Schizophrenia Flashcards
Hallucinations, Delusions, Perceptions, Thought insertion, Echo, Withdrawal, Broadcasting, Disorganised speech, Disorganised or catatonic behaviour are examples of what Schizophrenia Symptoms?
Positive
Flattened moods, Avolition, Alogia, Anhedonia, Social isolation, Slow movements and Poor self-care or self-neglect are examples of what Schizophrenia Symptoms?
Negative
Speech may be reduced in quantity (poverty of speech), is known as what?
Alogia
A failure to enjoy positive emotional or pleasurable experiences is known as what?
Anhedonia
Can a patient with Schizophrenia experience cognitive symptoms?
YES!
What are the two diagnostic tools of Schizophrenia?
DSM5 and ICD10
What are the first generation, Phenothiazine anti-psychotic drugs?
-Chlorpromazine
-Levomepromazine
-Promazine
-Pericyazine
-Trifluoperazine
-Periphenazine
What are the first generation, Butyrophenones anti-psychotic drugs?
Haloperidol, Benperidol
What are the first generation, Thioxanthenes anti-psychotic drugs?
Flupentixol, Zuclpenthixol
What are the first generation, Diphenylbutylpiperidines anti-psychotic drugs?
Pimozide
What are the first generation, Substituted benzamides anti-psychotic drugs?
Sulpiride and Amisulpride
What are the second generation anti-psychotics?
-Clozapine
-Olanzapine
-Risperidone
-Paliperidone
-Quetiapine
-Aripiprazole
-Lurasidone
What generation anti-psychotic do we use for negative symptoms?
Second generation
If a patient has a first generation depot / long acting injection, what needs to be done first?
A small test dose to test for sensitivities to EPSE’s and the oil base
If a patient has a second generation depot / long acting injection, what needs to be done first?
No test dose of injection but need trail or SGA oral treatment
What is high dose antipsychotic prescribing? (HDAT)
1) A single antipsychotic prescribed above the BNF max
OR
2) 2+ antipsychotics prescribed concurrently (100%+ of daily dose!)
If a patient is at risk of self harm or accidents what could we consider doing?
Rapid Tranquillisation
What does NICE recommend for Rapid Tranquillisation?
-IM Lorazepam
*On its own or
-IM Haloperidol with IM Promethazine
What medication is licensed for the treatment of resistant Schizophrenia?
Clozapine
What drug class is Clozapine?
D2 Weak Antagonist at dopamine D2 receptor
What receptor does Clozapine act through?
5-HT2A receptor
How long is blood monitoring weekly for on Clozapine?
18 weeks - 2 weekly until one year!
If a patient gets a green result on Clozapine what does that mean?
Continue blood tests are within range!
If a patient gets a Amber result on Clozapine what does that mean?
Repeat bloods twice weekly until either red or green
If a patient gets a RED result on Clozapine, what does that mean?
Immediate stopping of therapy and DAILY bloods!
How should you discontinue Antipsychotics?
Slowly and gradually particularly after long term treatment
What can symptomatic treatment include when stopping anti-psychotic treatment?
Short-term use of benzodiazepines for anxiety and sleep
Should you cross taper when switching antipsychotics?
YES
What type of anti-psychotic can cause:
-Metabolic side effects
-Weight gain
-Hyperglycemia
-Hyperlipidemia
-Anticholinergic
-Cardiac
-Hyperprolactemia
-Sexual dysfunction
Second generation antipsychotics
What drug can cause hyperprolactemia?
Risperidone
What anti-psychotic can cause:
-Neurological s/e
-Extrapyramidal side effects (EPSEs)
-Anticholinergic
-Cardiac
-Hyperprolactemia
-Sexual dysfunction
First generation antipsychotics
What are examples of Extrapyramidal side effects?
EPSEs
Acute:
-Akathesia, Dystonia, Parkinsonism
Tardive dyskinesia
Extrapyramidal side effects (EPSEs), are associated with what type of dose?
High does of high potency first gen
Uncontrolled muscle spasms are known as?
Dystonia
How can Dystonia be treated?
