question 14

what is the treatment for EPSE - acute dystonia ?

Answer 14

Anticholinergics -> Procyclidine (PO/IM)

Question 15

what is the treatment for EPSE - akathisia?

Answer 15

reduce dose of antipsychotic

give short term benzodiazepines

Question 16

what is normal QTc interval?

Answer 16

<440m/s men

<470m/s women

Question 17

what is the treatment for EPSE - tardive dyskinesia?

Answer 17

reduce dose of antipsychotic

Question 18

what is the issue with a prolonged QTc?

Answer 18

Sudden cardiac death - mainly!

hence why you must do ECG before starting antipsychotic and regularly afterwards

others; torsades de pointes - a type of VT

Question 19

blockage of which receptors cause weight gain and sedation?

Answer 19

anti-histiminergic

Question 20

blockage of which receptors cause postural hypotension, dizziness and syncope?

Answer 20

a adrenergic

Question 21

what are the conditoins before you can prescribe clozapine?

Answer 21

are they on 2 antipsychotics?
is at least one an atypical?

are they on adequate doses?

adherence - have they been taking the drugs for 6 weeks?

Question 22

define agranulocytosis

Answer 22

a severe and dangerous leukopenia (lowered white blood cell count),

most commonly of neutrophils, and thus causing a neutropenia in the circulating blood.

susceptible to infections - hence death from SEPTICAEMIA

Question 23

what is the tetrad seen in NMS?

Answer 23

Autonomic instbaility
Mental state changes
Hyprethermia
Muscle rigidity

Question 24

what is the tetrad seen in NMS?

Answer 24

Autonomic instability
Mental state changes
Hyperthermia
Muscle rigidity - veery stiff; lead pipe

Question 25

risk factors for NMS?

Answer 25

Newly started antipsychotic

High dose antipsychotic

typical antipsychotics

Depot

males

rapid dose increase

Question 26

treatment for NMS?

Answer 26

stop antipsychotic

take to a&e / itu - likely require intubation

supportive care; fluids, dialysis, antipyretics

others; muscle relaxant, dopaminergic drugs -
Bromocriptine, ECT

Question 27

what are very important markers to look for in blood tests for NMS?

Answer 27

Creatine kinase - very high - due to rhabdomyolysis

WCC - high

Question 28

give cause of death in NMS?

Answer 28

acute renal failure

secondary to skeletal muscle breakdown (rhabdomyolysis).

Question 29

MOA of antipsychotics?

Answer 29

D2 receptor antagonists

Atypical ones are also serotonin 5HT2A recepto antagonists - helps to reduce the side effects

Apart from aripiprazole