Schizophrenia Flashcards
what is schizophrenia?
severe mental disorder, characterised by profound disruptions in thinking, affected language, perception and sense of self.
often includes psychotic experiences e.g. hearing voices or delusions
what is the major cause of violence in schizophrenia?
reacting to delusions of schizophrenia
when is schizophrenia mainly developed?
females = 25 years old
males = 19 years old
how is schizophrenia diagnosed?
symptoms develop slowly
after becoming socially withdrawn and changes in sleeping patterns can be mistaken for adolescence age
DSM V - 1 positive symptom for 1 month+ and continuous problems for 6months+
what are the symptoms of schizophrenia classified into?
positive and negative symptoms
what are the positive symptoms of schizophrenia?
Changes in behaviour or thoughts ‘psychosis’
Delusions (sudden or weeks/months)
Hallucinations
- Visual
- Auditory (most common)
- Tactile
- Somatic
Thought disorder
which type of schizophrenia symptoms are easier to treat?
negative symptoms
which type of schizophrenia occurs before psychotic episodes?
negative symptoms, known as the prodromal period
what are the negative symptoms of schizophrenia?
A withdrawal or lack of function
Social withdrawal
Lack of emotion
Reduced speech
Poor self care
how do you treat schizophrenia?
tailored combination of medication and therapy
community mental health services
- support/ treatment/independence
- MDT
drugs:
antipsychotics
depot injections
what is the classification of antipsychotics?
- First Generation (typical antipsychotics)
Predominantly block the dopamine D2 receptor in the brain
- Chlorpromazine, flupentixol, haloperidol, perphenazine, pimozide, sulpiride, zuclopenthixol - Second Generation (atypical antipsychotics)
Act on a range of receptors (5HT2 and D2)
- Amisulpiride, aripiprazole, clozapine, lurasidone, olanzapine, palperidone, quetiapine, risperidone
what is the indication of antipsychotics for schizophrenia?
initial treatment of symptoms of an acute schizophrenic episode
reducing the feeling of anxiety or aggression
blocks dopamine
what is the side effects of antipsychotics?
extrapyramidal side effects (EPS)
what are extrapyramidal side effects (EPS)?
what does blocking the D2 receptor do?
- increase mesocortical
- decrease mesolimbic
- increase tuberoinfundibular
why are second generation antipsychotics preferred?
decrease affinity of D2 receptor = decreased EPS effect
reduced affinity for mesolimbic pathways = prevent worsening of if negative symptoms
what does a decrease in mesolimbic pathways mean?
worsening of if negative symptoms
what receptors do second generation antipsychotics work on?
5-HT2C
H1
a1
what are the side effects of blocking second generation antipsychotics?
5-HT2C - increase glucose and lipids = weight gain
H1 - increase sedation
a1 - orthostatic hypotension
what are examples of second generation antipsychotics?
clozapine
olanzapine
quetiapine
risperidone
what do NICE guidance suggest to talk to the patient about before commencing treatment?
provide information and discuss likely benefits and possible side effects of the drugs including:
1. metabolic (including weight gain and diabetes)
2. extrapyramidal (including akathisia, dyskinesia and dystonia)
3. cardiovascular (including prolonging the QT interval)
4. hormonal (including increasing plasma prolactin)
what patient information must be provided when commencing treatment?
Antipsychotics treat the symptoms
- Some antipsychotics may be more effective than others
ADRs should be discussed so the best tolerated drug can be found
Long term treatment is required to prevent relapse
Treatment should not be stopped abruptly
Psychological and psychosocial interventions increase the chance of staying well
what do you monitor for antipsychotics ?
Response to treatment
- Changes in behaviour and symptoms
- Patient or carer satisfaction
Monitoring:
~ weight (plotted on a chart)
~ waist circumference
~ pulse and blood pressure
~ fasting blood glucose, glycosylated haemoglobin (HbA1c), blood lipid profile and prolactin levels
~ assessment of any movement disorders
~ assessment of nutritional status, diet and level of
physical activity.
~ ECG if specified in the summary of product characteristics (SPC) or there is CVD risk
what are depot injections?
Long acting IM depot injections are useful in preventing relapse in patient who may not reliably take regular oral medication.
what are the advs/disadvs of depot injections?
adv’s:
- assured compliance
- steady plasma levels
- given every few weeks
disadv’s:
X Impossible to alter dose if side effects develop
X Patients may see administration as taking things out of their control
X Painful
X Skilled person to
administer (CPN)
what drug is given who aren’t responding adequately to treatments?
clozapine
what is clozapine’s main side effect?
agranulocytosis, Agitation, drowsiness, dry mouth,erectile dysfunction
what is DSM-V?
diagnose schizophrenia