Anticholinergics (Procyclidine)
OR switching to second gen or reducing dose
How do we treat the EPSE of Parkinsonism symptoms?
-Reduce the dose
-Switch medication to one less likley
-Anticholinergic - procyclidine
Inner restlessness is known as?
Akathisia
How do we treat Akathisia?
-Dose reduction
-Switch
-Short course of benzos
When starting what drug is a short course of benzos considered?
Aripiprazole
How do we treat tardive dyskinesia?
-Stop Anticholinergic meds
-Reduce dose of antipsychotic meds
-Switch to clozapine or quetiapine
Weight gain, increased insulin and glucose levels, dyslipidaemia are examples of what side effect of anti-psychotics?
Metabolic syndrome
What inhibits prolactin release?
Dopamine - hence dopamine antagonists increase prolactin plasma levels
How do we manage Hyperprolactinemia?
-Reduce dose
-Switch to a prolactin sparing
-Consider adding low dose aripiprazole
How can sexual dysfunction be managed from anti-psychotics?
-Adjust antipsychotic dose
-Add 3-6mg Aripiprazole (off license)
-Sildenafil
What is an example of a psychostimulant?
Modafinil
A patient with narrow-angle glaucoma can’t have what anti-psychotic?
Olanzapine
What drugs at high doses can cause anticholinergic side effects?
Olanzapine and Quetiapine
What anti-psychotics can cause Anticholinergic side effects?
First gen with low potency and Clozapine
What anti-psychotics can cause sudden cardiac death?
-Quetiapine and Venlafaxine
*QT interventions
What drug has serious cardiac side effects of:
Thromboembolism
Myocarditis
Cardiomyopathy
Clozapine
What drug can cause serious haematological effects:
Agranulocytosis
Clozapine
A patient on Clozapine is constipated, what should we offer?
1st - Stimulant
2nd - Stool softer/Osmotic laxative
A patient on Clozapine is experience Hypersalivation, what can be used to manage this?
-Antimuscarinics = constipation
-Hyoscine hydrobromide
What can Clozapine cause?
Aspiration Pneumonia due to Hypersalivation
What is NMS - in relation to anti-psychotics?
Neuroleptic Malignant Syndrome
What is NMS?
An acute disorder of thermoregulation and neuromotor control
What is the treatment for NMS?
-STOP antipsychotic
-Consider benzos
-Call ambulance and transfer to hospital
When restarting anti-psychotics after NMS how many days should we wait?
5 days
What anti-psychotics should we try when restarting after NMS?
One that is structurally unrelated to the causative agent or one with lower dopamine affinity such as:
Quetiapine, Clozapine or Aripiprazole
What drug levels are 50% reduced by smoking?
Clozapine and Olanzapine
What drug levels are 20% reduced by smoking?
Haloperidol
Clozapine levels are increased by 60% by what?
Caffeine
In what pathway in Schizophrenia is there a reduction in dopaminergic activity?
Mesocortical pathway
All drugs that are used in the treatment of Schizophrenia have activity at what receptors?
D2
What pathways are Dopamine pathways?
-Mesocortical pathway
-Mesolimbic pathway
-Tuberohypophyseal
How can cocaine cause psychosis?
Dopamine release stimulates D2 receptors
How does Reserpine decrease psychosis?
Depletes dopaminergic and noradrenergic synapses
How does bromocriptine exacerbate Schizophrenia?
Dopamine agonist which makes a response happen increases symptoms
How does L-DOPA cause hallucinations?
This is a side effect of dopaminergic drugs (DOPA) - Dopamine = positive symptoms occur
How does taking Chlorpromazine cause Psuedo-Parkinsonism?
Affects motorsymptoms in the nigrostriatal pathways
Why does lactation occur from taking Chlorpromazine?
D2 is blocked in tuberoseal pathway increasing prolactin secretion.
Why can sedation occur from taking Chlorpormazine?
H1 antagonism causing sedation
Why can postural HTN occur from taking Chlorpromazine?
A1 antagonism
Why can patients taking Chlorpromazine get a dry mouth?
Muscarinic side effect
