psychosis/schizophrenia

Question 1

symptoms of psychosis

Answer 1

positive - hallucinations, delusions, disorganisation
negative - emotional apathy, social withdrawal, neglect

Pts should receive antipsychotic for 4-6 weeks at optimum dose before deemed ineffective

Question 2

1st gen antipsychotics - phenothiazines

Answer 2

act by blocking dopamine receptors in brain - more likely to cause range of S.Es e.g. EPSEs, hyperprolactinaemia

1st gen - PHENOTHIAZINES

group 1 - chlorpromazine, levomepromazine, promazine
- most sedating, moderate antimuscarinic & EPSE

group 2 - pericyazine
- moderate sedation, LEAST EPSE

group 3 - prochlorperazine, fluphenazine, trifluoperazine
- moderate sedation. HIGH EPSEs

Question 3

1st gen - others

Answer 3

butyrophenones: benperidol, haloperidol
- moderate sedation + high EPSE (similar to group 3 pehnothiazines)

thioxanthenes: flupentixol, zuclopenthixol
- moderate sedation, antimuscarinic & EPSE

other: pimozide, sulpiride
- less sedation, antimuscarinic + EPSE

Question 4

2nd gen: atypical antipsychotics

Answer 4

2nd gen act on a range of receptors compared to 1st gen
lower risk of EPSE and tardive dyskinesia
however they have other SE’s such as weight gain, glucose intolerance

amisulpride
aripiprazole
clozapine
olanzapine
quietapine
risperidone

Question 5

antipsychotic side effects

Answer 5

EPSE - most common in group 3 phenothiazines and butyrophenones

hyperprolactinaemia - least in aripiprazole as its a dopamine partial agonist (dopamine inhibits prolactin)

sexual dysfunction - all antipsychotics

cardiovascular SE - QT prolongation most common in pimozide and haloperidol

hypotension - clozapine and quietapine

hyperglycaemia - clozapine, risperidone, olanzapine, quietapine

weight gain - clozapine and olanzapine

all antipsychotics carry risk of NMS - neuroleptic malignant syndrome
- STOP treatment - treat with bromocriptine (ergot derived dopamine agonist) - should resolve in 5-7 days
- dantrolene also used

Question 6

antipsychotic monitoring

Answer 6

weight - at start, weekly for first 6 weeks, at 12 weeks, at 1 year, then yearly

fasting blood glucose, hba1c, blood lipid conc. - at start, at 12 week, at 1 year, then yearly

ecg - before initiation

blood pressure - at start, at 12 week, at 1 year, then yearly

FBC, U&Es, LFTs - at start, then yearly

Question 7

clozapine imp points

Answer 7

used in resistant SCZ - when 2 + antipsychotics including one 2nd gen have been used for 6-8 weeks each

if missed more than 48 hours of doses - specialist re initiation

monitoring for leucocyte/WBC differential count:
weekly for 18 weeks
fortnightly till 1 year
monthly thereafter

Question 8

clozapine main SEs

Answer 8

M - myocarditis and cardiomyopathy
- report and stop on tachycardia
- cardio SE most common in children

A - agranulocytosis and neutropenia
- monitoring schedule for WBC differential - weekly for 18, 2 weekly till 1 year, monthly

G - GI disturbance (CONSTIPATION)
- report and stop on constipation (intestinal blockage)