psychoses and related drugs

Question 1

Question: What are the two main categories of symptoms in psychosis and schizophrenia?

Answer: Positive symptoms (e.g., hallucinations, delusions) and negative symptoms (e.g., emotional apathy, social withdrawal).

Question: What is the prodromal period in schizophrenia characterized by?

Answer: It involves a decline in personal functioning and emergence of negative symptoms.

Question: Describe the acute phase of schizophrenia.

Answer: It’s marked by positive symptoms, which may improve with treatment, but sometimes, negative symptoms persist and affect daily life.

Question: What’s the primary goal of initial treatment in schizophrenia?

Answer: To reduce acute phase symptoms and restore the patient to their baseline level of functioning.

Question: Why might patients with schizophrenia require maintenance treatment?

Answer: Many might experience further episodes, necessitating ongoing treatment to prevent relapses.

Question: How do antipsychotic drugs primarily help in schizophrenia treatment?

Answer: They are more effective at alleviating positive symptoms than negative symptoms.

Question: What factors influence the choice of antipsychotic drug for a patient?

Answer: Factors include side effects like extrapyramidal symptoms, cardiovascular effects, metabolic effects, hormonal changes, and patient/carer preference.

Question: How should treatment with antipsychotic drugs be approached?

Answer: Start with low doses, titrate slowly, and aim for an optimum dose for 4–6 weeks before assessing effectiveness.

Question: Why is the prescription of multiple antipsychotic drugs generally avoided?

Answer: It increases the risk of adverse effects such as extrapyramidal symptoms, QT-interval prolongation, and sudden cardiac death.

Question: When should clozapine be considered in schizophrenia treatment?

Answer: When at least two different antipsychotic drugs have been tried and failed, one of which should be a second-generation antipsychotic.

Question: What’s the consideration before adding a second antipsychotic drug to augment clozapine?

Answer: Check for non-response causes, review diagnosis, and assess plasma-clozapine concentration after allowing 8–10 weeks of treatment.

Question: In what situations are long-acting depot injectable antipsychotic drugs recommended?

Answer: They’re considered when preventing non-adherence is a clinical priority for patients with psychosis and schizophrenia.

Answer 1

Question: What are the two main categories of symptoms in psychosis and schizophrenia?

Answer: Positive symptoms (e.g., hallucinations, delusions) and negative symptoms (e.g., emotional apathy, social withdrawal).

Question: What is the prodromal period in schizophrenia characterized by?

Answer: It involves a decline in personal functioning and emergence of negative symptoms.

Question: Describe the acute phase of schizophrenia.

Answer: It’s marked by positive symptoms, which may improve with treatment, but sometimes, negative symptoms persist and affect daily life.

Question: What’s the primary goal of initial treatment in schizophrenia?

Answer: To reduce acute phase symptoms and restore the patient to their baseline level of functioning.

Question: Why might patients with schizophrenia require maintenance treatment?

Answer: Many might experience further episodes, necessitating ongoing treatment to prevent relapses.

Question: How do antipsychotic drugs primarily help in schizophrenia treatment?

Answer: They are more effective at alleviating positive symptoms than negative symptoms.

Question: What factors influence the choice of antipsychotic drug for a patient?

Answer: Factors include side effects like extrapyramidal symptoms, cardiovascular effects, metabolic effects, hormonal changes, and patient/carer preference.

Question: How should treatment with antipsychotic drugs be approached?

Answer: Start with low doses, titrate slowly, and aim for an optimum dose for 4–6 weeks before assessing effectiveness.

Question: Why is the prescription of multiple antipsychotic drugs generally avoided?

Answer: It increases the risk of adverse effects such as extrapyramidal symptoms, QT-interval prolongation, and sudden cardiac death.

Question: When should clozapine be considered in schizophrenia treatment?

Answer: When at least two different antipsychotic drugs have been tried and failed, one of which should be a second-generation antipsychotic.

Question: What’s the consideration before adding a second antipsychotic drug to augment clozapine?

Answer: Check for non-response causes, review diagnosis, and assess plasma-clozapine concentration after allowing 8–10 weeks of treatment.

Question: In what situations are long-acting depot injectable antipsychotic drugs recommended?

Answer: They’re considered when preventing non-adherence is a clinical priority for patients with psychosis and schizophrenia.

Question 2

Question: What receptors do first-generation antipsychotic drugs primarily block in the brain?

Answer: Dopamine D2 receptors.

Question: What are some common side effects associated with first-generation antipsychotic drugs?

Answer: Acute extrapyramidal symptoms and hyperprolactinaemia.

Question: Name the categories of first-generation antipsychotic drugs.

