Pharmacological Interventions

Question 1

On what dimensions is psychosis a pathology?

Answer 1

Selfhood, perception, thinking and beliefs.

Question 2

What is the most common symptom of acute psychosis?

Answer 2

Lack of insight

Question 3

Are psychosis and schizophrenia synomous?

Answer 3

No, only 1 in 8 with psychosis will develop schizophrenia

Question 4

What can mania be thought of?

Answer 4

A lack of insight. Elevated mood, lack of sleep.

Question 5

What drugs can cause psychosis after one use and which need repeated use?

Answer 5

Synthetic cannabinoids, LSD, Ketamine

repeat: Crack cocaine, meth

Question 6

What was the first antipsychotic found?

Answer 6

Rauwolfia serpentina

Active ingredient is reserpine, which depletes nerve varicosities. 1950 realisation it was not as good as we thought. potentially toxic

Question 7

When did the first pharmacological treatments enter the medical world?

Answer 7

1950’s, not just sedation.

1954 saw RCT:
lithium for mania
Chlorpromazine for Schizophrenia

reduced beds in NHS radically

Question 8

What are the goals of treatment at differing stages of psychosis?

Answer 8

Acute stage: Symptom relief. Antipsychotics work well

Maintenance: Prevent relapse. High risk of this

Question 9

What contributes to relapse of psychosis and why is it significant?

Answer 9

1: Not taking meds: 77% vs 3% also 5 fold increase.
2: Substance abuse, critical comments, poor premorbid adjustment

Each relapse results in a progressive social decline

Question 10

What does a recent meta-analyis tell us about the use of drugs in Schizophrenia?

Answer 10

That in all instances drugs are favoured, however there is little change in employment or death by other causes.

Question 11

Is CBT effective in preventing relapse?

Answer 11

No, but is useful for reducing symptoms

Question 12

What drugs have been shown to be Anti manic?

Answer 12

Lithium, Valproate, antipsychotics, carbamazepine.

Question 13

Why is relapse rate in Mania an important issue?

Answer 13

90% relapse rate.

20-30% increased chance of suicide.

Question 14

Is lithium a useful drug for relapse in mania?

Answer 14

1967: 88 women- seemed so, but this was open label study.

By 1970 RCT show it is useful, with caveat it must be adhered to as one missed pill can trigger new episode, even after years of health.

Question 15

What has been the evidence form the sparkle study of mania over two years?

Answer 15

20% of Placebo group relapse free

60% lithium and quetiapine group.

Question 16

What is the most effective approach to reducing relapse rates in Mania?

Answer 16

Montherepy only 60%

Combination: Quetiapine and lithium or divalporex.

90% avoiding relapse
and 80% chance of avoiding depression

Question 17

What was the first introduced antipsychotic and what was it useful against?

Answer 17

Chlorpromazine. 1950s

Hallucinations, Delusions, Agitation

Question 18

How was haloperidol discovered?

Answer 18

After Jansen noticed the psychotic effects of amphetamines. Question became what can block amphetamine.

Highly effective against Hal, Del and Ag. In small continuous doses

Question 19

What was the assay used to develop antipsychotics?

Answer 19

Conditioned avoidance. Unable to make connection between cue and danger. First done with Chlorpromazine.

Question 20

What have we learnt about dopamine since the 1960s?

Answer 20

That it is not simply a building block.

Few neurons, but extensive arborisation.

Neurons influence large areas of CNS

Question 21

How is dopamine different from glutamate and Gaba?

Answer 21

It is a slow release, biochemical modulator.

So it can alter strength of connections
Role in leaning and memory.

Question 22

What is dopamines major function?

Answer 22

It is a teaching signal.

It projects to higher circuits. Via varicosities.

Signals importance of event

Question 23

What three firing patterns did Wolfram Schultz find for dopamine?

Answer 23

Steady: Every second. Tonic firing for well rehearsed thoughts and patterns.
Burst: The release in the response to a reward.
Switching off: No release due to no reward-a way to refine leanring.

Striatum known to be critical for new habits, thoughts and movements.

Striatum changes structure in repsonse.

Question 24

What ways are all antipsychotics similar and in what way are they different?

Answer 24

All act on D2 receptors.

Vary in which other receptors they target.

Targeting histamine will result in sedation. (quetiapine and chlorpromazine)

Question 25

How is Clozapine different from the other antipsychotics?

Answer 25

It is effective on TR patients.

TR constitues 20-30% Clozapine: 30% of these improve after 6 weeks
6 months: its 70%

Weak affinity for D2, potentially acetylcholine

Prevents sucide (5-10%)
Reduces violence
No Parkinsonism

BUT: Weekly and Monthly checks on blood as disrupts ability to fight infection in 1%

Question 26

What is the caveat in administering Clozapine?

Answer 26

It must be done in conjunction with Support, including psychosocial rehibiltation

Question 27

What has been the most effective administration technique for resperidone?

Answer 27

Long-acting depot.

7% relapse rate. vs 50% in oral form

Stays in sytem for weeks
Gold standard
Only 50% of patients will know about it