Psychotic Disorder

Question 1

What is resistant schizophrenia

Answer 1

It the failure to respond to two different classes of antipsychotics at an adequate dose for the a sufficient time

Question 2

How do you treat resistant schizophrenia? And what is the SE (SOS GAM)

Answer 2

Clozapine 50-600mg in divided doses
Agranulosis
Sedation
Orthostatic Hypotension and syncope
Metabolic syndrome (hyperglycaemia, hyperlipidemia, weight gain)
GI: Constipation, hypersalivation
Decrease in the threshold for seizures

Question 3

How do you monitor the major side effects of the treatment of resistant schizophrenia?

Answer 3

WCC weekly for 18 weeks, 2weekly for 6months and monthly theafter

Question 4

Delusion Disorder Vs Schizophrenia

Answer 4

1. SYMPTOMS
   A)-DD : delusion is the primary symptom
   A)-S: delusion is accompanied by other symptoms of psychosis (hallucinations, disorganised behaviour and thoughts and negative symptoms)
   B)-DD: delusion has to be present to make diagnosis
   B)-S: delusion does not have to be present to make diagnosis
   C)-DD: hallucinations less common and usually congruent with delusions
   C)-S: hallucinations are common may be present without delusions

AGE OF ONSET
D)-DD: middle age or above
D)-S: late teens and early adulthood

FUNCTION
E)-DD: level of functioning is intact, i.e not markedly impaired with the area that is related to the delusion usually impaired
E)-S: level of functioning in markedly impaired

DURATION:
F)- DD: at least 1 month or more
F)- S: at 6 months with 1 month of active phase
G)-DD: Course usually stable
G)-S: Course usually fluctuates

Question 5

List of reasons one may remain psychotic even if using antipsychotics

Answer 5

-incorrect dose
-incorrect class of drug used
-incorrect administration of drugs or not taking the medication as prescribed
-incorrect diagnosis
-sub therapeutic concentration in serum
-drug-drug interaction
-treatment resistant to treatment
-stop taking medication due to side effects
-stop taking medication due to insight
-ongoing use of alcohol
-ongoing emotional stressors

Question 6

Typical antipsychotic: MOA, SE, example

Answer 6

Also known as first generation
MOA: blocks the dopamine receptor at the post-synaptic neurones, predominantly D2.
Also binds histaminic, alpha-adrenergic, muscarinic, and serotonin receptors.
SE: MA3HN
1.Movement disorder: A TAP
Acute Dystonia: painful, prolonged contraction of muscles (neck, tongue, mouth) causing abnormal movement and posture.
Tandive Dyskinesia: abnormal involuntary movements (mouth, tongue, trunk, extremity)
Akathisia: subjective tension and anxiety, objective restlessness and agitation
Parkinsonism: rigidity, resting tremor and bradykinesia
2. Anticholinergic: dry mouth, blurred vision, constipation and urinary retention, confusion
Antihistaminic: sedation and drowsiness and weight gain
Antiadrenergic: arrhythmia, hypotension, sexual dysfunction
3.Neuroepileptic Malignant Syndrome
4.Hyperprolactemia: galactorrhea, infertility
EXAMPLE
Haliperodol
Chlorpromazine

Question 7

What is NMS: Characteristics and management

Answer 7

Life-threatening condition characterised by:
Fever
Autonomic dysregulation
Rigidity
Mental state change- Delirium
-about 1 week after initiation and dose change
Management
Stop antipsychotics
Admit
Monitor vitals
Cool and hydrate
Medication:
Benzodiazepines: lorazepam and diazepam
Dantrolene
Bromocriptine
ECT if no response
Rechallenge using SGA

Question 8

Atypical antipsychotics: MOA, SE, example

Answer 8

Second generation
MOA: blocks serotonin and dopamine receptors at the post-synaptic neurones, also binds the histaminic, alpha-adrenergic and muscarinic receptors, with less affinity
SE:
Cardiac: Qt prolongation and arrhythmia
Metabolic: hyperglycaemia, dyslipidamia, weight gain, impaired glucose tolerance, hyperprolactemia
Reproductive: sexual dysfunction
Example: risperidone, olanzapine and clonazepine

Question 9

Clonazepine: SE, complication and monitoring

Answer 9

Sedation
Orthostatic hypotension and syncope
Seizure threshold decreased
GI: constipation and hypersalivation
Metabolic syndrome: hyperglycaemia, dyslipidemia and weight gain
Complication: Agranulosis
Monitoring
WCC before starting, every week for 18 months and every 2 weeks for 6 months and monthly thereafter