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Health 32 > Mental Health: Schizophrenia > Flashcards

Mental Health: Schizophrenia Flashcards

1
Q

What is schizophrenia?

A

severe mental disorder characterised by profound disruptions in thinking affecting language, perception and the sense of self

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2
Q

What are examples of psychotic experiences in schizophrenia?

A

hearing voices, delusions

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3
Q

How does schizophrenia impair functioning?

A

through loss of acquired capability to earn livelihood or disruption of studies

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4
Q

exact mechanism of schizophrenia unknown but thought to be due to what?

A

elevated dopamine levels in brain

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5
Q

what is the average age of onset in males and females?

A

18 for males and 25 for females

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6
Q

When is the risk of suicide greatest in schizophrenic patients?

A

at the onset/diagnosis

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7
Q

what symptoms that develop slowly during the teenage years can be mistaken for an adolescent phase?

A

socially withdrawn and unresponsive or changes in sleeping pattern

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8
Q

what is the DSM V used for?

A

diagnostic and statistic manual for mental health disorders

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9
Q

How is schizophrenia diagnosed?

A

DSM V - at least 1 positive symptom for 1 month associated w continuous problems for at least 6 months

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10
Q

positive symptoms are those changes in behaviour or thoughts that relate to pyschosis ie happening to the person. What 3 ways are these split?

A

delusions, hallucinations and thought disorder

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11
Q

are positive or negative symptoms harder to treat?

A

positive (happening to px)

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12
Q

What are the different hallucinations experienced as part of positive symptoms?

A
  • visual
  • auditory
  • tactile
  • somatic
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13
Q

What are the negative symptoms of schizophrenia?

A

withdrawal or lack of function:

  • social withdrawal
  • lack of emotion
  • reduced speech
  • poor self care
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14
Q

when do negative symptoms appear and do they improve/ worsen with time?

A

appear months or years before first acute schizophrenic episode and get worse over time

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15
Q

Treatment for schizophrenia is normally a combination of what?

A

individually tailored medication AND therapy

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16
Q

What healthcare professionals are given to care for a schizophrenic patient?

A

Community Mental Health Services (CMHT): MDT

  • social workers
  • mental health nurses
  • pharmacists
  • psychiatrists
  • psychologists
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17
Q

what drug class are usually recommended as the initial treatment for symptoms of an acute schizophrenic episode?

A

antipyschotics

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18
Q

How to antipsychotics work?

A

block effect of dopamine on brain

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19
Q

how long can it take for antipsychotic drugs to reduce feelings of anxiety and aggression?

A

few hours

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20
Q

how long can it take for antipyschotic drugs to reduce symptoms such as hallucinations and delusional thoughts?

A

several days or weeks

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21
Q

what sort of durg INCrease dopamine in brain and –> similar symptoms to those in psychosis?

A

Amphetamines, cocaine, other stimulants

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22
Q

Px with parkinsons: treated with dopamine enhancing Levodopa, what may this lead to?

A

psychotic side effects

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23
Q

What are the two types of antipsychotics?

A
  • 1st gen: typical
  • 2nd gen: atypical
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24
Q

How do 1st gen typical antipsychotics work?

A

block D1 receptors in all areas of brain

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25
Q

How do 2nd gen atypical antipsychotics work?

A

act on range of receptors: 5HT2 and D2

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26
Q

What class do the following belong to?

chlorpromazine
flupentixol
haloperidol
perphenazine
pimozide
sulpride
zuclopenthioxol

A

typical (1st gen)

27
Q

are the following drugs typical or atypical?

amisulpride
aripiprazole
clozapine
lurasidone
olanzapine
palperidone
quetiapine
risperidone

A

atypical (2nd gen)

28
Q

what was one major problem with typical anti pyschotics?

A

extra pyramidal side effects EPS
- drug induced movement disorders, experienced by px on dopamine receptor blockers

29
Q

What are 4 examples of eps?

A
  • pseudoparkinsonism
  • acute dystonia
  • akathisia
  • tardive dyskinesia
30
Q

one type of eps is pseudoparkinsonism, name the symptoms?

A

stooped posture,
shuffling gait,
rigidity,
tremors at rest
bradykinesia

31
Q

one type of eps is acute dystonia, name some signs of this?

A

facial grimacing,
involuntary upward eye movement,
muscle spasms of face, neck, back

32
Q

some signs of akathisia?

A

restless,
trouble standing still,
paces the floor

33
Q

signs of tardive dyskinesia?

A

protrusion and rolling of tongue,
sucking and smacking of lips
chewing motion

34
Q

dopamine acts in the way in what 4 ways/ pathways?

