Schizophrenia and psychosis Flashcards
Four dopamine brain pathways and their symptoms etc
Mesocorticol- negative- apathy, social withdrawal and catatonic
Mesolimbical- positive symptoms dellusions hallucinations
Nigrostriatal- EPS
Tuberofundibular- hyperprolactinaemia
Antipsychotic drugs in emergency
Can give IM dose in emergency. But prescription cannot imply same dose oral and IM. IM dose lower as no first pass metabolism
Antipsychotics in the elderly
Give half the oral dose of adults
Don’t give if mild to moderate symptoms
Patients with dementia= increased risk of EPS
Review regularly
Antipsychotics in those with learning difficulties
Don’t give if not needed and review regularly
1st generation antipsychotic classes
Phenothiazines
Butyrophenones
Thiozxanthens
What are the three groups of Phenothiazines and their side effects and of the different first gen drugs
Phentothiazines:
Group 1: Levopromazine Promazine Chlorpromazine These are the most sedating but moderate antimuscarinic and EPS
Group 2:
Pericyclizine- least EPS
Group 3: Fluropenazine Triclorophenazine Prephenazine These have the most EPS but less antimuscarinic
Butyrophenones:
haloperidol and Benperidol
These have most EPS and QT prolongation
Thioxanthanes:
Flupenthixol- alerting affect dont take at night
Zuclopenthixol
2nd Generation antipsychotics
Clozapine- agranulocytosis, weight gain and hyperglycaemia
Olanzapine- weight gain and hyperglycaemia
Quetiapine
Resperidone- most hyperprolactinaemia
Amisulpride- most hyperprolactinaemia
and Aripiprazole- only one that does not cause hyperprolactinaemia
Most metabolic side effects
When do you add Clozapine?
When you have tried 2 or more antipsychotics for at least 6-8 weeks that have been ineffective
How long should you trial Clozapine for?
8-10 weeks
After how many missed doses does clozapine need to be re-titrated
2 or more
Side effects of Clozapine
Agranulocytosis- council patients to report sore throat anf flu like symptoms
Myocarditis and Cardiomyopathy-
Weight gain and hyperglycaemia
GI obstruction- MHRA severe risk of paralytic ileum and , intestinal obstruction and faecal impaction. Take caution with drugs like hyoscine that can be constipating and is used to treat hyper salivation
Interactions of Clozapine
Increased risk of agranulocytosis so avoid any immunosupressants, aminosalicylates etc
Depot antipsychotics
Given 1-4 weekly
Give oral whilst stabilising on depot
Main Antipsychotic drug side effects
EPS- most common with 1st gen, Haloperidol/ Benperidol/ Phenothiazines group 3
Akathisia
Tardive dyskinesia
Parkinsonism
Dystonia
Stop at first signs of movements of tongue
Hyprolactinaemia- common with first gen and Risperidone and Amisulpride
Breast enlargement
Sexual dysfunction
Menstrual issues
Metabolic side effects
Hyperglycaemia- Clozapine, Olanzapine, Risperidone and Quetiapine
Weight gain- Clozapine and Olanzapine
Sexual dysfunction- risperidone and haloperidol
Cardiac side effects-
QT prolongation- Primozine and Haloperidol
Arrhythmia, hypotension, tachycardia
Which antipsychotic does not cause hyperprolactinaemia
Aripiprazole