Answer: Phenothiazine derivatives, butyrophenones, thioxanthenes, diphenylbutylpiperidines, and substituted benzamides.

Question: How do second-generation antipsychotic drugs differ from first-generation ones regarding receptor action?

Answer: Second-generation drugs act on a broader range of receptors compared to first-generation drugs.

Question: What distinguishes second-generation antipsychotic drugs regarding the risk of extrapyramidal symptoms and tardive dyskinesia?

Answer: They are generally associated with a lower risk compared to first-generation drugs, but the extent varies among individual drugs.

Question: List some important adverse effects associated with second-generation antipsychotic drugs.

Answer: Weight gain and glucose intolerance are notable adverse effects.

Question: Name some examples of second-generation antipsychotic drugs.

Answer: Amisulpride, aripiprazole, asenapine, cariprazine, clozapine, lurasidone hydrochloride, olanzapine, paliperidone, quetiapine, and risperidone.

Answer 2

Question: What receptors do first-generation antipsychotic drugs primarily block in the brain?

Answer: Dopamine D2 receptors.

Question: What are some common side effects associated with first-generation antipsychotic drugs?

Answer: Acute extrapyramidal symptoms and hyperprolactinaemia.

Question: Name the categories of first-generation antipsychotic drugs.

Answer: Phenothiazine derivatives, butyrophenones, thioxanthenes, diphenylbutylpiperidines, and substituted benzamides.

Question: How do second-generation antipsychotic drugs differ from first-generation ones regarding receptor action?

Answer: Second-generation drugs act on a broader range of receptors compared to first-generation drugs.

Question: What distinguishes second-generation antipsychotic drugs regarding the risk of extrapyramidal symptoms and tardive dyskinesia?

Answer: They are generally associated with a lower risk compared to first-generation drugs, but the extent varies among individual drugs.

Question: List some important adverse effects associated with second-generation antipsychotic drugs.

Answer: Weight gain and glucose intolerance are notable adverse effects.

Question: Name some examples of second-generation antipsychotic drugs.

Answer: Amisulpride, aripiprazole, asenapine, cariprazine, clozapine, lurasidone hydrochloride, olanzapine, paliperidone, quetiapine, and risperidone.

Question 3

Question: Is there robust evidence supporting the effectiveness of high-dose antipsychotic drug treatment in schizophrenia?

Answer: No, there is no robust evidence indicating that high doses are more effective than standard doses for treating schizophrenia.

Question: What is the relationship between adverse effects and antipsychotic drug treatment doses?

Answer: Adverse effects associated with antipsychotic treatment are often dose-related, and there’s clear evidence of a greater side-effect burden with high-dose antipsychotic drug use.

Question: What factors are strongly associated with high-dose prescribing of antipsychotic drugs?

Answer: Antipsychotic polypharmacy and ‘when required’ antipsychotic drug treatment are strongly linked to high-dose prescribing practices.

Question: What should be considered when prescribing antipsychotic drugs for emergency use (e.g., rapid tranquillisation)?

Answer: Initial treatment aims to calm and sedate without inducing sleep. The prescription should start with a single dose, to be reviewed before repeating. Oral and intramuscular drugs should be prescribed separately. Patients must be monitored for side effects and vital signs, hourly at least, and every 15 minutes if a high dose is given.

Question: Where can further information and advice on prescribing high-dose antipsychotic medication be found?

Answer: The Royal College of Psychiatrists consensus statement provides detailed guidance and information, available at https://www.rcpsych.ac.uk/.

Answer 3

Question: Is there robust evidence supporting the effectiveness of high-dose antipsychotic drug treatment in schizophrenia?

Answer: No, there is no robust evidence indicating that high doses are more effective than standard doses for treating schizophrenia.

Question: What is the relationship between adverse effects and antipsychotic drug treatment doses?

Answer: Adverse effects associated with antipsychotic treatment are often dose-related, and there’s clear evidence of a greater side-effect burden with high-dose antipsychotic drug use.

Question: What factors are strongly associated with high-dose prescribing of antipsychotic drugs?

Answer: Antipsychotic polypharmacy and ‘when required’ antipsychotic drug treatment are strongly linked to high-dose prescribing practices.

Question: What should be considered when prescribing antipsychotic drugs for emergency use (e.g., rapid tranquillisation)?

Answer: Initial treatment aims to calm and sedate without inducing sleep. The prescription should start with a single dose, to be reviewed before repeating. Oral and intramuscular drugs should be prescribed separately. Patients must be monitored for side effects and vital signs, hourly at least, and every 15 minutes if a high dose is given.

Question: Where can further information and advice on prescribing high-dose antipsychotic medication be found?