A
  • nigrostriatal
  • mesocortical
  • mesolimbic
  • tuberoinfundibular
35
Q

what effect does blockage of d2 receptors in mesolimbic pathway have (on positive symptoms)?

A

reduce positive symptoms such as delusions and hallucinations

36
Q

what effect can blocking of the mesocortical pathway have (on negative symptoms)?

A

make negative symptoms worse - social withdrawal

37
Q

blockage of which dopamine pathway is associated with increased ESPE?

A

nigrostriatal

38
Q

disruption in which dopamine pathway can lead to reduced prolactin levels and lead to conditions like gynae?

A

tuberoinfundibular

39
Q

Blocking dopamine receptor in ALL areas of brain has good and bad effects, why?

A

= generalised effect of D2  beneficial AND negative effects of first gen antipsychotics

40
Q

What other receptors can 2nd gen (atypical) antipsychotics act on?

A
  • serotonin 5HT2C
  • H1
  • alpha-1
41
Q

how are epse reduced with atypical antipsychotic drugs?

A

reduced affinity for d2 at nigrostriatal pathway

42
Q

what effect does reduced affinity for the mesolimbic pathway have on patients that are taking atypical second gen anti pyschotics, in terms of negative symptoms ?

A

prevents worsening of negative symptoms

43
Q

What 2nd gen antipsychotics have affinity for the 5HT2C receptor? What is the consequence?

A
  • clozapine
  • olanzapine
  • weight gain
  • increased glucose and lipid profile
44
Q

What 2nd gen antipsychotics have affinity for the H1 receptor? What is the consequence?

A
  • clozapine
  • olanzapine
  • quetiapine
  • sedation, weight gain
45
Q

What 2nd gen antipsychotics have affinity for the alpha-1 receptor? What is the consequence?

A
  • clozapine
  • risperidone
  • orthostatic hypOtension
46
Q

what did the CATIE and CUTLASS trials show regarding advantage of different classes?

A

no difference but 1st gen limited by epse and 2nd risk of metabolic side effects

47
Q

What is 1st gen use limited by?

A

EPS

48
Q

What is 2nd gen use limited by?

A

metabolic effects

49
Q

maudsley prescribing is guide is used to help prescribe in mental health conditions, true or false?

A

true

50
Q

What is the NICE guidance regarding the choice of antipsychotic medication?

A

made by service user and HCP together, taking into account views of both

51
Q

What are key points that should be provided to a patient regarding their antipsyhotics?

A
  • doesn’t cure schizophrenia, treats symptoms
  • some more effective than others
  • long-term required to prevent relapse
  • don’t stop abruptly
  • psychosocial + logical interventions increase chance of staying well
52
Q

Prescriber should provide information and discuss the likely benefits and possible side effects of each drug, including: 4

A

metabolic
extrapyramidal
cardiovascular
hormonal

53
Q

2 things to monitor?

A

MH benefits and SEs

54
Q

in what ways do we monitor the mental health benefits?

A

response to treatment such as changes in behaviour and symptoms and satisfaction

55
Q

How do we monitor for side-effects when on antipsychotics?

A
  • weight
  • waist circumference
  • pulse + BP
  • fasting blood glucose, HbA1c, blood lipid profile, prolactin levels
  • assessment of movement disorders
  • assessment of nutritional status/diet/level of physical activity
  • ECG if on SPC or CVD risk
56
Q

why and how to monitor weight as a SE?

A

(plotted on a chart for trends) antipsychotics can cause weight gain

57
Q

why are long acting IM depot injections useful option?

A

prevent relapse in patient who may not reliably take regular oral medication

58
Q

advantages of depot injections?

A
  • Assured compliance for px who aren’t compliant with oral med, and given by team
  • Steady plasma levels
  • Given every few weeks, easier and less complicated than other drug regime
59
Q

cons of depot injections?

A

impossible to alter dose if SEs as gievn every 2-4wks
patients may see admin as lack of control
painful
skilled task

60
Q

frequency of depot injections?

A

every 2-4 weeks

61
Q

what drug should be offered to patients with TRS who have not responded to treatment despite sequential use of adequate uses of 2 different anti pyschotic drugs, one of which is a non clozapine 2nd gen drug?

A

clozapine

62
Q

clozapine has a significant side effect profile, what is the worst one?

A

agranulocytosis

63
Q

What is agranulocytosis?
and what may it lead to?

A

Reduction in WBC called leukopenia and particularly reduction in neutrophils called neutropenia
major lack of infection fighting cells… = at risk of neutropenic sepsis!)

64
Q

medication must be combined with what?

A

psychological support

Health 32 (11 decks)

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