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2. General adult psychiatry > Schizophrenia and psychotic disorders > Flashcards

Schizophrenia and psychotic disorders Flashcards

1
Q

Environmental risk factors for developing schizophrenia

A

Urban living
Being a migrant
Winter/spring birth

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2
Q

Male:female incidence of schizophrenia

A

1.4:1

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3
Q

Point prevalence of schizophrenia

A

4.6/1000

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4
Q

Lifetime risk of schizophrenia

A

0.7%

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5
Q

Differences in schizophrenia epidemiology in developing countries

A

Lower rates overall
Higher comparative rates of catatonia
Lower comparative rates of hebephrenic schizophrenia

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6
Q

Percentage of patients with schizophrenia who have catatonia in developed countries

A

1%

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7
Q

Percentage of patients with schizophrenia who have catatonia in developing countries

A

10%

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8
Q

Percentage of patients with schizophrenia who have hebephrenia in developed countries

A

13%

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9
Q

Percentage of patients with schizophrenia who have hebephrenia in developing countries

A

4%

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10
Q

Percentage of apparently healthy people who report experiencing hallucinations

A

4.2%

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11
Q

Percentage of apparently people who report hearing voices saying ‘quite a few words’ when there was nobody around to account for it

A

0.7%

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12
Q

Average age of onset of delusional disorders

A

39

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13
Q

OR of schizophrenia with associated cannabis use

A

2.1

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14
Q

Figures who identified that patients with schizophrenia in high expressed emotion families were more likely to experience a relapse

A

Brown and Rutter

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15
Q

Risk of relapse within a year for patients with schizophrenia in high expressed emotion families without family therapy

A

64%

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16
Q

Risk of relapse within a year for patients with schizophrenia in high expressed emotion families after family therapy

A

24%

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17
Q

Three forms of social skills training for patients with schizohprenia

A

Basic model
Problem solving model
Cognitive remediation model

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18
Q

Description of the basic model of social skills training

A

Complex social repertoires are broken down into smaller steps, learned, practiced, and then applied to natural settings

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19
Q

Description of the social problem solving model of social skills training

A

Suggests that deficits in information processing are the cause of deficits in social skills
Aims to improve impairments in information processing
Targets medication and symptom management, recreation, basic conversation, and self care

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20
Q

Description of the cognitive remediation model of social skills training

A

Targets fundamental cognitive skills such as attention and planning
Suggests that improvements in fundamental skills will transfer to more complex processes

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21
Q

Percentage of patients with a first episode of psychosis who relapse within a year despite antipsychotic treatment

A

27%

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22
Q

Percentage of patients with a first episode of psychosis who relapse within a year with placebo treatment

A

61%

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23
Q

Percentage of all patients with psychosis who relapse within one year despite antipsychotic treatment

A

40%

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24
Q

Percentage of patients with psychosis who live in a stressful situation who relapse within one year despite antipsychotic treatment

A

62%

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25
Q

Lifetime suicide risk among patients with schizophrenia

A

5.6%

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26
Q

Subtypes of schizophrenia with the best prognosis

A

Catatonic
Paranoid

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27
Q

Subtype of schizophrenia with the worse prognosis

A

Hebephrenic

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28
Q

Positive prognostic factors in schizophrenia

A

Late onset
Clear precipitating factors
Acute onset
Good premorbid functioning
Affective symptoms
Being married
Family history of affective disorders
Positive symptoms only
Good initial treatment response
Female sex

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29
Q

Most important positive prognostic factor in schizophrenia

A

Good initial treatment response

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30
Q

Poor prognostic factors in schizophrenia

A

Early onset
Insidious onset
No clear precipitating factors
Social withdrawal
Being single, divorced, or widowed
Poor social support
High expressed emotion families
Negative symptoms
Poor treatment compliance
No remisson in 3 years
Many relapses
Perinatal trauma history
History of violence

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31
Q

Best predictors of a poor prognosis following a psychotic episode

A

Stressful life events
High expressed emotion families
Non-compliance with treatment

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32
Q

Drug which shows a moderate to large improvement over first generation antipsychotics in studies

A

Clozapine

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33
Q

Drugs which show a small to moderate improvement over first generation antipsychotics in studies

A

Olanzapine
Risperidone

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34
Q

Near maximal effective dose for aripiprazole

A

10mg/day

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35
Q

Near maximal effective dose for haloperidol

A

3.3-10mg/day

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36
Q

Near maximal effective dose for clozapine

A

> 400mg/day

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37
Q

Near maximal effective dose for olanzapine

A

> 16mg/day

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38
Q

Near maximal effective dose for risperidone

A

4mg/day

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39
Q

Findings in CATIE trial for staying with the same medication or switching when patients require a treatment review

A

Patients who stayed on the same medication did better, especially for olanzapine

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40
Q

Description of primary negative symptoms of schizophrenia

A

Negative symptoms that are intrinsic to schizophrenia

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41
Q

Description of secondary negative symptoms of schizophrenia

A

Negative symptoms that occur as a result of positive symptoms, treatment side effects, environmental deprivation etc.

