Management of Schizophrenia Flashcards
What are some currently used antipsychotics?
Flupentixol, perphenazine, olanzapine, clozapine, aripiprazole, sulpiride, quetiapine, prochlorperazine, lurasidone, haloperidol, chloropromazine
What are some examples of typical antipsychotics?
Chloropromazine, perphenazine, zuclopenthixol, prochlorperazine, trifluperazine, flupentixol, haloperidol, amisulpride, sulpiride
What are some examples of atypical antipsychotics?
Clozapine, quetiapine, lurasidone, risperidone, palperidone, olanzapine, aripiprazole
How effective are antipsychotics?
Reduce overall symptoms and relapse prevention
2nd generation antipsychotics increased percentage responding to 41% in acute treatment
Maintenance treatment reduced relapse rates to 22% within 10 months
What are the dopaminergic side effects of antipsychotics?
Extra pyramidal side effects, neuroleptic malignant syndrome, hyperprolactinaemia, akathisia/restless legs
What are some examples of extra pyramidal side effects?
Acute dystonic reactions, Parkinsonism, tardive dyskinesia
What are some features of acute dystonia?
Onset in minutes = increasing muscle tone, energetic, torticolis, oculogyric crisis, tongue protrusion
What are the features of Parkinsonism?
Bradykinesia, cogwheeling rigidity, resting tremor, shuffling gait, dead-pan facial expression
What are the features of tardive dyskinesia?
Long term and often permanent
Responds fairly poorly to treatment
May involve limbs and/or trunk
Involuntary repetitive orofacial movements = blinking, grimacing, pouting, lip smacking
How are extra pyramidal side effects treated?
Procyclidine 5mg, trihexyphenidyl, orphenadrine
What are some features of neuroleptic malignant syndrome?
Rare = 1-2 per 10000 of patients on antipsychotics
Onset over 24-72hrs and lasts for days if untreated
Fatal in up to 20% (oral) or 30% (depot) if untreated
Investigate using creatine kinase
What are the symptoms of neuroleptic malignant syndrome?
Increasing muscle tone, pyrexia, changing pulse or BP
Leads to rhabdomyolysis then acute renal failure
Coma develops which may progress to death
How is neuroleptic malignant syndrome treated?
Stop antipsychotic
Rapid cooling and renal support
Skeletal muscle relaxants = dantroline
Dopamine agonists = bromocriptine
Why do antipsychotics cause hyperprolactinaemia?
Prolactin release inhibited by dopamine = blockade of dopamine by antipsychotic leads to increased prolactin levels
How does hyperprolactinaemia present?
Women = galactorrhoea, decreased libido and arousal, anorgasmia, anovulation, amenorrhoea Men = gynaecomastia, erectile dysfunction, oligospermia, decreased libido
What effect does hyperprolactinaemia have on bone density?
Decreases bone mineralisation = reduced bone density so increased risk of osteoporosis
What are some features of akathisia?
Affects up to 20% and manifests days-weeks = pacing, rocking from foot to foot, unable to sit or stand still, poor sleep as a result, links to increased suicide risk
What are some anticholinergic side effects?
Dry mouth, blurred vision, constipation
What are some side effects linked to serotonin?
Implicated in weight gain and metabolic syndrome
What are some other side effects of antipsychotics?
Anti-adrenergic = postural hypotension
Hepatoxicity, prolonged QT interval, photosensitivity
What kind of side effects do 1st generation antipsychotics cause?
Extra pyramidal side effects
What kind of side effects do 2nd generation antipsychotics cause?
Weight gain and sedation
What are the benefits of clozapine?
20% better efficacy than others = better for treatment of non-responders, good for negative symptoms, antisuicidal
What are the side effects of clozapine?
Agranulocytosis = leads to neutropenic sepsis
Constipation = leads to gastric paresis and perforation
Myocarditis, sedation, weight gain, siallorrhoea
