Schizophrenia

Question 1

what is schizophrenia?

Answer 1

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

Question 2

what is the major cause of violence in schizophrenia?

Answer 2

reacting to delusions of schizophrenia

Question 3

when is schizophrenia mainly developed?

Answer 3

females = 25 years old
males = 19 years old

Question 4

how is schizophrenia diagnosed?

Answer 4

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after becoming socially withdrawn and changes in sleeping patterns can be mistaken for adolescence age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+

Question 5

what are the symptoms of schizophrenia classified into?

Answer 5

positive and negative symptoms

Question 6

what are the positive symptoms of schizophrenia?

Answer 6

Changes in behaviour or thoughts ‘psychosis’
 Delusions (sudden or weeks/months)
 Hallucinations
- Visual
- Auditory (most common)
- Tactile
- Somatic
 Thought disorder

Question 7

which type of schizophrenia symptoms are easier to treat?

Answer 7

negative symptoms

Question 8

which type of schizophrenia occurs before psychotic episodes?

Answer 8

negative symptoms, known as the prodromal period

Question 9

what are the negative symptoms of schizophrenia?

Answer 9

A withdrawal or lack of function
 Social withdrawal
 Lack of emotion
 Reduced speech
 Poor self care

Question 10

how do you treat schizophrenia?

Answer 10

tailored combination of medication and therapy
community mental health services
- support/ treatment/independence
- MDT

drugs:
antipsychotics
depot injections

Question 11

what is the classification of antipsychotics?

Answer 11

1. First Generation (typical antipsychotics)
   Predominantly block the dopamine D2 receptor in the brain
   - Chlorpromazine, flupentixol, haloperidol, perphenazine, pimozide, sulpiride, zuclopenthixol
2. Second Generation (atypical antipsychotics)
   Act on a range of receptors (5HT2 and D2)
   - Amisulpiride, aripiprazole, clozapine, lurasidone, olanzapine, palperidone, quetiapine, risperidone

Question 12

what is the indication of antipsychotics for schizophrenia?

Answer 12

initial treatment of symptoms of an acute schizophrenic episode
reducing the feeling of anxiety or aggression
blocks dopamine

Question 13

what is the side effects of antipsychotics?

Answer 13

extrapyramidal side effects (EPS)

Question 14

what are extrapyramidal side effects (EPS)?

Answer 14

Question 15

what does blocking the D2 receptor do?

Answer 15

1. increase mesocortical
2. decrease mesolimbic
3. increase tuberoinfundibular

Question 16

why are second generation antipsychotics preferred?

Answer 16

decrease affinity of D2 receptor = decreased EPS effect
reduced affinity for mesolimbic pathways = prevent worsening of if negative symptoms

Question 17

what does a decrease in mesolimbic pathways mean?

Answer 17

worsening of if negative symptoms

Question 18

what receptors do second generation antipsychotics work on?

Answer 18

5-HT2C
H1
a1

Question 19

what are the side effects of blocking second generation antipsychotics?

Answer 19

5-HT2C - increase glucose and lipids = weight gain
H1 - increase sedation
a1 - orthostatic hypotension

Question 20

what are examples of second generation antipsychotics?

Answer 20

clozapine
olanzapine
quetiapine
risperidone

Question 21

what do NICE guidance suggest to talk to the patient about before commencing treatment?

Answer 21

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)

Question 22

what patient information must be provided when commencing treatment?

Answer 22

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

Question 23

what do you monitor for antipsychotics ?

Answer 23

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

Question 24

what are depot injections?

Answer 24

Long acting IM depot injections are useful in preventing relapse in patient who may not reliably take regular oral medication.

Question 25

what are the advs/disadvs of depot injections?

Answer 25

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)

Question 26

what drug is given who aren’t responding adequately to treatments?

Answer 26

clozapine

Question 27

what is clozapine’s main side effect?

Answer 27

agranulocytosis, Agitation, drowsiness, dry mouth,erectile dysfunction

Question 28

what is DSM-V?

Answer 28

diagnose schizophrenia