Answer: The Royal College of Psychiatrists consensus statement provides detailed guidance and information, available at https://www.rcpsych.ac.uk/.

Question 4

Question: Is there robust evidence supporting the effectiveness of high-dose antipsychotic drug treatment in schizophrenia?

Answer: No, there is no robust evidence indicating that high doses are more effective than standard doses for treating schizophrenia.

Question: What is the relationship between adverse effects and antipsychotic drug treatment doses?

Answer: Adverse effects associated with antipsychotic treatment are often dose-related, and there’s clear evidence of a greater side-effect burden with high-dose antipsychotic drug use.

Question: What factors are strongly associated with high-dose prescribing of antipsychotic drugs?

Answer: Antipsychotic polypharmacy and ‘when required’ antipsychotic drug treatment are strongly linked to high-dose prescribing practices.

Question: What should be considered when prescribing antipsychotic drugs for emergency use (e.g., rapid tranquillisation)?

Answer: Initial treatment aims to calm and sedate without inducing sleep. The prescription should start with a single dose, to be reviewed before repeating. Oral and intramuscular drugs should be prescribed separately. Patients must be monitored for side effects and vital signs, hourly at least, and every 15 minutes if a high dose is given.

Question: Where can further information and advice on prescribing high-dose antipsychotic medication be found?

Answer: The Royal College of Psychiatrists consensus statement provides detailed guidance and information, available at https://www.rcpsych.ac.uk/.

Answer 4

Question: Is there robust evidence supporting the effectiveness of high-dose antipsychotic drug treatment in schizophrenia?

Answer: No, there is no robust evidence indicating that high doses are more effective than standard doses for treating schizophrenia.

Question: What is the relationship between adverse effects and antipsychotic drug treatment doses?

Answer: Adverse effects associated with antipsychotic treatment are often dose-related, and there’s clear evidence of a greater side-effect burden with high-dose antipsychotic drug use.

Question: What factors are strongly associated with high-dose prescribing of antipsychotic drugs?

Answer: Antipsychotic polypharmacy and ‘when required’ antipsychotic drug treatment are strongly linked to high-dose prescribing practices.

Question: What should be considered when prescribing antipsychotic drugs for emergency use (e.g., rapid tranquillisation)?

Answer: Initial treatment aims to calm and sedate without inducing sleep. The prescription should start with a single dose, to be reviewed before repeating. Oral and intramuscular drugs should be prescribed separately. Patients must be monitored for side effects and vital signs, hourly at least, and every 15 minutes if a high dose is given.

Question: Where can further information and advice on prescribing high-dose antipsychotic medication be found?

Answer: The Royal College of Psychiatrists consensus statement provides detailed guidance and information, available at https://www.rcpsych.ac.uk/.

Question 5

Question: What considerations are important before prescribing antipsychotic drugs to elderly patients?

Answer: The balance of risk and benefit should be discussed with the patient or carers due to increased risks in this population.

Question: What risks are associated with the use of antipsychotic drugs in elderly patients with dementia?

Answer: There’s a small increased risk of mortality, an elevated risk of stroke or transient ischaemic attack, and a susceptibility to postural hypotension.

Question: When is it recommended to use antipsychotic drugs in elderly patients with dementia?

Answer: They should only be considered if the patient is at risk of self-harm or harming others, or if they experience severe distress due to agitation, hallucinations, or delusions.

Question: What dosing strategy is advised for antipsychotic drugs in elderly patients?

Answer: Use the lowest effective dose for the shortest possible duration.

Question: How frequently should treatment with antipsychotic drugs in elderly patients be reviewed?

Answer: Regular reviews are essential, recommended at least every 6 weeks (earlier for in-patients) to assess efficacy and monitor for adverse effects.

Answer 5

Question: What considerations are important before prescribing antipsychotic drugs to elderly patients?

Answer: The balance of risk and benefit should be discussed with the patient or carers due to increased risks in this population.

Question: What risks are associated with the use of antipsychotic drugs in elderly patients with dementia?

Answer: There’s a small increased risk of mortality, an elevated risk of stroke or transient ischaemic attack, and a susceptibility to postural hypotension.

Question: When is it recommended to use antipsychotic drugs in elderly patients with dementia?

Answer: They should only be considered if the patient is at risk of self-harm or harming others, or if they experience severe distress due to agitation, hallucinations, or delusions.

Question: What dosing strategy is advised for antipsychotic drugs in elderly patients?

Answer: Use the lowest effective dose for the shortest possible duration.

Question: How frequently should treatment with antipsychotic drugs in elderly patients be reviewed?

