Psychosis schizophrenia and bipolar disorder

Question 1

Describe the positive, negative, cognitive, and affective symptoms of schizophrenia.

Answer 1

Positive symptoms of schizophrenia include:
* hallucinations, delusions , disorganized speech, thought disorder, and catatonic behavior.
Negative symptoms involve:
* emotional blunting, reduced speech, loss of motivation, self-neglect, and social withdrawal.
Cognitive symptoms and affective symptoms are also present in schizophrenia.

Question 2

What are the risk factors associated with psychotic disorders like schizophrenia?

Answer 2

Risk factors for psychotic disorders include
* heritability, stressful life events like childhood adversity, family heritage, migration (especially from developing countries), urban living, cannabis and substance use, high dose corticosteroids, exposure to Toxoplasma gondii, and early life factors.

Question 3

Explain the complications that can arise from psychosis, such as schizophrenia.

Answer 3

Complications of psychosis include premature death, increased risk of suicide, certain physical disorders like cardiovascular disease, Type 2 diabetes, smoking-related illnesses, cancer, infections, social exclusion, impaired ability to learn, work, and maintain relationships, and substance misuse.

Question 4

What are some other psychotic disorders besides schizophrenia?

Answer 4

Other psychotic disorders include schizoaffective disorder, characterized by symptoms of both schizophrenia and a mood disorder; drug-induced psychosis, which usually remits within a month of cessation of substance use; and persistent delusional disorder, where the most pervasive symptom is delusion.

Question 5

How do positive, negative, and cognitive symptoms differ in schizophrenia?

Answer 5

Positive symptoms of schizophrenia involve hallucinations, delusions, disorganized speech, and thought disorder. Negative symptoms include emotional blunting, reduced speech, loss of motivation, self-neglect, and social withdrawal. Cognitive symptoms also manifest in schizophrenia.

Question 6

Describe the management approach for patients with schizophrenia, including risk assessment, specialist referral, treatment of co-existing conditions, medication options, and therapeutic interventions.

Answer 6

The management of patients with schizophrenia involves assessing the risk of harm, referring for specialist assessment, treating co-existing conditions like anxiety and depression, conducting therapeutic trials of antipsychotics, offering family intervention, individual CBT, and arts therapies.

Question 7

Define the difference between typical and atypical antipsychotic medications, listing examples of each category and their respective receptor profiles.

Answer 7

Typical antipsychotics primarily target D2 receptors, Examples of typical antipsychotics include haloperidol and chlorpromazine
atypical antipsychotics act on a variety of receptors like D2, H1, a1, a2, 5-HT2A, 5-HT2c, 5-HT1A, and 5-HT1c. Examples include aripiprazole and clozapine.

Question 8

How do extrapyramidal symptoms manifest in patients taking antipsychotic medications, and what are the common adverse effects associated with these drugs?

Answer 8

Extrapyramidal symptoms in patients on antipsychotics include acute dystonia, pseudoparkinsonism, tardive dyskinesia, and akathisia. Common adverse effects of antipsychotics include weight gain, hyperprolactinemia, sexual dysfunction, cardiovascular issues, hyperglycemia, and neuroleptic malignant syndrome.

Question 9

Describe the monitoring and management considerations specific to clozapine treatment in patients with schizophrenia, including registration requirements, potential adverse effects, and necessary medical interventions.

Answer 9

Clozapine treatment in schizophrenia requires exclusive management in secondary care, registration with the Patient Monitoring Service, frequent monitoring for neutropenia, myocarditis, and cardiomyopathy, as well as vigilance for gastrointestinal issues like constipation and intestinal obstruction.

Question 10

What are the key considerations regarding depot injections of antipsychotic medications, and which drugs are commonly administered in this form?

Answer 10

Depot injections of antipsychotics offer long-acting treatment options. Commonly administered drugs in this form include aripiprazole, haloperidol, and risperidone, providing sustained release and potentially improving medication adherence.

Question 11

Explain the potential cardiovascular effects of antipsychotic medications, including tachycardia, arrhythmias, hypotension, and the risk of QT-interval prolongation with specific drugs.

Answer 11

Antipsychotic medications can lead to cardiovascular effects such as tachycardia, arrhythmias, and hypotension. Some drugs like pimozide carry a risk of QT-interval prolongation, necessitating monitoring and potential dose adjustments to prevent adverse cardiac events.

Question 12

Describe the characteristics of bipolar disorder, including manic episodes, hypomanic episodes, and depressive episodes.

Answer 12

Bipolar disorder is characterized by episodic depressed and elated moods, with manic episodes featuring abnormally elevated mood lasting at least 1 week, hypomanic episodes not causing marked impairment, and depressive episodes lasting at least 2 weeks.

