Psychosis and Schizophrenia Flashcards
Positive symptoms- remember positive means adding something on!!!
Delusions,hallucinations,disorganisations (adding something new)
Negative symptoms:
Social withdrawal,neglect,poor hygiene (taking something away)
Two classes of antipsychotics.
1st Gen and 2nd gen
FiRST GENERATION GROUP 1!!!!!!
(SEDATION,ESPE,ANTIMUSCARINS)
Group 1:
- Promatives(pro- 1st place)
- Chlorpromazine,levomepromazine and promazine
Most sedation,moderate antimuscarinic and EPSEs(Extrapyrmidal side effects)
Parkinsons and Psychosis- patients with Parkinson’s already have what???
already decreased dopamine in your body so these reduce it so we don’t give antipsychotics
Thioxanthenes - flupentixol and zulcopenthizol, pimozide and sulphide also also antipsychotics and have what kind of effect in muscatiniv and extrapyramidal??
Thioxanthenes:
Flupentixol and zuclopenthixol
- Moderate sedation,anti muscarinic effects and EPSEs
Others: Pimozide and sulphide Reduced sedation,anti muscarinic effects and EPSEs
Second generations:
- Amisulpride
- Aripiprizole
- Clozapine
- Olanzapine
- Quetiapine
- Rispridone
Weight Gainnnnn
Olanazapine and cloazapine cause weight gain!
Antipsychotics Side effects:
MAIN 4? Occurring with which groups?
Extrapyramidal side effects- Most in group 3, phenothiazines and butyrophenones
Hyperprolactinaemia: least in aripiprazole
Sexual dysfunction: all anti psychotics
Cardiovascular side effects - QT prolongation most common with Pimozide and haloperidol
Hypotension is caused by CQ
clozapine and quetiapine
Hyperglycaemia is caused by which 4? (Ciroq)
Clozapine,risperidone,olanzapine and quetiapine (CIROQ)
Neuroleptic Malignant syndrome - what is it caused by??? What is it??? What do we treat it with??? How long does it take to resolve
STOP treatment - treat with bromocriptine- should resolve within 5-7 days
Bromocripitine- what is it?
is an ergot-dervived dopamine- receptor agonist, not COMT-inhibitor
Monitoring- how often should we monitor HB1aC???- what parameters do we also monitor?whar else before invitation
- Weight
- Fasting blood glucose,Hb1Ac and blood lipid concentrations:Start at 12 weeks, at 1 year then yearly
- ECG: before initiation
- Blood pressure:start at 12 weeks, at 1 year then yearly
- FBC,Uand E’s and LFTs:Start, then yearly
Severe resistance
use clozapine
If more than 48 hours of doses missed
specialist reinstantiating required
Used in resistant schizophrenia:
For how long??? What types are they?? What happens if missed more than 2 doses?
CLONAZAPINEEEEE
- 2 or more antipsychotics used for 6-8 weeks
- 2+ antipsychotics including one 2nd gen
- If missed more than 2 doses-specialist re initiation
-Monitor leukocyte and differential blood counts:
HOW OFTEN? FOR HOW LONG??? THEN WHAT? CLONAZIPINE MONITORING
Duration for:
-18 weeks
-one year
- after that
- then after ending?
- Weekly for 18 weeks
- Fortnightly till one year
- Monthly
- All till one month after the last dose
Clozapine heart side effect? What do we do??
Myocarditis and cardiomyopathy-
- Report and stop on tachycardia
Agranulocytes and neutropenia- clozapine side effect / what about GI (Rememeber all three are MAG)
REPORT IF THERE IS WHAT???
- Monitor leukocyte and differential blood counts as prev
Gastrointestinal disturbance:
Report and stop on constipation - intestinal block
Group 2: FIRST GENERATIONSSSSSSS(Sedation,ESPE??)
Pericyazine!!!
Pericyazine
Moderate sedation,least extrapyridmal side effects
GROUP 3: 1ST GENERATIONS(SEDATION,ESPE?)
butyrophenones - benperidol and haloperidol /fluphenazine
Butyrophenones:
Benperidol and haloperidol
- Moderate sedation and high extra pyramidal side effects(similar to group 3 phenothiazines)
Group 3:
Fluphenazine, prochloperazine,trifluoperazine
Moderate sedation and high extrapyrmidal side effects
