Schizo Flashcards
Positive symptoms
Hallucinations
deluisons
negative symptoms
Emotional apathy
Social withdrawal
Principles of prescribing
-Patient preference
- Before deemed ineffective- try at max dose for 4-6 weeks
- Avoid prescribing >1 antipsychotic (Higher risk of SE)
- No evidence that one is better than another
First gen
Chlorpromazine
Haloperidol
Flupentixol
Zuclopenthixol
Trifluoperazine
Perphenazine
Prochlorperazine
Sulpiride
Pimozide
Loxapine
Thioridazine
Second gen
Risperidone
Olanzapine
Quetiapine
Clozapine (used in treatment-resistant schizophrenia)
Aripiprazole (a partial D2 agonist)
Amisulpride
Lurasidone
Paliperidone
Ziprasidone
Cariprazine
Brexpiprazole
EPSE
Highest risk in first gen and are usually dose dependent
Parkinsonism symptoms, dystonia, restlessness, tardive dyskinesia
Hyperprolactinaemia
Highest risk with risperidone, amisulpride and 1st gen
Aripiprazole reduces prolactin concentration as it is a dopamine parietal agonist receptor
Symptoms: Sexual dysfunction, reduced bone density, breast enlargement, increased risk of breast cancer,
Sexual dysfunction
Highest risk: risperidone, haloperidol, olanzapine
Consider dose reduction or discontinue or switch
CV side effects
tachycardia, arrhythmia, hypotension, QT prolongation
Highest risk: Pimozide (ECG required before and annually)
Hypotension
Common SE. Presents acutely during initial dose titration but can be chronic leading to falls
Highest risk: Second gen and clozapine
Which antipsychotics can be used for nausea and vomiting
Chlorpromazine
Prochlorperazine
Haloperidol
Antipsychotics in elderly
Do not use in elderly in patients with dementia unless risk to self/others. There is an increased risk of mortality, stroke and TIA
Hyperglycaemia and diabetes
Lowest risk in 1st gen but also amisulpride and aripiprazole
Weight gain
Highest risk: Clozapine and olanzapine
Neuroleptic malignant syndrome symptoms
Can be fatal and is a rare se of all antipsychotics
Symptoms: Hyperthermia, fluctuating levels of consciousness, muscle righty, tachycardia, labile blood pressure, sweating
Treatment of neuroleptic malignant syndrome
Discontinue the drug is essential for at least 5 days. Sometimes treat with bromocriptine and dantrolene
Monitoring of antipsychotics and how often
1) Weight: Baseline, weekly for 6 weeks, at 12 weeks, 1 year then yearly
2) Fasting blood glucose: HbA1c blood lipid conc: baseline, 12 weeks, 1 year then yearly
3) Prolactin conc: Baseline
4) ECG: may be required if CV risk factors are identified/ hx of CVD
5) BP: baseline, 12 weeks, 1 year then yearly
6) FBC: baseline then yearly
Antipsychotic depot injections
- Adherence
- 1st gen have more SE including EPSE
