PSYCHOSIS + SCHIZOPHRENIA Flashcards
What are the positive symptoms?
- Delusions
- Hallucinations
- Disorganisation
What are the negative symptoms?
- Social withdrawal
- Neglect
- Poor hygiene
Which drug is most commonly used in practice for the treatment of psychosis and schizophrenia?
aripiprazole due to the smaller side effects profile
What are the 1st gen antipsychotics?
Phenothiazines and butyrophenone
Others: thioxanthenes
pimozide, sulpride
Group 1 phenothiazines
chlorpromazine, levomepromazine
promazine
Group 1 phenothiazines properties
- Most sedation
- Moderate antimuscarinic and EPSEs
Group 2 phenothiazines
periciazine
Group 2 phenothiazines properties
- Moderate sedation
- Least EPSEs
Group 3 phenothiazines
fluphenazine
prochloperazine
trifluoperazine
Group 3 phenothiazines properties
- Moderate sedation
- High EPSEs (e.g. someone with parkinson’s, we must avoid these)
Butyrophenones
benperidol, haloperidol
Butyrophenones properties
- Moderate sedation
- High EPSEs (similar to group 3 phenothiazines)
Thioxanthenes
flupentixol
zuclopentixol
Thioxanthenes properties
- Moderate sedation
- Antimuscarinic effects
- EPSEs
Pimozide and sulpride
- Reduced sedation
- Antimuscarinic effects
- EPSEs
2nd generation antipsychotis
Amisulpride
Aripirazole
Clozapine (very specialist)
Olanzapine
Quetiapine
Risperidone
Antipsychotic Side effects
- EPSEs
o Most in group 3 phenothiazines an butyrophenones - Hyperprolactinaemia
o Least in aripiprazole - Sexual disfunction
- CV Sfx: QT prol most common in haloperidol and pimozide
- Hypotension
o Clozapine and quetiapine - Hyperglycaemia
o Clozapine, Risperidone, Olanzapine, Quetiapine (CiROQ) - Weight gain
o Clozapine and olanzapine - Neuroleptic malignant syndrom
o Stop treatment
o Treat with bromocrimptine (ergot-derived dopamine receptor agonist)
o Should resolve in 5-7 days
Which antipsychotics cause weight gain?
olanzapine and clozapine
Which antipsychotics cause EPSEs?
Most in group 3 phenothiazines ad butyrophenones
Which antipsychotic least causes hyperprolactinaemia?
Least in aripiprazole
Which antipsychotics cause hypotension?
Clozapine and quetiapine
Which antipsychotics cause hyperglycaemia?
o Clozapine, Risperidone, Olanzapine, Quetiapine (CiROQ)
Monitoring parameters
- Weight
o Start, weekly for first 6 weeks, 12 weeks and then 1 yr then yearly - Fasting blood glucose, HbA1c and blood lipid conc: start,12 weeks, 1 yr then yearly
- ECG: before initiation
- BP: start, 12 weeks, 1 yr, then yearly
- FBC, UAE, LFTs: start, then yearly
Which antipsychotics causes neuroleptic malignant syndrome?
o Stop treatment
o Treat with bromocrimptine (ergot-derived dopamine receptor agonist)
o Should resolve in 5-7 days
How often should you monitor a patient’s weight?
Start, weekly for first 6 weeks, 12 weeks and then 1 yr then yearly
How often should you monitor a patient’s fasting blood glucose, HbA1c and blood lipid conc?
start, 12 weeks, 1 yr then yearly
When should you do an ECG?
before initiation
How often should you monitor a patient’s blood pressure?
start, 12 weeks, 1 yr, then yearly
How often should you monitor a patient’s FBC, UAE, LFTs?
start, then yearly
Clozapine indication
Severe resistant psychosis and schizophrenia
* Only used when 2+ antipsychotics including one 2nd gen has been used for 6-8 weeks each
What happens if you miss a dose of clozapine?
- If missed more than two doses = specialist reinitiation
Monitoring for clozapine
- Monitory leukocyte and differential blood counts:
o Weekly for 18 weeks
o Fornightly till one year
o Monthly
Side effects of clozapine
Myocarditis and cardiomyopathy
* Report and stop on tachycardia
Agranylocytes and neutropenia
* Monitor leucocyte and differential blood counts
GI disturbances
* Reduces intestinal peristalsis rate
* Report and stop on constipation = intestinal block
