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Pharm + Patient Year 3 Sem 2 > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

What is the normal age for onset of schizophrenia?

A

Men 20-28 years

Women 26-32 years

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2
Q

What evidence is there for physiological changes in schizophrenia?

A

Evidence seen in identical twins, only one of whom presented with symptoms
Dilated ventricles in disease potentially due to loss of brain tissue

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3
Q

Give examples of positive symptoms of schizophrenia.

A

Delusions
Hallucinations
Disorganised

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4
Q

Give examples of negative symptoms of schizophrenia.

A

Reduced motion
Lack of motivation/interest
Reduced pleasure
Thought and speech

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5
Q

Give examples of cognitive deficits of schizophrenia.

A

Attention

Working and verbal memory executive function

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6
Q

Give examples of mood symptoms of schizophrenia.

A

Depression
Anxiety
Hostility/aggression
Suicide

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7
Q

Positive schizophrenic symptoms are associated with malfunctioning of which brain circuits?

A

Mesolimbic and striatal

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8
Q

Negative schizophrenic symptoms are associated with malfunctioning of which brain circuits?

A

Mesocortical/prefrontal cortex

Nucleus accumbens reward circuits

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9
Q

Cognitive schizophrenic symptoms are associated with malfunctioning of which brain circuits?

A

Dorsolateral prefrontal cortex

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10
Q

Aggressive schizophrenic symptoms are associated with malfunctioning of which brain circuits?

A

Orbitofrontal cortex

Amygdala

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11
Q

Affective (mood) schizophrenic symptoms are associated with malfunctioning of which brain circuits?

A

Ventromedial prefrontal cortex

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12
Q

What criteria of the DSM-V must be met for schizophrenia diagnosis?

A

At least two of delusions, hallucinations, disorganised speech, grossly disorganised behaviour, negative symptoms
Social/occupational dysfunction
Duration of at least 6 months

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13
Q

Describe the action of antipsychotics.

A

Inhibit D2 receptors
Competes with dopamine to occupy the receptors thus preventing dopamine from acting on all receptors, thus controlling positive symptoms
Does not manage high concentration of dopamine, thus stopping medication will mean reoccurrence of psychotic symptoms

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14
Q

Describe the glutamate theory of schizophrenia.

A

GABA inhibits NMDA receptors, which also respond to glutamate, leading to further receptor activation and GABA function
Glutamate activation of dopamine cell bodies where GABA is not active, leading to too much dopamine thus psychosis

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15
Q

Describe the action of phencyclidine.

A

NMDA antagonist
Renders NMDA receptors hypo functional leading to disinhibition of pyramidal cell
Patients as a result experience positive symptoms as well as affective symptoms

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16
Q

Describe the dopamine theory of schizophrenia.

A

Increased dopamine in subcortical pathways leading to psychotic symptoms

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17
Q

Give examples of atypical antipsychotics.

A

Clozapine
Olanzapine
Risperidone

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18
Q

Give examples of typical antipsychotics.

A

Haloperidol

Chlorpromazine

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19
Q

Describe the action of typical antipsychotics.

A

High affinity for D2 receptors
Effective against positive symptoms
Cause motor control impairments due to increased blockade of D2
Less side effects potentially due to less rich pharmacology

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20
Q

Describe the action of atypical antipsychotics.

A

Higher affinity for serotonin than D2 receptors
Potentially improved efficacy against negative symptoms
Rich pharmacology means significant side effects
Less motor impairment

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21
Q

What are the significant side effects of atypical antipsychotics?

A

Weight gain
Metabolic syndrome
Agranulocytosis

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22
Q

When is clozapine shown to do best efficacy?

A

Treatment resistant schizophrenia

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23
Q

What is the efficacy threshold for D2 receptor occupancy?

A

65% occupancy

The more D2 receptors blocked, the increased likelihood of EPSEs

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24
Q

Describe the D2 receptor occupancy of haloperidol.

A

Very small effective window
Above 70% occupancy results in hyperprolactinaemia
EPS resent at >78% occupancy

25
Q

Describe the theories of antipsychotics inducing weight gain.

A

Antagonism of histamine, serotonin 5HT2c and D2 receptors

Affecting hormonally controlled symptoms i.e. leptin

26
Q

What psychotropic drugs show greatest risk of weight gain?