Question 13

Describe the management approach for mania or mixed episodes, including the sequence of antipsychotic medications and potential adjunct treatments.

Answer 13

The management of mania involves a trial of oral antipsychotics like haloperidol, olanzapine, quetiapine, or risperidone. If the first antipsychotic is ineffective, a second one is offered. If the second-line antipsychotic fails, lithium or sodium valproate may be added. Antidepressants are usually tapered. To prevent relapse, current treatment is continued, or long-term treatment with lithium is started. If lithium is ineffective, valproate may be added. Psychological therapies may also be considered.

Question 14

How should Olanzapine be managed to prevent adverse effects, and what monitoring is necessary during its use?

Answer 14

Olanzapine use requires caution to avoid photosensitization and sunlight exposure. Intramuscular use needs careful monitoring. Regular monitoring for acute myocardial infarction, bradycardia, and weight gain is essential. Blood lipids and weight should be monitored every 3 months for the first year, then yearly. Dose reduction should be gradual if other antimanic drugs are continued.

Question 15

Define the key considerations for the use of Lithium in the treatment of mood disorders, including dosing, monitoring, and potential side effects.

Answer 15

Lithium may take 6-12 months for full effect and should be prescribed by brand name due to bioavailability differences. Lithium carbonate and lithium citrate are not dose equivalent. Dosing aims for a plasma level of 0.6-1.0 mmol/L, requiring therapeutic drug monitoring due to a narrow therapeutic range. Side effects include GI disturbances, tremors, CNS issues, and renal problems. Abrupt discontinuation should be avoided.

Question 16

What are the recommended treatment options for depression in the context of mood disorders, and what monitoring is typically involved?

Answer 16

For depression in mood disorders, treatment options include Quetiapine alone, Fluoxetine combined with Olanzapine, Olanzapine alone, or Lamotrigine alone. Monitoring usually involves regular physical and mental health checks, drug effects assessment, and potential psychological therapy.

Question 17

Describe the monitoring and management approach for individuals undergoing long-term treatment with Lithium, including potential side effects and necessary precautions.

Answer 17

Long-term Lithium use requires monitoring for thyroid disorders, cognitive impairment, and signs of toxicity like renal dysfunction. Adequate fluid intake is crucial, and dietary changes affecting sodium intake should be avoided. Gradual dose reduction over weeks to months is recommended to prevent relapse.

Question 18

How should antidepressant medication be managed in the treatment of mania or mixed episodes, and what are the considerations for tapering and discontinuation?

Answer 18

In the treatment of mania, antidepressant medication is usually tapered and discontinued. This is done to prevent relapse and manage the condition effectively. Tapering should be gradual, and discontinuation should be supervised to minimize the risk of adverse effects or relapse.

Question 19

Describe the two forms of Valproate and their respective uses in bipolar disorder treatment.

Answer 19

Valproate is available as semisodium valproate (Depakote®) for acute mania and as sodium valproate (Epilim®) and valproic acid (Convulex®) for bipolar disorder, despite being unlicensed It has a high teratogenic risk and should not be used during pregnancy. It is highly protein bound (94%) and can interact with other medications.

Question 20

What precautions should be taken when prescribing Lamotrigine for patients with myoclonic seizures or Parkinson’s disease?

Answer 20

Lamotrigine should be prescribed with caution for these patients due to the risk of skin rash. Prompt evaluation is necessary if a rash appears, and lamotrigine should be withdrawn immediately. There is also a small risk of suicidal thoughts and behavior, so patients should be monitored for mood changes and distressing thoughts.

Question 21

How should patients be advised to recognize and respond to potential adverse effects of Valproate?

Answer 21

Patients should be advised on how to recognize signs and symptoms of blood disorders, liver disorders, and pancreatitis while taking Valproate. They need to seek immediate medical help if any of these adverse effects develop to ensure timely intervention.

Question 22

What are the key interactions to be aware of when prescribing Lamotrigine?

Answer 22

When prescribing Lamotrigine, healthcare providers should be cautious of interactions with CNS depressants, carbamazepine, phenytoin, primidone, oestrogens, progestogens, desmopressin, ritonavir, and valproate. Monitoring for these interactions is crucial to avoid adverse effects.

Question 23

Define the term ‘teratogenic risk’ in the context of Valproate use during pregnancy.

Answer 23

Teratogenic risk refers to the potential of a medication like Valproate to cause harm to the developing fetus, leading to birth defects or other abnormalities. Due to its high teratogenic risk, Valproate should not be used during pregnancy in patients with bipolar disorder.