Psychosis and Schizophrenia

Question 1

Positive symptoms- remember positive means adding something on!!!

Answer 1

Delusions,hallucinations,disorganisations (adding something new)

Question 2

Negative symptoms:

Answer 2

Social withdrawal,neglect,poor hygiene (taking something away)

Question 3

Two classes of antipsychotics.

Answer 3

1st Gen and 2nd gen

Question 4

FiRST GENERATION GROUP 1!!!!!!
(SEDATION,ESPE,ANTIMUSCARINS)

Answer 4

Group 1:
- Promatives(pro- 1st place)
- Chlorpromazine,levomepromazine and promazine
Most sedation,moderate antimuscarinic and EPSEs(Extrapyrmidal side effects)

Question 5

Parkinsons and Psychosis- patients with Parkinson’s already have what???

Answer 5

already decreased dopamine in your body so these reduce it so we don’t give antipsychotics

Question 6

Thioxanthenes - flupentixol and zulcopenthizol, pimozide and sulphide also also antipsychotics and have what kind of effect in muscatiniv and extrapyramidal??

Answer 6

Thioxanthenes:
Flupentixol and zuclopenthixol
- Moderate sedation,anti muscarinic effects and EPSEs

Others:
Pimozide and sulphide 
Reduced sedation,anti muscarinic effects and EPSEs

Question 7

Second generations:

Answer 7

• Amisulpride
  
  • Aripiprizole
  • Clozapine
  • Olanzapine
  • Quetiapine
  • Rispridone

Question 8

Weight Gainnnnn

Answer 8

Olanazapine and cloazapine cause weight gain!

Question 9

Antipsychotics Side effects:
MAIN 4? Occurring with which groups?

Answer 9

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

Question 10

Hypotension is caused by CQ

Answer 10

clozapine and quetiapine

Question 11

Hyperglycaemia is caused by which 4? (Ciroq)

Answer 11

Clozapine,risperidone,olanzapine and quetiapine (CIROQ)

Question 12

Neuroleptic Malignant syndrome - what is it caused by??? What is it??? What do we treat it with??? How long does it take to resolve

Answer 12

STOP treatment - treat with bromocriptine- should resolve within 5-7 days

Question 13

Bromocripitine- what is it?

Answer 13

is an ergot-dervived dopamine- receptor agonist, not COMT-inhibitor

Question 14

Monitoring- how often should we monitor HB1aC???- what parameters do we also monitor?whar else before invitation

Answer 14

• 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

Question 15

Severe resistance

Answer 15

use clozapine

Question 16

If more than 48 hours of doses missed

Answer 16

specialist reinstantiating required

Question 17

Used in resistant schizophrenia:
For how long??? What types are they?? What happens if missed more than 2 doses?

Answer 17

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

Question 18

-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?

Answer 18

• Weekly for 18 weeks
  
  • Fortnightly till one year
  • Monthly
  • All till one month after the last dose

Question 19

Clozapine heart side effect? What do we do??

Answer 19

Myocarditis and cardiomyopathy-
- Report and stop on tachycardia

Question 20

Agranulocytes and neutropenia- clozapine side effect / what about GI (Rememeber all three are MAG)
REPORT IF THERE IS WHAT???

Answer 20

• Monitor leukocyte and differential blood counts as prev

Gastrointestinal disturbance:
Report and stop on constipation - intestinal block

Question 21

Group 2: FIRST GENERATIONSSSSSSS(Sedation,ESPE??)
Pericyazine!!!

Answer 21

Pericyazine
Moderate sedation,least extrapyridmal side effects

Question 22

GROUP 3: 1ST GENERATIONS(SEDATION,ESPE?)
butyrophenones - benperidol and haloperidol /fluphenazine

Answer 22

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