A 
TCAs
Mirtazapine
Lithium
Valproate
Carbamazepine
27
Q

What is the prodromal phase?

A

The first episode of schizophrenia, prior to psychotic symptoms
Antipsychotics not offered

28
Q

Which antipsychotics are most likely to give EPSE?

A

Typicals

29
Q

What are the 4 types of EPSEs?

A

Dystonia
Pseudo-parkinsonism
Akathisia
Tardive dyskinesia

30
Q

What is dystonia?

A

Muscle spasms in any part of the body

31
Q

How is dystonia treated?

A

Anticholinergic agents

32
Q

What is pseudo-parkinsonism?

A

Tremor, rigidity, bradykinesia

33
Q

How is pseudo-parkinsonism treated?

A

Reducing dose of antipsychotic

Anticholinergics may be used short term

34
Q

What is akathisia?

A

Inner restlessness and compulsion to move

35
Q

How is akathisia treated?

A

Reducing antipsychotic dose

36
Q

What is tardive dyskinesia?

A

Lip smacking, tongue protrusion

37
Q

How is tardive dyskinesia treated?

A

Approximately 50% of cases are irreversible
Stop anticholinergics
Reduce antipsychotic dose

38
Q

What is metabolic syndrome?

A

Collection of side effects causing increased weigh gain, blood glucose and lipid profiles

39
Q

Which antipsychotics most commonly cause metabolic syndrome?

A

Clozapine
Olanzapine

Risperidone
Quetiapine

40
Q

What can hyperprolactinaemia cause?

A 
Impaired sexual function
Breast growth
Amenorrhoea
Cancer
BMD
41
Q

How can hyperprolactinaemia be managed when on antipsychotics?

A

Switch to alternative drug or add aripiprazole

42
Q

How can QT prolongation risk be monitored?

A

ECG

Limited to 440ms in men and 470ms in women

43
Q

Which antipsychotics most commonly cause QT prolongation?

A

Quetiapine
Haloperidol
Amisulpride

44
Q

Which antipsychotics is safest in QT prolongation risk?

A

Aripiprazole

45
Q

What is the dangerous side effect caused by chlorpromazine?

A

Photosensitivity

46
Q

Which antipsychotics commonly have anticholinergic effects?

A

Clozapine

Some typicals

47
Q

What is neuroleptic malignant syndrome?

A

Dopamine depletion causing autonomic effects such as tachycardia, sweating, hyperthermia, rigidity, raised CK

48
Q

Give examples of side effects of antipsychotics.

A 
Sedation
Lowered seizure threshold
Hyponatraemia
Neutropenia
Postural hypotension
49
Q

What common monitoring is required for antipsychotic therapy?

A 
Weight
Pulse and BP
Fasting BMs
Lipids
Prolactin
Nutrition/exercise adherence
ECG at baseline
50
Q

Describe the use of depot antipsychotics.

A

Injection into gluteal/deltoid muscle to ensure adherence, given at the longest possible dose interval

51
Q

When is a test dose required for antipsychotics?

A

For depots given in oily bases i.e. typicals

52
Q

What are the nice guidelines for combination antipsychotic treatment?

A

Do not initiate combination medication except for short periods i.e. such as when changing medication

53
Q

What are the nice guidelines for treatment with clozapine?

A

Should be offered to those who do not respond adequately despite sequential use of at least 2 different antipsychotics, one of which being 2nd gen

54
Q

What are the 6 main side effects associated with clozapine?

A 
Sedation
Hypersalivation
Constipation
Venous thromboembolism
Myocarditis/cardiomyopathy
Agranulocytosis/neutropenia
55
Q

How can hypersalivation be managed?

A

Hyoscine hydrobromide

Chewing SF gum

56
Q

What are the symptoms of myocarditis/cardiomyopathy?

A 
Fatigue
Chest pain
Fever
Palpitations
Low BP, high pulse
Shortness of breath
57
Q

Describe the interaction between clozapine and aromatic hydrocarbons in cigarettes.

A

Induce CYP1A2 causing clozapine levels to fall by up to 50%

Upon stopping smoking, serum levels can rise by 50-72%

58
Q

Describe the interaction between clozapine and caffeine.

A

Compete at CYP1A2

Clozapine levels rise by 14-47%

Pharm + Patient Year 3 Sem 2 (29 decks)

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