Psychosis And Schizophrenia Flashcards
What receptors do typical vs atypical antipsychotics work on
Typical: D2 receptor antagonist (block)
Atypical: D2, D3, D4 and 5-HT antagonists
(Clozapine has high affinity to D4)
What type of antipsychotics are hyperprolactineamia more common in
Typical (haloperidol and chlorpromazine)
3 types of symptoms in schizophrenia
Positive - delusions and hallucinations
Negative - self neglect, apathy, anergia, alogia
Disorganised - disorganised thinking and speech
What is the commonest type of schizophrenia?
Paranoid
What is hebephrenic schizophrenia
Disorganised
Prominent mood changes - often inappropriate and accompanied by giggling
Disorganised thought, speech rambling
Behaviour empty of purpose
What is catatonic schizophrenia
Psychomotor disturbances - sudden jerky movements (hyperkinesis) followed by states of stupor (almost unconscious in movements)
Now very rare
What is undifferentiated schizophrenia
Patients that meet general diagnostic criteria but not a subtype
What is post schizophrenia depression
Patient has had schizophrenia in last 12 months
Now has depressive symptoms
What is residual schizophrenia
Patient had schizophrenia
Now has ONLY NEGATIVE symptoms
What is simple schizophrenia
Dominated by negative symptoms
Hard to define
What is avolition
Lack of energy or ambition to do tasks with an end goal
Negative schizophrenia symptom
What is apathy
Lack of feeling or emotion
Negative schizophrenia symptom
What is affective flattening
Flat affect
Reduction in range of emotions and feelings
Is affective flattening a positive or negative schizophrenia symptom
Negative
What is a labile mood
Unstable and changes lots
How long must schizophrenia symptoms be present for, for a diagnosis
At least 1 month with signs of disturbance for 6 months
For a diagnosis of schizophrenia a person must have two of what five key symptoms
Delusions Hallucinations Disorganised thought/ speech Disorganised behaviour Negative symptoms
Concordance rate of schizophrenia in monozygotic twins
50%
Why may lorazepam be initially used in a patient who was diagnosed with schizophrenia
Antipsychotics can take several days to work
When may clozapine be used in a pt with schizophrenia
After two other antipsychotic drugs have been tied for 6-8 weeks each
Common atypical antipsychotic that doesn’t end in -apine
Risperidone
Aripriprazole
Key risk with clozapine
Angrolocytosis (1%) 18 weeks of weekly FBC
5 receptors that antipsychotics act on
Dopamine Serotonin Histamine Adrenergic Cholinergic
5 groups of side effects from antipsychotics
Linked to receptor they act on:
Antidopaminergic - EPSE, negative symptoms, hyperprolactinaemia, NMS, weight gain
Serotonergic - anxiety, insomnia, diabetes
Antihistamine - sedation (may be good)
Antiadrenergic - postural hypotension, ejection failure
Anticholinergic - dry mouth, blared vision, constipation, urinary retention
What receptor do antipsychotics work on that helps negative symptoms and what helps positive symptoms
Positive - antidopaminergic
Negative - serotnergic
Cardiac condition associated with clozapine
Myocarditis and QTC prolongation (risk of TDP)
When should patients on clozapine have an ECG
At initiation and then yearly
4 key EPSE’s
Acute dystonias - painful spastic contractions of muscles
Akathisia - inner feeling of restlessness
Parkinson like - tremor, rigidity, bradykinesia
Tardive dyskinesia - involuntary movements of face and tongue
What is akathisia
Inner feeling of restlessness
Fidgeting leg movements, pacing
