Schizophrenia and psychosis Flashcards
Risk factors for schizophrenia
viral infections, low birth weight/hypoxia, substance misuse, genetic link
Describe the positive symptoms of schizophrenia
visual and auditory hallucinations, delusions, lack of awareness of illness, vagueness of speech, social awkwardness, mood abnormailty
Describe the negative symptoms of schizophrenia
Apathy, social withdrawal, lack of motivation, poverty of speech
How long should an antipsychotic be given to work until it is deemed ineffective?
4-6 weeks
How long should a therapy regime consisting of clozapine augmented with another antipsychotic be given to work until it is deemed ineffective?
8-10 weeks
Describe the licensing for Clozapine
Psychosis associated with Parkinson’s disease.
If 2 antipsychotics have been deemed ineffective, one being a second generation antipsychotic, clozapine indicated.
In what exceptional circumstances can more than one antipsychotic be used?
If augmenting clozapine therapy OR if antipsychotics are being cross-tapered
What generation of antipsychotic is Clozapine?
Second-generation (atypical)
Which generation of antipsychotics is associated with a higher risk of EPSEs?
First generation (typical)
Which generation of antipsychotics is associated with a higher risk of hyperprolactinaemia?
First generation (typical)
Which generation of antipsychotics is associated with a higher risk of glucose intolerance?
Second generation (atypical)
Which generation of antipsychotics is associated with a higher risk of weight gain?
Second generation (atypical)
Which second generation antipsychotics have a lower risk of acute and late-onset EPSEs?
Olanzapine, Quetiapine, Aripiprazole, Clozapine
Describe acute dystonia
Involuntary muscle contractions causing repetitive movements/ posture twisting
Who is more likly to experience acute dystonias?
Males
From what point in treatment can acute dystonias present?
Within hours of starting antipsychotic
Describe tardive dyskinesia
involuntary movements of face and mouth e.g., lip smacking
At what point in treatment is tardive dyskinesia likely to develop?
After months/ years of treatment or if treatment is discontinued
Which EPSE is likely to be irreversible?
Tardive dyskinesia
Describe Akathisia
Internal restlessness often mistaken for psychotic agitation
How is tardive dyskinesia managed?
Reduce antipsychotic dose and discontinue procyclidine
How is acute dystonia managed?
Can be managed with procyclidine
How are Parkinsonism’s managed?
Procyclidine can be used
Which EPSE does procyclidine worsen?
Akathisia
Which patient group are parkinsonism EPSEs most likely to effect?
elderly females with previous neurological damage
When is akathisia likely to develop?
Can develop within hours to weeks
Which antipsychotic can LOWER prolactin concentrations?
Aripiprazole
What are the symptoms of hyperprloactinaemia?
galactorrhea, breast enlargement, increased risk of breast cancer, menstrual probelms, sexual dysfunction, reduced bone mineral density
How long should antipsychotics be stopped for after suspected neuroleptic malignant syndrome?
5 days
What are the symptoms are neuroleptic malignant syndrome?
Labile BP, tachycardia, hyperthermia, fever, sweating, muscle rigidity
Which second generation antipsychotics are more likely to be associated with weight gain?
Olanzapine and Clozapine
How often should a patient’s vital signs be monitored when using antipsychotics for rapid tranquilisation?
Every hour until stable
How often should a patient’s vital signs be monitored when using high-dose antipsychotics for rapid tranquilisation?
Every 15 minutes until stable
How often should antipsychotic use in the elderly be reviewed?
Every 6 weeks
What monitoring needs to take place when reviewing antipsychotics?
BP, weight, HbA1c, lipids, FBC, LFTs, U&Es, sometimes an ECG
What advantage does zuclopenthixol depot use have in comaprison to other first-generation antipsychotics?
Shown to be more effective in preventing relapses
What cardiovascular side effects are likely to occur with antipsychotic use?
Tachycardia, hypotension, and QT prolongation
Which serious side effect is most likley to occur betweek weeks 6-18 of Clozapine therapy?
Neutropenia/ agranulocytosis
When is cardiomyopathy at the highest risk with clozapine therapy?
In the first 2 months
What is the desired clozapine level?
0.35-0.5mg/L
When should clozapine levels be measured?
Trough level (12 hours post-dose)
