Mental Health: Schizophrenia Flashcards
What is schizophrenia?
severe mental disorder characterised by profound disruptions in thinking affecting language, perception and the sense of self
What are examples of psychotic experiences in schizophrenia?
hearing voices, delusions
How does schizophrenia impair functioning?
through loss of acquired capability to earn livelihood or disruption of studies
exact mechanism of schizophrenia unknown but thought to be due to what?
elevated dopamine levels in brain
what is the average age of onset in males and females?
18 for males and 25 for females
When is the risk of suicide greatest in schizophrenic patients?
at the onset/diagnosis
what symptoms that develop slowly during the teenage years can be mistaken for an adolescent phase?
socially withdrawn and unresponsive or changes in sleeping pattern
what is the DSM V used for?
diagnostic and statistic manual for mental health disorders
How is schizophrenia diagnosed?
DSM V - at least 1 positive symptom for 1 month associated w continuous problems for at least 6 months
positive symptoms are those changes in behaviour or thoughts that relate to pyschosis ie happening to the person. What 3 ways are these split?
delusions, hallucinations and thought disorder
are positive or negative symptoms harder to treat?
positive (happening to px)
What are the different hallucinations experienced as part of positive symptoms?
- visual
- auditory
- tactile
- somatic
What are the negative symptoms of schizophrenia?
withdrawal or lack of function:
- social withdrawal
- lack of emotion
- reduced speech
- poor self care
when do negative symptoms appear and do they improve/ worsen with time?
appear months or years before first acute schizophrenic episode and get worse over time
Treatment for schizophrenia is normally a combination of what?
individually tailored medication AND therapy
What healthcare professionals are given to care for a schizophrenic patient?
Community Mental Health Services (CMHT): MDT
- social workers
- mental health nurses
- pharmacists
- psychiatrists
- psychologists
what drug class are usually recommended as the initial treatment for symptoms of an acute schizophrenic episode?
antipyschotics
How to antipsychotics work?
block effect of dopamine on brain
how long can it take for antipsychotic drugs to reduce feelings of anxiety and aggression?
few hours
how long can it take for antipyschotic drugs to reduce symptoms such as hallucinations and delusional thoughts?
several days or weeks
what sort of durg INCrease dopamine in brain and –> similar symptoms to those in psychosis?
Amphetamines, cocaine, other stimulants
Px with parkinsons: treated with dopamine enhancing Levodopa, what may this lead to?
psychotic side effects
What are the two types of antipsychotics?
- 1st gen: typical
- 2nd gen: atypical
How do 1st gen typical antipsychotics work?
block D1 receptors in all areas of brain
How do 2nd gen atypical antipsychotics work?
act on range of receptors: 5HT2 and D2
What class do the following belong to?
chlorpromazine
flupentixol
haloperidol
perphenazine
pimozide
sulpride
zuclopenthioxol
typical (1st gen)
are the following drugs typical or atypical?
amisulpride
aripiprazole
clozapine
lurasidone
olanzapine
palperidone
quetiapine
risperidone
atypical (2nd gen)
what was one major problem with typical anti pyschotics?
extra pyramidal side effects EPS
- drug induced movement disorders, experienced by px on dopamine receptor blockers
What are 4 examples of eps?
- pseudoparkinsonism
- acute dystonia
- akathisia
- tardive dyskinesia
one type of eps is pseudoparkinsonism, name the symptoms?
stooped posture,
shuffling gait,
rigidity,
tremors at rest
bradykinesia
one type of eps is acute dystonia, name some signs of this?
facial grimacing,
involuntary upward eye movement,
muscle spasms of face, neck, back
some signs of akathisia?
restless,
trouble standing still,
paces the floor
signs of tardive dyskinesia?
protrusion and rolling of tongue,
sucking and smacking of lips
chewing motion
dopamine acts in the way in what 4 ways/ pathways?
- nigrostriatal
- mesocortical
- mesolimbic
- tuberoinfundibular
what effect does blockage of d2 receptors in mesolimbic pathway have (on positive symptoms)?
reduce positive symptoms such as delusions and hallucinations
what effect can blocking of the mesocortical pathway have (on negative symptoms)?
make negative symptoms worse - social withdrawal
blockage of which dopamine pathway is associated with increased ESPE?
nigrostriatal
disruption in which dopamine pathway can lead to reduced prolactin levels and lead to conditions like gynae?
tuberoinfundibular
Blocking dopamine receptor in ALL areas of brain has good and bad effects, why?
= generalised effect of D2 beneficial AND negative effects of first gen antipsychotics
What other receptors can 2nd gen (atypical) antipsychotics act on?
- serotonin 5HT2C
- H1
- alpha-1
how are epse reduced with atypical antipsychotic drugs?
reduced affinity for d2 at nigrostriatal pathway
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 ?
prevents worsening of negative symptoms
What 2nd gen antipsychotics have affinity for the 5HT2C receptor? What is the consequence?
- clozapine
- olanzapine
- weight gain
- increased glucose and lipid profile
What 2nd gen antipsychotics have affinity for the H1 receptor? What is the consequence?
- clozapine
- olanzapine
- quetiapine
- sedation, weight gain
What 2nd gen antipsychotics have affinity for the alpha-1 receptor? What is the consequence?
- clozapine
- risperidone
- orthostatic hypOtension
what did the CATIE and CUTLASS trials show regarding advantage of different classes?
no difference but 1st gen limited by epse and 2nd risk of metabolic side effects
What is 1st gen use limited by?
EPS
What is 2nd gen use limited by?
metabolic effects
maudsley prescribing is guide is used to help prescribe in mental health conditions, true or false?
true
What is the NICE guidance regarding the choice of antipsychotic medication?
made by service user and HCP together, taking into account views of both
What are key points that should be provided to a patient regarding their antipsyhotics?
- 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
Prescriber should provide information and discuss the likely benefits and possible side effects of each drug, including: 4
metabolic
extrapyramidal
cardiovascular
hormonal
2 things to monitor?
MH benefits and SEs
in what ways do we monitor the mental health benefits?
response to treatment such as changes in behaviour and symptoms and satisfaction
How do we monitor for side-effects when on antipsychotics?
- 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
why and how to monitor weight as a SE?
(plotted on a chart for trends) antipsychotics can cause weight gain
why are long acting IM depot injections useful option?
prevent relapse in patient who may not reliably take regular oral medication
advantages of depot injections?
- 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
cons of depot injections?
impossible to alter dose if SEs as gievn every 2-4wks
patients may see admin as lack of control
painful
skilled task
frequency of depot injections?
every 2-4 weeks
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?
clozapine
clozapine has a significant side effect profile, what is the worst one?
agranulocytosis
What is agranulocytosis?
and what may it lead to?
Reduction in WBC called leukopenia and particularly reduction in neutrophils called neutropenia
major lack of infection fighting cells… = at risk of neutropenic sepsis!)
medication must be combined with what?
psychological support
