Mental Health: Schizophrenia

Question 1

What is schizophrenia?

Answer 1

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

Question 2

What are examples of psychotic experiences in schizophrenia?

Answer 2

hearing voices, delusions

Question 3

How does schizophrenia impair functioning?

Answer 3

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

Question 4

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

Answer 4

elevated dopamine levels in brain

Question 5

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

Answer 5

18 for males and 25 for females

Question 6

When is the risk of suicide greatest in schizophrenic patients?

Answer 6

at the onset/diagnosis

Question 7

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

Answer 7

socially withdrawn and unresponsive or changes in sleeping pattern

Question 8

what is the DSM V used for?

Answer 8

diagnostic and statistic manual for mental health disorders

Question 9

How is schizophrenia diagnosed?

Answer 9

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

Question 10

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

Answer 10

delusions, hallucinations and thought disorder

Question 11

are positive or negative symptoms harder to treat?

Answer 11

positive (happening to px)

Question 12

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

Answer 12

• visual
• auditory
• tactile
• somatic

Question 13

What are the negative symptoms of schizophrenia?

Answer 13

withdrawal or lack of function:

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

Question 14

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

Answer 14

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

Question 15

Treatment for schizophrenia is normally a combination of what?

Answer 15

individually tailored medication AND therapy

Question 16

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

Answer 16

Community Mental Health Services (CMHT): MDT

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

Question 17

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

Answer 17

antipyschotics

Question 18

How to antipsychotics work?

Answer 18

block effect of dopamine on brain

Question 19

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

Answer 19

few hours

Question 20

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

Answer 20

several days or weeks

Question 21

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

Answer 21

Amphetamines, cocaine, other stimulants

Question 22

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

Answer 22

psychotic side effects

Question 23

What are the two types of antipsychotics?

Answer 23

• 1st gen: typical
• 2nd gen: atypical

Question 24

How do 1st gen typical antipsychotics work?

Answer 24

block D1 receptors in all areas of brain

Question 25

How do 2nd gen atypical antipsychotics work?

Answer 25

act on range of receptors: 5HT2 and D2

Question 26

What class do the following belong to? chlorpromazine flupentixol haloperidol perphenazine pimozide sulpride zuclopenthioxol

Answer 26

typical (1st gen)

Question 27

are the following drugs typical or atypical? amisulpride aripiprazole clozapine lurasidone olanzapine palperidone quetiapine risperidone

Answer 27

atypical (2nd gen)

Question 28

what was one major problem with typical anti pyschotics?

Answer 28

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

Question 29

What are 4 examples of eps?

Answer 29

- pseudoparkinsonism - acute dystonia - akathisia - tardive dyskinesia

Question 30

one type of eps is pseudoparkinsonism, name the symptoms?

Answer 30

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

Question 31

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

Answer 31

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

Question 32

some signs of akathisia?

Answer 32

restless, trouble standing still, paces the floor

Question 33

signs of tardive dyskinesia?

Answer 33

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

Question 34

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

Answer 34

- nigrostriatal - mesocortical - mesolimbic - tuberoinfundibular

Question 35

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

Answer 35

reduce positive symptoms such as delusions and hallucinations

Question 36

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

Answer 36

make negative symptoms worse - social withdrawal

Question 37

blockage of which dopamine pathway is associated with increased ESPE?

Answer 37

nigrostriatal

Question 38

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

Answer 38

tuberoinfundibular

Question 39

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

Answer 39

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

Question 40

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

Answer 40

- serotonin 5HT2C - H1 - alpha-1

Question 41

how are epse reduced with atypical antipsychotic drugs?

Answer 41

reduced affinity for d2 at nigrostriatal pathway

Question 42

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 ?

Answer 42

prevents worsening of negative symptoms

Question 43

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

Answer 43

- clozapine - olanzapine - weight gain - increased glucose and lipid profile

Question 44

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

Answer 44

- clozapine - olanzapine - quetiapine - sedation, weight gain

Question 45

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

Answer 45

- clozapine - risperidone - orthostatic hypOtension

Question 46

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

Answer 46

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

Question 47

What is 1st gen use limited by?

Answer 47

EPS

Question 48

What is 2nd gen use limited by?

Answer 48

metabolic effects

Question 49

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

Answer 49

true

Question 50

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

Answer 50

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

Question 51

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

Answer 51

- 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

Question 52

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

Answer 52

metabolic extrapyramidal cardiovascular hormonal

Question 53

2 things to monitor?

Answer 53

MH benefits and SEs

Question 54

in what ways do we monitor the mental health benefits?

Answer 54

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

Question 55

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

Answer 55

- 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

Question 56

why and how to monitor weight as a SE?

Answer 56

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

Question 57

why are long acting IM depot injections useful option?

Answer 57

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

Question 58

advantages of depot injections?

Answer 58

* 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

Question 59

cons of depot injections?

Answer 59

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

Question 60

frequency of depot injections?

Answer 60

every 2-4 weeks

Question 61

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?

Answer 61

clozapine

Question 62

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

Answer 62

agranulocytosis

Question 63

What is agranulocytosis? and what may it lead to?

Answer 63

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

Question 64

medication must be combined with what?

Answer 64

psychological support