Answer: Regular reviews are essential, recommended at least every 6 weeks (earlier for in-patients) to assess efficacy and monitor for adverse effects.

Question 6

Question: What should be considered for patients with learning disabilities who are taking antipsychotic drugs but not experiencing psychotic symptoms?

Answer: Considerations include reducing the dose or discontinuing long-term antipsychotic treatment.

Question: What is recommended after reducing the dose or discontinuing an antipsychotic drug in patients with learning disabilities?

Answer: It’s advised to review the patient’s condition to assess the effects of the dose reduction or discontinuation.

Question: What specialist referral is suggested for patients with learning disabilities taking antipsychotic drugs?

Answer: Referral to a psychiatrist experienced in working with patients who have learning disabilities and mental health problems is recommended.

Question: What documentation is advised regarding the prescription of antipsychotic drugs for patients with learning disabilities?

Answer: Annual documentation of reasons for continuing a prescription is suggested if the antipsychotic drug is not reduced or discontinued.

Answer 6

Question: What should be considered for patients with learning disabilities who are taking antipsychotic drugs but not experiencing psychotic symptoms?

Answer: Considerations include reducing the dose or discontinuing long-term antipsychotic treatment.

Question: What is recommended after reducing the dose or discontinuing an antipsychotic drug in patients with learning disabilities?

Answer: It’s advised to review the patient’s condition to assess the effects of the dose reduction or discontinuation.

Question: What specialist referral is suggested for patients with learning disabilities taking antipsychotic drugs?

Answer: Referral to a psychiatrist experienced in working with patients who have learning disabilities and mental health problems is recommended.

Question: What documentation is advised regarding the prescription of antipsychotic drugs for patients with learning disabilities?

Answer: Annual documentation of reasons for continuing a prescription is suggested if the antipsychotic drug is not reduced or discontinued.

Question 7

Question: What is the efficacy difference between most antipsychotic drugs, except for clozapine?

Answer: There is little difference in efficacy among most antipsychotic drugs, except for clozapine. Response and tolerability to each drug can vary.

Question: Is there a first-line antipsychotic drug suitable for all patients?

Answer: No, there’s no universally suitable first-line antipsychotic drug. The properties of individual drugs should be considered and discussed with the patient or carers when prescribing.

Question: What is a significant issue associated with both first-generation and second-generation antipsychotic drugs?

Answer: They are associated with common side effects that significantly contribute to non-adherence and treatment discontinuation.

Question: Why is it essential to consider and discuss the properties of individual antipsychotic drugs with patients or carers?

Answer: Variation in response and tolerability among different antipsychotic drugs means individual patient preferences and experiences are crucial in choosing the most suitable medication.

Answer 7

Question: What is the efficacy difference between most antipsychotic drugs, except for clozapine?

Answer: There is little difference in efficacy among most antipsychotic drugs, except for clozapine. Response and tolerability to each drug can vary.

Question: Is there a first-line antipsychotic drug suitable for all patients?

Answer: No, there’s no universally suitable first-line antipsychotic drug. The properties of individual drugs should be considered and discussed with the patient or carers when prescribing.

Question: What is a significant issue associated with both first-generation and second-generation antipsychotic drugs?

Answer: They are associated with common side effects that significantly contribute to non-adherence and treatment discontinuation.

Question: Why is it essential to consider and discuss the properties of individual antipsychotic drugs with patients or carers?

Answer: Variation in response and tolerability among different antipsychotic drugs means individual patient preferences and experiences are crucial in choosing the most suitable medication.

Question 8

Question: Which antipsychotic drugs are most likely to cause extrapyramidal symptoms?

Answer: High doses of high-potency first-generation antipsychotic drugs like fluphenazine, trifluoperazine, haloperidol, and some first-generation depot preparations are more likely to cause extrapyramidal symptoms.

Question: Are some second-generation antipsychotics less likely to cause extrapyramidal symptoms?

Answer: Yes, some second-generation antipsychotics like clozapine, olanzapine, quetiapine, and aripiprazole (QOAC)have a lower liability for both acute and late-onset extrapyramidal symptoms.

Question: How do parkinsonian symptoms, dystonia, akathisia, and tardive dyskinesia manifest?

Answer: Parkinsonian symptoms appear gradually, dystonia is more common in young males, akathisia can occur within hours to weeks of starting treatment, and tardive dyskinesia develops on long-term or high-dose therapy, sometimes even after discontinuation.

Question: What should be considered in managing parkinsonian symptoms caused by antipsychotic drugs?

Answer: Treatment review should aim to reduce exposure to high-dose and high-potency antipsychotic drugs. Antimuscarinic drugs may alleviate symptoms but should not be routinely prescribed for prophylaxis.

