Psychosis And Schizoprenia Flashcards
What are the two symptoms of schizophrenia
Positive symptoms: delusions, hallucinations and disorganisations
Negative symptoms: social withdrawal, neglect, poor hygiene
Name second generation antipsychotic
Olanzapine
Quetapine
Risperidone
Clozapine
Aripiprazole
Ziprasidone
Palliperidone
Asenapine
Lurasidone
Lloperidone
Cariprazine
Amisulpride
FIRst gen end with a zines or ol
Second gen -apine or one
What are 1st generation phenothiazine
Split into 3 groups
Group 1:
Chlorpromazine, levomepromazine, promazine
SE: most sedation, moderate anti-muscarinic and EPSEs
Group 2:
Pericyazine
SE: moderate sedation, least EPSEs
Group 3:
Fluphenazine, prochlorperazine, trifluperazine
SE: most sedations, high EPSES
EPSE = extra pyramidal side effects (side effects of antipsychotic eg restlessness, agitation etc )
Never give antipsychotic to someone who has Parkinson’s disease because it has opposite side effects to what you want to achieve when being treated for Parkinson’s
Antipyschotics reduces the amount of dopamine
What are the other first generation antipsychotic
BUTYROPHENONES
Drugs includes: benperidol, haloperidol
SE: moderate sedation, high EPSEs (similar to first generation group 3 phenothiazines)
AVOID IN PARKINSON
THIOXANTHENES
Drugs includes: flupentixol and zuclopenthixol
SE: moderate sedation, anti-muscarinic effects and EPSEs
OTHERS:
Drugs includes: pimozide and sulpiride
SE: reduced sedation, anti-muscarinic effects and EPSEs
Which antiemetic do you avoid
Haloperidol
What are the side effects of antipsychotic
Extrapyramidal: most in group 3 phenothiazine and butyrophenones
Hyperprolactinaemia: least in aripiprazole
People who lactate
Sexual dysfunction: all antipsychotic
Cardiovascular side effects: QT prolongation most common with haloperidol and pimozide
What is meant by Extrapyramidal side effects
Acute dyskinesia- involuntary movements
Systolic reactions
Tardive dyskinesia- irregular jerky movement
Parkinsonism- rigidity
Akinesia- freezing in terms of muscles
Neuroleptic malignant syndrome
Akathisia- motor restlessness
ADAPPT
AcuteDystonia
Akathisia
Parkinsonism
Prolactinameia
Tardive dyskinesia
What other side effects are associated with antipsychotic
Hypotension: clozapine and quetiapine
Hyperglycaemia: clozapine, risperidone, olanzapine, quetapine (ciROQ has the sweet flavours)
Weight gain: Olanazpaine and clozapine (WOC)
Neuroleptic malignant syndrome
STOP TREATMENT, treat with bromocriptine, should resolve in 5-7 days
What monitoring is required for antipsychotic
Weight: start, weekly for the first 6 weeks, at 12 weeks, at 1 year then yearly
Fasting blood glucose, HbA1c, blood lipid conc: start, at 12 weeks, at 1 year then yearly
ECG: before initiation (haloperidol can cause QT prolongation)
Blood pressure: start, at 12 weeks, at 1 year then yearly
FBC,U&Es and LFTs: start then yearly
What is clozapine used for
Used for in resistant schizophrenia
-used only when 2+ antipsychotic including one 2nd generation hard been used for 6-8 weeks each
What do you do if you miss more than 2 doses of clozapine
Specialist reinitiation is required if you have missed more than 2 doses
How often do you monitor leukocytes and differential blood counts
Weekly for 18 weeks then
Fortnightly til 1 year (34 weeks)
Then monthly
What are the side effects of clozapine
Myocarditis and cardiomyopathy (MaG)
- report and stop on tachycardia
Agranulocytes and neutropenia
-monitor leukocytes and differential blood counts as previously mentioned
GI disturbances
-report and stop on constipation = intestinal block!
