Questions Asked in morning meetings Flashcards
What is treatment resistant schizophrenia?
Persistent positive symptoms after a trial of 2 or more antipsychotics at maximum dose for an adequate duration, one of the antipsychotics should be an atypical.
What is the preferred drug of treatment for treatment resistant schizophrenia, and what is it’s drug class?
Clozapine (Atypical Antipsychotic)
What precautions should one take before prescribing Clozapine, and most common side effects?
Mandatory: FBC (wcc & diff), U&E, LFT, Lipids, HBA1c
Consider: Cardiac Markers, CRP,BNP,ESR
Imaging: ECG, Echocardiogram
How frequently should one monitor for clozapine related agranulocytosis?
WEEKLY for first 18 weeks then fortnightly for the rest of the year.Then monthly
What are other side effects of clozapine?
Lowers the seizure threshold
Myocarditis
Postural hypotension
Sedation
Hypersalivation
Constipation
Tachycardia
Weight gain
Fever
Myoclonus
Nocturnal Eneuresis
Hepatic failure
Describe the haematologic monitoring values for clozapine
WBC: >3.5, Neutrophil >2.0 (good range)
WBC >3.0-3.4 Neutrophils: >1.5 & 2.0
WBC <3.0 Neutrophils < 1.5
How many clusters of personality disorder are there?
3 clusters (A,B and C)
Cluster A personality disorders
- Schizoid
- Schizotypal
- Paranoid
Cluster B personality disorders
- Borderline personality disorder
- Antisocial personality disorder
- Histrionic personality disorder
- Narcissitic personality disorder
Cluster C personality disorder
- Avoidant
- Dependent
- Obsessive compulsive
What are the domains of personality
What is the plasma level for clozapine to be at an adequate trial?
350-420 micrograms per liter
What are some contraindications to clozapine
Epillepsy, cardiac disease, Paralytic illeus, Unstable diabetes mellitus, NMS, previous side effects,choatic lifestyle that can hinder follow-ups, Alcohol.