Question: What is an important consideration regarding tardive dyskinesia?

Answer: Tardive dyskinesia is the most serious manifestation of late-onset extrapyramidal symptoms without a satisfactory treatment. Changes in antipsychotic treatment should be made gradually to minimize the risk of withdrawal tardive dyskinesia. Early signs may prompt drug withdrawal to halt its full development, according to some manufacturers.

Answer 8

Question: Which antipsychotic drugs are most likely to cause extrapyramidal symptoms?

Answer: High doses of high-potency first-generation antipsychotic drugs like fluphenazine, trifluoperazine, haloperidol, and some first-generation depot preparations are more likely to cause extrapyramidal symptoms.

Question: Are some second-generation antipsychotics less likely to cause extrapyramidal symptoms?

Answer: Yes, some second-generation antipsychotics like clozapine, olanzapine, quetiapine, and aripiprazole (QOAC)have a lower liability for both acute and late-onset extrapyramidal symptoms.

Question: How do parkinsonian symptoms, dystonia, akathisia, and tardive dyskinesia manifest?

Answer: Parkinsonian symptoms appear gradually, dystonia is more common in young males, akathisia can occur within hours to weeks of starting treatment, and tardive dyskinesia develops on long-term or high-dose therapy, sometimes even after discontinuation.

Question: What should be considered in managing parkinsonian symptoms caused by antipsychotic drugs?

Answer: Treatment review should aim to reduce exposure to high-dose and high-potency antipsychotic drugs. Antimuscarinic drugs may alleviate symptoms but should not be routinely prescribed for prophylaxis.

Question: What is an important consideration regarding tardive dyskinesia?

Answer: Tardive dyskinesia is the most serious manifestation of late-onset extrapyramidal symptoms without a satisfactory treatment. Changes in antipsychotic treatment should be made gradually to minimize the risk of withdrawal tardive dyskinesia. Early signs may prompt drug withdrawal to halt its full development, according to some manufacturers.

Question 9

Question: Which antipsychotic drugs are known to reduce prolactin concentration?

Answer: Aripiprazole reduces prolactin concentration in a dose-dependent manner as it acts as a dopamine-receptor partial agonist.

Question: Which antipsychotic drugs are most likely to cause symptomatic hyperprolactinemia?

Answer: Risperidone, amisulpride, sulpiride,(RAS) and first-generation antipsychotic drugs are most likely to cause symptomatic hyperprolactinemia.

Question: Are there antipsychotic drugs with a lower risk of causing hyperprolactinemia?

Answer: Yes, hyperprolactinemia is very rare with aripiprazole, asenapine, cariprazine, clozapine, and quetiapine treatments.

Question: What are the clinical symptoms associated with hyperprolactinemia?

Answer: Symptoms include sexual dysfunction, reduced bone mineral density, menstrual disturbances, breast enlargement, galactorrhea, and a potential increased risk of breast cancer.

Answer 9

Question: Which antipsychotic drugs are known to reduce prolactin concentration?

Answer: Aripiprazole reduces prolactin concentration in a dose-dependent manner as it acts as a dopamine-receptor partial agonist.

Question: Which antipsychotic drugs are most likely to cause symptomatic hyperprolactinemia?

Answer: Risperidone, amisulpride, sulpiride, and first-generation antipsychotic drugs are most likely to cause symptomatic hyperprolactinemia.

Question: Are there antipsychotic drugs with a lower risk of causing hyperprolactinemia?

Answer: Yes, hyperprolactinemia is very rare with aripiprazole, asenapine, cariprazine, clozapine, and quetiapine treatments.

Question: What are the clinical symptoms associated with hyperprolactinemia?

Answer: Symptoms include sexual dysfunction, reduced bone mineral density, menstrual disturbances, breast enlargement, galactorrhea, and a potential increased risk of breast cancer.

Question 10

Question: What are some cardiovascular side effects associated with antipsychotic drugs?

Answer: Antipsychotic drugs can cause tachycardia, arrhythmias, hypotension, and QT-interval prolongation.

Question: Which antipsychotic drug has a particular concern for QT-interval prolongation?

Answer: Pimozide is notably associated with QT-interval prolongation.

Question: Is the risk of QT-interval prolongation dose-related?

Answer: Yes, the overall risk of QT-interval prolongation is probably dose-related.

Question: Are there specific antipsychotic drugs or combinations that are more likely to cause QT-interval prolongation?

Answer: Any intravenous antipsychotic drug or any antipsychotic drug or combination exceeding recommended maximum doses carries a higher probability of QT-interval prolongation.

Question: Which antipsychotic drugs have a lower tendency to prolong the QT interval?

