Schizophrenia Flashcards
risk ^ 50% by ?
childhood viral CNS infection
what is it assumed that SZP is related to?
over activity of dopamine pathways in the brain
positive symptoms
delusions
hallucinations
thought disorder
negative symptoms
apathy
lack of volition (will power)
social withdrawal
cognitive impairment
1st rank symptoms
passivity phenomena delusional perception delusional hallucinations (mainly auditory) thought interference
what is passivity phenomena
belief that they are no longer in control of their own body
Time frame after which SZP can be diagnosed
dont diagnose unless symptoms last for >= 6 months and are present much of the time for at least 1m
poor prognostic indiactors
male insidious onset early onset cognitive impairment enlarged ventricles
Examples of atypical antipsychotics
risperidone
olanzapine
quetiapine
what is more common with the use of atypicals than typicals?
metabolic syndrome
What is better about atypicals
less likely to induce EPSE’s
better at tx -ve symptoms
why do EPSE’s occur
antipsychotics block D2 receptors in the nigrostriatum
examples of typical antipsychotics
HTC
chlorpromazine
thioridazine
haloperidol
what is acute dystonia
muscle spasms
can occur within hours of starting antipsychotics
try procyclidine to treat
treatment of EPSE’s
decrease dose, change to atypical, or try procyclidine (an Ach antagonist)
do antipsychotics increase or decrease seizure threshold
decrease
what is tar dive dyskinesia
repetitive involuntary purposeless movements
normally takes years to develop and may be irreversible
why can antipsychotics cause hyperprolactinaemia?
secretion of prolactin is under inhibitory control by dopamine
symptoms of hyperprolactinaemia
galactorrhea
amenorrhoea
oligomenorrhoea
infertility
treatment of symptomatic hyperprolactinaemia
decrease dose or switch to quetiapine (amantadine if not tolerated)
how is antipsychotic use related to osteoporosis
hyperprolactinaemia > decreased oestrogen and testosterone > osteoporosis
what is akathisia and how is it managed
s/e of antipsychotics > restlessness
if tx needed > propranolol +/- cyproheptadine
which antipsychotics increase the risk of stroke in elderly
olanzapine and respiridone
what CV effect is common with antipsychotics
postural hypotension
what are the purposeless movements that can occur with tardive dyskinesia
grimacing
sticking tongue out
lip smacking
name the antipsychotic that is used ONLY when all others are intolerated
clozapine
clozapine s/e’s
metabolic syndrome and sedation more than any other
hyper salivation
AGRANULOCYTOSIS»_space; FBC even if patient only has a sore throat
how is smoking related to clozapine
if smoking its fine if it stays constant
but if a patient smokes then stops, they will start metabolising clozapine much faster
cardiac problem assoc with clozapine
myocarditis
clozapine FBC monitoring
weekly for 1st 6 months
fortnightly for next 6m
every 4 weeks thereafter
for 1m after cessation
examples of acute dystonia
torticollis
oculogyric crisis
prolonged involuntary upward deviation of the eyes
oculogyric crisis
‘crick in the neck’
torticollis
poor prognostic indicators in SZP
low IQ strong fam hx gradual onset premorbid social withdrawal no obvious precipitant
