Psychotic symptoms Flashcards
What is the extrapyramidal syste
neural network within the brain that helps regulate and control motor activity, including posture, locomotion, and coordination
What is akathisia
subjective feeling of restlessness with an urge to move around
What is akathisia
subjective feeling of restlessness with an urge to move around
What are dystonias
range of movement disorders characterized by sustained or intermittent muscle contractions causing abnormal movements or postures
What is parkinsonism
characterized by the triad of tremor, rigidity (lead pipe or cogwheel), and bradykinesia
EPSE’s are thought to be due to
antagonism of dopaminergic D2 receptors in the basal ganglia
EPSE’s are thought to be due to
antagonism of dopaminergic D2 receptors in the basal ganglia
Name the types of dystonia
Torticollis - cervical muscles spasms, resulting in a twisted posturing of the neck.
Trismus (lock jaw) - contraction of the jaw musculature.
Opisthotonus - arched posturing of the head, trunk, and extremities.
Laryngeal dystonia - difficulty in breathing
Oculogyric crises - involuntary contraction of one or more of the extraocular muscles, which may result in a fixed gaze with diplopia
Name the types of dystonia
Torticollis - cervical muscles spasms, resulting in a twisted posturing of the neck.
Trismus (lock jaw) - contraction of the jaw musculature.
Opisthotonus - arched posturing of the head, trunk, and extremities.
Laryngeal dystonia - difficulty in breathing
Oculogyric crises - involuntary contraction of one or more of the extraocular muscles, which may result in a fixed gaze with diplopia
Which antipsychotic carries the highest risk of epses
Haloperidol
What is the most resistant epse to treat
Akathisia
Dystonia Prevalence?
Approximately 10%
But more common in
- young males
- neuroleptic-naive
- high potency drugs (e.g. haloperidol)
Acute dystonia can develop within XXXXX of starting antipsychotics
minutes or hours
Which medications are used to manage acute dystonia?
Anticholinergics used include trihexyphenidyl, procyclidine, orphenadrine, benztropine. The antihistamine, diphenhydramine, is also used due to its anticholinergic properties
Pseudo-parkinsonism (e.g. tremor) prevalence
Approximately 20%
But more common in
- elderly females
- those with pre-existing neuro damage (e.g. stroke)
Pseudo-parkinsonism develops XXXXXX after antipsychotic started or dose increased
Days to weeks
Akathisia prevalence?
25%
Tardive dyskinesia prevalence?
5% of patients per year of antipsychotic exposure
But more common in
- elderly women
- those with affective illness
- those who have had EPSE early on in treatment
Tardive dyskinesia develops over?
Months to years
Prolactin sparing antipsychotics?
Clozapine
Aripiprazole
Asenapine
Quetiapine
High risk / major change prolactin antipsychotics?
All the typical antipsychotics
Risperidone
Amisulpride
Paliperidone
Sulpiride
Psychiatric patients with long standing hyperprolactinaemia have an increased risk of:-
Osteoporosis
Breast cancer
Hyperprolactinaemia is only very occasionally seen with antidepressants.
True
Sexual dysfunction is common in the general population (estimated 30%) but is thought to be increased in people with psychiatric illness
True
Which scale does maudesy suggest use for measuring sexual dysfunction?
Arizona Sexual Experiences Scale (ASEX)
The propensity for the antipsychotics to cause sexual dysfunction appears related, in part, to their effect on
prolactin levels
Relationship of Risperidone / paliperidone with sexual dysfunction.
The atypical with the highest prolactin elevation.
Increase is dose dependent.
Approx 70% of people using risperidone report sexual dysfunction in the first year of use.
Causes reduced libido, erectile dysfunction, vaginal dryness, and ejaculatory disorder.
Relationship of Haloperidol with sexual dysfunction
Causes significant prolactin increase.
Approx 70% of people using haloperidol report sexual dysfunction in the first year of use.
Causes reduced libido, erectile dysfunction, vaginal dryness, and ejaculatory disorder.