Answer: Antipsychotic drugs with a low tendency to prolong the QT interval include aripiprazole, asenapine, clozapine, flupentixol, fluphenazine decanoate, loxapine, olanzapine, paliperidone, prochlorperazine, risperidone, and sulpiride.

Answer 10

Question: What are some cardiovascular side effects associated with antipsychotic drugs?

Answer: Antipsychotic drugs can cause tachycardia, arrhythmias, hypotension, and QT-interval prolongation.

Question: Which antipsychotic drug has a particular concern for QT-interval prolongation?

Answer: Pimozide is notably associated with QT-interval prolongation.

Question: Is the risk of QT-interval prolongation dose-related?

Answer: Yes, the overall risk of QT-interval prolongation is probably dose-related.

Question: Are there specific antipsychotic drugs or combinations that are more likely to cause QT-interval prolongation?

Answer: Any intravenous antipsychotic drug or any antipsychotic drug or combination exceeding recommended maximum doses carries a higher probability of QT-interval prolongation.

Question: Which antipsychotic drugs have a lower tendency to prolong the QT interval?

Answer: Antipsychotic drugs with a low tendency to prolong the QT interval include aripiprazole, asenapine, clozapine, flupentixol, fluphenazine decanoate, loxapine, olanzapine, paliperidone, prochlorperazine, risperidone, and sulpiride.

Question 11

Question: What is postural hypotension, and when does it commonly occur with antipsychotic drugs?

Answer: Postural hypotension is a drop in blood pressure upon standing and typically occurs acutely during initial dose titration of antipsychotic drugs.

Question: Can postural hypotension become a chronic problem with antipsychotic drug use?

Answer: Yes, while it usually presents acutely during dose titration, it can also persist as a chronic issue.

Question: What risks does postural hypotension pose, especially in the elderly?

Answer: Postural hypotension can lead to syncope (fainting) and dangerous falls, especially in elderly patients, causing injuries.

Question: Which second-generation antipsychotics are most likely to cause postural hypotension?

Answer: Clozapine and quetiapine are among the second-generation antipsychotics most likely to cause postural hypotension.

Question: How is postural hypotension managed or minimized during antipsychotic drug use?

Answer: Slow dose titration is a common approach used to minimize the risk of postural hypotension associated with antipsychotic drugs.

Answer 11

Question: What is postural hypotension, and when does it commonly occur with antipsychotic drugs?

Answer: Postural hypotension is a drop in blood pressure upon standing and typically occurs acutely during initial dose titration of antipsychotic drugs.

Question: Can postural hypotension become a chronic problem with antipsychotic drug use?

Answer: Yes, while it usually presents acutely during dose titration, it can also persist as a chronic issue.

Question: What risks does postural hypotension pose, especially in the elderly?

Answer: Postural hypotension can lead to syncope (fainting) and dangerous falls, especially in elderly patients, causing injuries.

Question: Which second-generation antipsychotics are most likely to cause postural hypotension?

Answer: Clozapine and quetiapine are among the second-generation antipsychotics most likely to cause postural hypotension.

Question: How is postural hypotension managed or minimized during antipsychotic drug use?

Answer: Slow dose titration is a common approach used to minimize the risk of postural hypotension associated with antipsychotic drugs.

Question 12

Question: What association exists between schizophrenia, antipsychotic drugs, and diabetes?

Answer: Schizophrenia is associated with insulin resistance and an increased risk of diabetes, particularly among patients taking antipsychotic drugs.

Question: Is there a difference in the likelihood of causing diabetes between first- and second-generation antipsychotic drugs?

Answer: Some evidence suggests that first-generation antipsychotic drugs are less likely to cause diabetes compared to second-generation drugs.

Question: Among first-generation antipsychotic drugs, which ones have the lowest risk of causing diabetes?

Answer: Fluphenazine decanoate and haloperidol are identified to have the lowest risk of causing diabetes among the first-generation antipsychotic drugs.

Question: Which second-generation antipsychotic drugs have the lowest risk of causing diabetes?

Answer: Amisulpride and aripiprazole are noted to have the lowest risk of causing diabetes among the second-generation antipsychotic drugs.

Question: Why is the risk of diabetes considered when prescribing antipsychotic drugs?

Answer: Considering the increased risk of diabetes in patients with schizophrenia and its association with antipsychotic drug use, selecting medications with lower diabetes risk is crucial for patient management.

Answer 12

Question: What association exists between schizophrenia, antipsychotic drugs, and diabetes?

Answer: Schizophrenia is associated with insulin resistance and an increased risk of diabetes, particularly among patients taking antipsychotic drugs.

