Schizophrenia Flashcards
Which dopamine pathway is responsible for the +ve Sx?
Mesolimbic pathway
Which dopamine pathway is responsible for the -ve Sx?
Mesocortical pathway
What are the +ve Sx of schizophrenia?
Hallucinations and delusions
What are the -ve Sx of schizophrenia?
Poverty of speech, flat affect, poor motivation, social withdrawal and lack of concern for social convention
What are the 1st rank (cardinal) Sx of schizophrenia?
- Third-person auditory hallucinations
- Thought echo
- Delusional perception – believe actual things are ‘giving them a message’
- Thought insertion/withdrawal/broadcast
- Delusions of passivity
What are the 2nd rank Sx of schizophrenia?
- Second-person auditory hallucinations
- Catatonic behaviour
- Negative symptoms
What are the three neurological Sx that have been seen in schizophrenia?
- Hyperactivity of dopaminergic, serotonergic and noradrenergic systems
- Enlargement of the lateral and third ventricles
- Abnormalities of the frontal lobes
What are the advantages of typical antipsychotics?
- Cheap
- Have been used for a long time - lots of experience with them
- Can be injected - long-acting depot can be used in patients with poor compliance
What are the types of S/Es that can occur with typical?
Dopamine
Histamine
Anticholinergic
Alpha-1
What are the Alpha-1 S/Es of typicals?
- Impotence
2. Postural hypotension
What are the anticholinergic S/Es of typicals?
- Constipation
- Blurred vision
- Dry mouth
- Confusion
What are the histamine S/Es of typicals?
- Sedation
What are the dopamine S/Es of typicals?
- Hyperprolactinaemia - galactorrhoea, impotence
- Acute dystonia - e.g. oculo-gyric crisis
- Parkinsonism
- Akathasia - restless legs
- Tardive dyskinesia - e.g. lip-smacking
How may dopamine S/Es (EPSEs) be managed?
Procyclidine (except akathasia)
What may procyclidine also be used for?
Acute dystonic reaction than can occur with haloperidol OD
How may akathasia be managed?
Lorazepam (or BZD, or beta-bloker)
What are the ‘other’ S/Es of typical?
- Weight gain
- Arrhythmia
- Decreased seizure threshold
- Neuroleptic malignant syndrome
What is the mnemonic for neuroleptic malignant syndrome?
FEVER
F - fever E - elevated enzymes (CK) V - vitals unstable E - encephalopathy R - renal failure (+DCIS)/rigidity
What are some examples of typicals?
Haloperidol
What are some examples of atypicals?
Olanzapine, amisulpride, risperidone, aripiprazole
What are the advantages of atypicals?
- Lower risk of EPSEs than typicals
2. But as effective as typicals
What are the disadvantages of atypicals?
- More expensive
- Less experience using them
- Only available in oral form
What are the S/Es of atypicals?
- Weight gain - more so than typicals
- Sedation
- Decreased seizure threshold
- Metabolic syndrome
When is clozapine used?
Treatment-resistant schizophrenia
What are the S/Es of clozapine?
- Agranulocytosis
- Sedation
- Constipation/dry mouth/blurred vision
- Weight gain
- Decreased seizure threshold
- Hypersalivation
What is the mnemonic for good prognostic indicators in schizophrenia?
FINDING PLANS
F - female I - in a relationship N - no -ve Sx D - aDheres to medication I - intelligent N - no stress G - good pre-morbid personality P - paranoid subtype L - late onset A - acute onset N - no substance misuse S - scan normal
