Schizophrenia Flashcards
What are the symptoms of schizophrenia?
Positive
- Hallucination
- Delusions
- Disturbed thoughts + speech
Negative
- Apathy
- Social w/drawal
- Poor hygiene
- Catatonia
What is the treatment for schizophrenia?
Monotherapy: oral antipsychotics
Resistant schizophrenia (tried 2+ antipsychotics drugs inc 2nd gen)
- Clozapine
- No response → + oral antipsychotics
Non-adherence: Depot (long acting IM injection)
- Ends in embonate or deconate
Acute episode: IM antipsychotics
- Lower dose than oral
- Rx specify dose for each route + review daily
Unlicensed high doses in schizophrenia
- First try alt (clozapine)
- INC side effects + drug interaction
- Monitoring: ECG, pulse, BP + temperature
- INC dose slowly, stop if no improvement
Schizophrenia in Learning disability
No psychotic symptoms:
- RED dos/discontinue antipsychotic + review
- Annual documentation of reasons for continuing
- Refer to experienced psychiatric
Schizophrenia in Elderly
- Dementia: INC risk of stroke + mortality
- Postural hypotension, hyperthermia, hypothermia
- Don’t treat mild-moderate symptoms
- Initial dose: half adult dose
- Regular reviews
What is the MOA of 1st gen antipsychotics?
Blocks post synaptic D2 receptors
Phenothiazine (hepatotoxic + acute dystonic reactions)
INC sedation:
- Chlorpromazine (contact sensitisation)
- Promazine (OTC insomnia)
INC EPS: Prochlorperazine
What is the MOA of 2nd gen antipsychotics?
Blocks D2 + other receptors: distinct clinical profile + More effective treating negative symptoms
Amisulpride (INC hyperprolactinaemia)
Aripripazole (no hyperlacticaemia)
- MHRA: Pathological gambling
Clozapine:
- Agranulocytosis
- Myocarditis
- GI obstruction
- Weight gain
- Diabetes
Olanzapine (weight gain + diabetes)
Quetiapine
Risperidone (INC hyperprolactinaemia)
What are the indications of antipsychotics?
- Schizophrenia
- Bipolar disorder
- 1st gen: N+V
What are the side effects of antipsychotics?
Extrapyramidal symptoms (phenothiazines, holoperidol + depot)
- Parkinsonism, dystonia, akathisia, tardive dyskinesia
- STOP if vericular tongue movements
Hyperprolactinaemia
- Hormonal disturbances, Breast enlargement, Galactorrhoea, Sexual dysfunction, RED bone density
- Monitor: prolactin level
Metabolic effects
- 2nd gen: Hyperglycaemic + diabetes,
Weight gain: clozapine + olanzapine
- 1st gen more suitable for overweight or risk of diabetes
CV effects:
- QT prolongation (pimozide)
- Postural hypotension (clozapine, quetiapine)
Neuroleptic malignant syndrome → STOP
Antimuscarinic effects
Seizures
Sedation
Sexual dysfunction (haloperidol, olanzapine, risperidone)
Photosensitivity (high dose)
What is neuroleptic malignant syndrome?
- Muscle rigidity
- Fluctuating consciousness
- Hyperthermia
- Autonomic dysfunction
What are the side effects of clozapine?
MHRA: monitor blood concentration for toxicity
Blood disorders
- Monitor: leucocyte + differential WBC
- Counsel: report signs of infection
Myocarditis (tachycardia)
Intestinal obstruction
- Caution: colonic disease, lower abdominal surgery, constipating med (antimuscarinic)
- MHRA: fatal intestinal obstruction, faecal impaction, paralytic ileus
- Counsel: report constipation before next dose
What are the side effects of chlorpromazine?
Contact sensitization - Avoid direct contact. Do not crush tablets, handle solutions w/ care
What are the side effects of phenothiazines?
Hepatotoxicity
- Monitor: LFT
Acute dystonic reaction
What are the interactions of antipsychotics?
- Drugs that prolong QT interval (pimozide)→ arrhythmias
- Drugs that cause hypokalaemia → INC risk of torsade de pointes
- Antimuscarinic effect: Antihistamine, Hyoscine, Antipsychotic
- CNS depressant effect (sedation): Alcohol, Sedating antihistamine, Benzo
- Antihypertensive → hypotension
Dopaminergic drugs → hypotension