Question: Is there a difference in the likelihood of causing diabetes between first- and second-generation antipsychotic drugs?

Answer: Some evidence suggests that first-generation antipsychotic drugs are less likely to cause diabetes compared to second-generation drugs.

Question: Among first-generation antipsychotic drugs, which ones have the lowest risk of causing diabetes?

Answer: Fluphenazine decanoate and haloperidol are identified to have the lowest risk of causing diabetes among the first-generation antipsychotic drugs.

Question: Which second-generation antipsychotic drugs have the lowest risk of causing diabetes?

Answer: Amisulpride and aripiprazole are noted to have the lowest risk of causing diabetes among the second-generation antipsychotic drugs.

Question: Why is the risk of diabetes considered when prescribing antipsychotic drugs?

Answer: Considering the increased risk of diabetes in patients with schizophrenia and its association with antipsychotic drug use, selecting medications with lower diabetes risk is crucial for patient management.

Question 13

Question: Is weight gain a common side effect across all antipsychotic drugs?

Answer: Yes, weight gain is a potential side effect associated with all antipsychotic drugs, but the risk and extent vary.

Question: Which antipsychotic drugs are commonly associated with weight gain?

Answer: Clozapine and olanzapine are known to commonly cause weight gain among the antipsychotic drugs.

Question: Are there antipsychotic drugs less likely to cause weight gain?

Answer: Yes, among the antipsychotic drugs, amisulpride, asenapine, aripiprazole, cariprazine, haloperidol, lurasidone hydrochloride, sulpiride, and trifluoperazine are noted as least likely to cause weight gain.

Question: Why is understanding weight gain important in antipsychotic drug prescription?

Answer: Awareness of the likelihood of weight gain associated with different antipsychotic drugs helps in selecting medications that may have a lower propensity for this side effect, thus aiding in patient management and treatment adherence.

Answer 13

Question: Is weight gain a common side effect across all antipsychotic drugs?

Answer: Yes, weight gain is a potential side effect associated with all antipsychotic drugs, but the risk and extent vary.

Question: Which antipsychotic drugs are commonly associated with weight gain?

Answer: Clozapine and olanzapine are known to commonly cause weight gain among the antipsychotic drugs.

Question: Are there antipsychotic drugs less likely to cause weight gain?

Answer: Yes, among the antipsychotic drugs, amisulpride, asenapine, aripiprazole, cariprazine, haloperidol, lurasidone hydrochloride, sulpiride, and trifluoperazine are noted as least likely to cause weight gain.

Question: Why is understanding weight gain important in antipsychotic drug prescription?

Answer: Awareness of the likelihood of weight gain associated with different antipsychotic drugs helps in selecting medications that may have a lower propensity for this side effect, thus aiding in patient management and treatment adherence.

Question 14

Question: What is neuroleptic malignant syndrome (NMS), and what are its symptoms?

Answer: NMS is a rare but potentially fatal side effect of antipsychotic drugs characterized by hyperthermia, fluctuating level of consciousness, muscle rigidity, and autonomic dysfunction (fever, tachycardia, labile blood pressure, and sweating).

Question: Is neuroleptic malignant syndrome associated with specific types of antipsychotic drugs?

Answer: NMS can occur as a side effect of all antipsychotic drugs, regardless of their classification.

Question: What is the recommended course of action if neuroleptic malignant syndrome is suspected?

Answer: Expert advice suggests discontinuation of the antipsychotic drug, typically for at least 5 days or longer. The signs and symptoms of NMS should completely resolve.

Question: Are there specific treatments for neuroleptic malignant syndrome?

Answer: Bromocriptine and dantrolene have been used in the treatment of neuroleptic malignant syndrome, but their use should be guided by medical professionals.

Answer 14

Question: What is neuroleptic malignant syndrome (NMS), and what are its symptoms?

Answer: NMS is a rare but potentially fatal side effect of antipsychotic drugs characterized by hyperthermia, fluctuating level of consciousness, muscle rigidity, and autonomic dysfunction (fever, tachycardia, labile blood pressure, and sweating).

Question: Is neuroleptic malignant syndrome associated with specific types of antipsychotic drugs?

Answer: NMS can occur as a side effect of all antipsychotic drugs, regardless of their classification.

Question: What is the recommended course of action if neuroleptic malignant syndrome is suspected?

Answer: Expert advice suggests discontinuation of the antipsychotic drug, typically for at least 5 days or longer. The signs and symptoms of NMS should completely resolve.

Question: Are there specific treatments for neuroleptic malignant syndrome?

Answer: Bromocriptine and dantrolene have been used in the treatment of neuroleptic malignant syndrome, but their use should be guided by medical professionals.

