Schizophrenia Flashcards
What are the core symptoms of schizophrenia?
- Persistent delusions/hallucinations
- Disorganised thinking/behaviour
- Negative symptoms
What is used to diagnose schizophrenia?
ICD-11 and DSM-V(US)
What are the four different dopamine pathways affected?
- Nigrostriatal
- Mesolimbic
- Mesocortical
- Tuberinfundibular
Nigrostriatal pathway
Controls movement and motor functions
- Normal dopamine activity
Mesolimbic pathway
Responsible for pleasurable sensations - euphoria, hallucinations and delusions
- Overactive dopamine activity
Mesocortical pathway
Cognitive and affective symptoms
- Underactive dopamine activity
Tuberinfundibular pathway
Controls prolactin release
- Normal dopamine activity
First generation/typical
Work on D2 receptor
- Cause extrapyridimal side effects
- May cause tardive dyskinesia
- Effective against positive symptoms
Second generation/atypical
Complicated receptor profile
- Do not usually have tardive dyskinesia
- Effective against both positive and negative symptoms
What are the extrapyridimal side effects?
- Dystonias (uncontrolled muscle spasms)
- Tremors and rigidity
- Akathisia - inner restlessness
- Tardive dyskinesia is involuntary movements of the mouth and tongue
Hormonal side effects
- Raised prolactin
- Galactorrhoea
- Amenorrhoea
- Sexual dysfunction
- Increased risk of osteoporosis and breast cancer
Why is weight gained on clozapine and olanzapine?
- Increased carb cravings
- Increases risk of heart disease, hypertension and diabetes
Cardiac side effects
- Orthostatic hypotension
- QT elongation which if prolonged can cause a fatal arrythmia
48 hour rule of clozapine
If patient has stopped taking clozapine for 48 hours or longer then they lose tolerance to their dose and the dose will need to be re-titrated otherwise it will cause a severe reaction.
Clozapine side effects
- Weight gain
- Hypersalvation (treated with hyoscine)
- Constipation which can lead to intestinal obstruction and ultimately death (treat with docusate and senna)
