lectures - schizophrenia Flashcards
what is the prognosis of schizo?
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
some extra important factors in aetiology of schiizo?
paternal age
genetics: genes implicated all affect dopamine metabolism
list some differentials for schizo?
affective psychosis - eg from mania or depressive psychosis
drug induced psychosis - cannabisi khat and ketamine can cause paranoia and thought disorder
delirium
personality disorder
list some differentials for schizo?
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
ivx for schiizo?
hx and mse
physical exam - any cvs symptoms?
urine drug screen
bloods - lipids, hba1c
EEG - if suspecting Temporal lobe epilepsy or post octal
ivx for schizo?
hx and mse
physical exam - any cvs symptoms?
urine drug screen
bloods - lipids, hba1c
EEG - if suspecting Temporal lobe epilepsy or post octal
ivx for schizo?
hx and mse
physical exam - any cvs symptoms?
urine drug screen
bloods - lipids, hba1c
EEG - if suspecting Temporal lobe epilepsy or post octal
what can present very similarly to severe depression?
‘residual schizophrenia’
Prominent negative symptoms are all that remain after
delusions and hallucinations subside
what is the difference between aripiprazole and other atypical?
it is a PARTIAL dopamine agonist
the rest are antagonists
which is the most effective antipsychotic?
clozapine
the rest have equal efficacy
issues with atypiical antipsychotics?
metabolic syndrome increasinig risk of cardio/cvs risk
excess dopamine in the 4 dopaminergic pathways are responsible for which sx?
mesoliimbic - positive sx
mesocortiical - negativie sx
nigrostriatal - epse
tuberoinfundibular - antipsychotics can led to hyperprolactinaemia
liist some sx of hyperprolactinaemia
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.
what is the treatment for EPSE - acute dystonia ?
Anticholinergics -> Procyclidine (PO/IM)
what is the treatment for EPSE - akathisia?
reduce dose of antipsychotic
give short term benzodiazepines
what is normal QTc interval?
<440m/s men
<470m/s women
what is the treatment for EPSE - tardive dyskinesia?
reduce dose of antipsychotic
what is the issue with a prolonged QTc?
Sudden cardiac death - mainly!
hence why you must do ECG before starting antipsychotic and regularly afterwards
others; torsades de pointes - a type of VT
blockage of which receptors cause weight gain and sedation?
anti-histiminergic
blockage of which receptors cause postural hypotension, dizziness and syncope?
a adrenergic
what are the conditoins before you can prescribe clozapine?
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?
define agranulocytosis
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
what is the tetrad seen in NMS?
Autonomic instbaility
Mental state changes
Hyprethermia
Muscle rigidity
what is the tetrad seen in NMS?
Autonomic instability
Mental state changes
Hyperthermia
Muscle rigidity - veery stiff; lead pipe
risk factors for NMS?
Newly started antipsychotic
High dose antipsychotic
typical antipsychotics
Depot
males
rapid dose increase
treatment for NMS?
stop antipsychotic
take to a&e / itu - likely require intubation
supportive care; fluids, dialysis, antipyretics
others; muscle relaxant, dopaminergic drugs -
Bromocriptine, ECT
what are very important markers to look for in blood tests for NMS?
Creatine kinase - very high - due to rhabdomyolysis
WCC - high
give cause of death in NMS?
acute renal failure
secondary to skeletal muscle breakdown (rhabdomyolysis).
MOA of antipsychotics?
D2 receptor antagonists
Atypical ones are also serotonin 5HT2A recepto antagonists - helps to reduce the side effects
Apart from aripiprazole