Question 15

Question: How often should weight be measured in patients starting antipsychotic drug therapy?

Answer: Weight should be measured at the start of therapy, weekly for the first 6 weeks, at 12 weeks, at 1 year, and then yearly thereafter.

Question: Which parameters related to glucose, lipids, and prolactin should be monitored in patients taking antipsychotic drugs?

Answer: Fasting blood glucose, HbA1c, blood lipid concentrations, and prolactin concentrations should be measured at baseline, at 12 weeks, at 1 year, and then yearly.

Question: Under what circumstances might an ECG be necessary before initiating antipsychotic drugs?

Answer: An ECG may be required before starting antipsychotic drugs, especially if there are cardiovascular risk factors, a personal history of cardiovascular disease, or in the case of inpatient admission.

Question: How often should blood pressure be monitored during antipsychotic drug therapy?

Answer: Blood pressure monitoring is advised before starting therapy, at 12 weeks, at 1 year, and then yearly during treatment and dose titration.

Question: Which laboratory tests should be conducted at the start of therapy and then yearly for patients on antipsychotic drugs?

Answer: Full blood count, urea and electrolytes, and liver function tests should be monitored at the start of therapy and then yearly thereafter.

Answer 15

Question: How often should weight be measured in patients starting antipsychotic drug therapy?

Answer: Weight should be measured at the start of therapy, weekly for the first 6 weeks, at 12 weeks, at 1 year, and then yearly thereafter.

Question: Which parameters related to glucose, lipids, and prolactin should be monitored in patients taking antipsychotic drugs?

Answer: Fasting blood glucose, HbA1c, blood lipid concentrations, and prolactin concentrations should be measured at baseline, at 12 weeks, at 1 year, and then yearly.

Question: Under what circumstances might an ECG be necessary before initiating antipsychotic drugs?

Answer: An ECG may be required before starting antipsychotic drugs, especially if there are cardiovascular risk factors, a personal history of cardiovascular disease, or in the case of inpatient admission.

Question: How often should blood pressure be monitored during antipsychotic drug therapy?

Answer: Blood pressure monitoring is advised before starting therapy, at 12 weeks, at 1 year, and then yearly during treatment and dose titration.

Question: Which laboratory tests should be conducted at the start of therapy and then yearly for patients on antipsychotic drugs?

Answer: Full blood count, urea and electrolytes, and liver function tests should be monitored at the start of therapy and then yearly thereafter.

Question 16

Question: When might long-acting depot injections of antipsychotic drugs be considered?

Answer: Long-acting depot injections may be considered for patients with psychosis or schizophrenia who prefer this treatment after an acute episode or when preventing non-adherence is a clinical priority.

Question: Are there differences in adverse effects between first- and second-generation antipsychotic depot injections?

Answer: First-generation antipsychotic depot injections may lead to a higher incidence of adverse effects like extrapyramidal reactions. Second-generation antipsychotic depot preparations such as aripiprazole, paliperidone, risperidone, and olanzapine embonate have fewer extrapyramidal reactions.

Question: Are there variations in efficacy among different first-generation antipsychotic depot injections?

Answer: There are minimal differences in efficacy between individual first-generation antipsychotic depot injections. Zuclopenthixol decanoate may be more effective in preventing relapses compared to other first-generation depot preparations.

Question: What is crucial in achieving the optimum effect with antipsychotic depot injections?

Answer: Individual responses to antipsychotic drugs vary. Experts recommend titrating dosage and dosage intervals according to the patient’s response to achieve the best possible effect.

Answer 16

Question: When might long-acting depot injections of antipsychotic drugs be considered?

Answer: Long-acting depot injections may be considered for patients with psychosis or schizophrenia who prefer this treatment after an acute episode or when preventing non-adherence is a clinical priority.

Question: Are there differences in adverse effects between first- and second-generation antipsychotic depot injections?

Answer: First-generation antipsychotic depot injections may lead to a higher incidence of adverse effects like extrapyramidal reactions. Second-generation antipsychotic depot preparations such as aripiprazole, paliperidone, risperidone, and olanzapine embonate have fewer extrapyramidal reactions.

Question: Are there variations in efficacy among different first-generation antipsychotic depot injections?

Answer: There are minimal differences in efficacy between individual first-generation antipsychotic depot injections. Zuclopenthixol decanoate may be more effective in preventing relapses compared to other first-generation depot preparations.

Question: What is crucial in achieving the optimum effect with antipsychotic depot injections?

Answer: Individual responses to antipsychotic drugs vary. Experts recommend titrating dosage and dosage intervals according to the patient’s response to achieve the best possible effect.