Psychosis and schizophrenia Flashcards
What is the prodromal period prior to psychosis characterised by
Transient, low-intensity psychotic symptoms
Reduced interest in daily activities
Problems with mood, sleep, memory, concentration, communication, affect, motivation
Anxiety, irritability or depressive features
Incoherent or illogical speech
Hallmark symptoms of psychotic illness
Delusions
Hallucinations
Thought disorder
Lack of insight
First rank symptoms
Lack of insight Auditory hallucinations Thought insertion Thought broadcasting Delusional perceptions External control of emotions Somatic passivity
Negative symptoms of schizophrenia
Under activity - which also affects speech Low motivation Social withdrawal Emotional flattening Self-neglect
Typical appearance and behaviour in an individual with schizophrenia
Withdrawal, suspicion, or(rarely) stereotypical behaviours and mannerisms
Typical speech in schizophrenia
Interruptions to the flow of thought(thought blocking), loosening of associations/loss of normal thought structure(knight’s move thinking)
Typical mood/affect in schizophrenia
Flattened, incongruous or ‘odd’
Organic disorders which may give rise to psychotic symptoms
Drug-induced psychosis Temporal lobe epilepsy Encephalitis Alcoholic hallucinosis Dementia Delirium Cerebral syphilis
Management of someone at risk of psychosis in primary care
Determine the level of risk to the person
Assess the person’s risk of unintentional harm to themselves
Determine risk of harms to others
Social factors in management of schizophrenia
Rates of homelessness, poverty and economic deprivation are increased in psychosis
Use of recovery action plan should be promoted
Features of psychological support for schizophrenia and psychosis
Education
Voluntary organisations and support groups
Family therapy
CBT
Art therapy for alleviation of negative symptoms
First-line pharmacological treatment for schizophrenia
Atypical antipsychotics eg. risperidone and olanzapine
When should depot formulations be considered
If patient prefers it after an acute episode or if there is non-compliance with medication
When is clozapine advised for management of schizophrenia
If symptoms have not responded to adequate doses of at least two different antipsychotics used sequentially for 6-8 weeks
When is ECT advised in management of schizophrenia
May be appropriate in patients resistant to pharmacological therapy
Which medications can cause psychosis
Adrenergic agents Anticholinergic(antihistamines) Benzodiazepines Corticosteroids Dopamine agonists
Why does an affective presentation of psychosis have a better prognosis than a non-affective presentation of schizophrenia
Lower likelihood of progression to schizophrenia
Main receptor targeted by antipsychotics
Dopamine receptor
Which set of symptoms are antipsychotics more effective at treating in schizophrenia
Alleviation of positive symptoms than negative symptoms
General advice regarding prescribing more than one antipsychotic drug at a time
Should be avoided in exceptional circumstances(e.g. clozapine augmentation or when changing meds during titration) because of the increased risk of adverse effects
How do first-generation antipsychotic drugs generally work
Act predominantly by blocking dopamine D2 receptors in the brain
Examples of 1st gen antipsychotics
Chlorpromazine hydrochloride
Haloperidol
Which side effects are 1st gen antipsychotics more likely to cause
Acute EPS symptoms and hyperprolactinaemia
Examples of extrapyramidal side effects
Dystonia
Akathisia
Parkinsonism characteristic symptoms such as rigidity, bradykinesia, tremor and tardive dyskinesia
What is tardive dyskinesia
Irregular, jerky movements
What is oculogyric crisis and which drug causes it as a side effect commonly
Acute dystonic reaction that involves the prolonged involuntary upward deviation of the eyes
Haloperidol
Management of extra-pyramidal symptoms
Anticholinergic agents such as IV procyclidine
Why should antipsychotics be prescribed with care in the elderly
Small increased risk of mortality and an increased risk of stroke or TIA
Furthermore, elderly patients are particularly susceptible to postural hypotension
Recommendations for use of antipsychotics in the elderly
Should not be used in patients with dementia unless at risk of harm to themselves or others
Lowest effective dose should be used for the shortest period of time
Treatment should be reviewed regularly(every 6 weeks)
Clinical symptoms of hyperprolactinaemia
Sexual dysfunction Reduced bone mineral density Menstrual disturbances Breast enlargement Galactorrhoea Possible increased risk of breast cancer
Which antipsychotics are more likely to cause symptomatic hyperprolactinaemia
Risperidone
Amisulpride
First gen antipsychotic drugs
Which antipsychotics are more likely to cause sexual dysfunction
Risperidone
Halperidol
Olanzapine
Cardiovascular side-effects associated with antipsychotics
Tachycardia
Arrhythmias
Hypotension
QT-interval prolongation
What type of antipsychotic usage increases risk of QT-interval prolongation in patients
IV antipsychotic drug usage
Doses exceeding maximum
Which second-generation antipsychotics are most likely to cause postural hypotension
Clozapine
Quetiapine
Link between schizphrenia and diabetes
Associated with insulin resistance and diabetes
Which antipsychotics are linked with weight gain
Clozapine and olanzapine
Symptoms of neuroleptic malignant syndrome
Hyperthermia Fluctuating GCS Muscle rigidity Autonomic dysfunction with fever Tachycardia Labile blood pressure Sweating
Pharmacological interventions in NMS
Bromocriptine
Dantrolene
Clozapine side effects
Agranulocytosis Weight gain Hypersalivation Myocarditis Constipation
Monitoring of patient parameters for clozapine
WCC monitoring weekly for 18 weeks, then fortnightly for up to one year, and then monthly
