Schizophrenia

Question 1

What do we give first line to treat schizophrenia ?

Answer 1

Atypical antipsychotics

Question 2

What are one of rare but serious side effect of antipsychotic drugs.

Answer 2

neuroleptic malignant syndrome

Question 3

classical features of the neuroleptic malignant syndrome

Answer 3

fever,
muscle rigidity,
encephalopathy,
myoglobinuria,
unstable vital signs and
raised creatine kinase

autonomic lability: typical features include hypertension, tachycardia and tachypnoea
agitated delirium with confusion

Question 4

treatment of neuroleptic malignant syndrome

Answer 4

In severe cases, it is treated with dantrolene which acts as an antagonist at the ryanodine receptors decreasing the free intracellular calcium concentration.

Question 5

What are some of the atypical antipsychotic drugs?

Answer 5

Amisulpride
Aripiprazole

Olanzapine

Risperidone
Quetiapine

Clozapine - used last

Question 6

Risk factors using Clozapine?

Answer 6

Agranulocytosis / neutropenia (3%)

FULL BLOOD COUNT MONITORING ESSENTIAL when using this drug

SO ONLY used According to guidelines when schizophrenia not controlled despite two or more antipsychotic drugs given for 6-8 weeks - One of which should be a SECOND GENERATION ANTIPSYCHOTIC DRUG

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Reduce seizure threshold

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Myocarditis - baseline ECG should be taken BEFORE STARTING CLOZAPINE

Question 7

When should we need dose adjustments for CLOZAPINE ?

Answer 7

If smoking is started or stopped during treatment

Question 8

What are the specific warning for anti psychotic drugs in the elderly

Answer 8

Can lead to stroke
Increase risk of venous thromboembolism

Question 9

What are the main advantage of atypical antipsychotic medications

Answer 9

Reduce side effects on the extra pyramidal system

Question 10

What are some of the atypical antipsychotic drugs which can increase dyslipidemia and obesity

Answer 10

Clozapine - HOWEVER NOT USED AS FIRST LINE , as it is first generation

OLANZAPINE - highest risk of dyslipidemia and obesity than other agents

Question 11

The atypical drugs with relatively less side effects ?

Answer 11

Aripiprazole

Question 12

should be offered to all patients as an intervention shown to be beneficial in a patient with schizophrenia?

Answer 12

cognitive behavioural therapy

Question 13

those taking antipsychotics close attention should be paid to

Answer 13

cardiovascular risk-factor modification due to the high rates of cardiovascular disease in schizophrenic patients

Question 13

those taking antipsychotics close attention should be paid to

Answer 13

cardiovascular risk-factor modification due to the high rates of cardiovascular disease in schizophrenic patients