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42
Q

Six features of deficit schizophrenia

A

Restricted affect
Diminished emotional range
Poverty of speech
Curbing of interest
Diminished sense of purpose
Diminished social drive

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43
Q

Number of features which must be present for a diagnosis of deficit schizophrenia

A

Two

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44
Q

Best studied second generation antipsychotic for negative symptoms

A

Amisulpride

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45
Q

Partial agonist at the glycine modulatory site of the glutamatergic NMDA receptor which has been investigated as an add on treatment for negative symptoms in schizophrenia

A

D-cycloserine

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46
Q

Antipsychotic shown to decrease suicidality among patients with schizophrenia better than olanzapine

A

Clozapine

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47
Q

First line treatment for patients with newly diagnosed schizophrenia

A

Oral atypical antipsychotic

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48
Q

Number of antipsychotics which should be tried at an adequate dose before trying clozapine

A

Two, with at least one atypical

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49
Q

Percentage of patients with schizophrenia who will have a relapse of a psychotic episode within a year despite treatment

A

20%

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50
Q

Percentage of patients with schizophrenia who will have a relapse of a psychotic episode within a year if they are not given treament

A

60%

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51
Q

Length of maintenance antipsychotic therapy usually suggested after a psychotic episode

A

At least 1-2 years

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52
Q

Antipsychotics to avoid if EPSEs are an issue

A

Typical antipsychotics, especially risperidone

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53
Q

Antipsychotics to avoid if metabolic syndrome is an issue

A

Olanzapine
Clozapine

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54
Q

Antipsychotics to try if metabolic syndrome is an issue

A

Amisulpride
Aripiprazole

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55
Q

Antipsychotic to avoid if raised prolactin is an issue

A

Amisulpride

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56
Q

Antipsychotics to try if raised prolactin is an issue

A

Aripiprazole
Olanzapine
Quetiapine

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57
Q

Antipsychotics to try if over-sedation is an issue

A

Haloperidol
Aripiprazole
Amisulpride

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58
Q

Antipsychotics to try if sexual dysfunction is an issue

A

Aripiprazole
Quetiapine

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59
Q

Depot antipsychotic which may be the best for relapse prevention

A

Zuclopenthixol

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60
Q

Depot antipsychotic which has a particularly high EPSE burden

A

Zuclopenthixol

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61
Q

Depot antipsychotic which may also treat depression

A

Flupentixol

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62
Q

Depot antipsychotic which may be useful for prevention of mania

A

Haloperidol

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63
Q

Depot antipsychotic which shows lower rate of EPSEs

A

Pipotiazine

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64
Q

Depot antipsychotic which may cause depression

A

Fluphenazine

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65
Q

Depot antipsychotic which needs an aqueous suspension immediately before injection

A

Risperidone

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66
Q

Depot antipsychotic which does not require a test dose

A

Risperidone

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67
Q

Risk of NMS with depot compared to oral antipsychotics

A

Equal

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68
Q

Equivalent chlorpromazine dose which is considered high dose antipsychotic prescribing

A

1g/day

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69
Q

Percentage of patients with treatment resistant schizophrenia who respond to clozapine within 6 weeks

A

30%

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70
Q

Percentage of patients with treatment resistant schizophrenia who respond to high dose chlorpromazine

A

4%

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71
Q

Likely minimum clozapine plasma level required before someone is said to be a non-responder

A

350-450 ng/ml

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72
Q

Length of time antipsychotics should be tried for before clozapine is tried

A

6-8 weeks each

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73
Q

Antipsychotics studied in phase one of the CATIE trial

A

Olanzapine
Quetiapine
Risperidone
Ziprasidone (added later)
Perphenazine

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74
Q

Percentage of patients in the CATIE trial who discontinued treatment within 18 months

A

74%

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75
Q

Antipsychotic with the lowest discontinuation rate in the CATIE trial

A

Olanzapine

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76
Q

Antipsychotic with the highest discontinuation rate in the CATIE trial

A

Quetiapine

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77
Q

Antipsychotic which caused the most weight gain in the CATIE trial

A

Olanzapine

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78
Q

Antipsychotic studied in phase two of the CATIE trial

A

Clozapine

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79
Q

Antipsychotic with the lowest discontinuation rate in phase two of the CATIE trial

A

Clozapine

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80
Q

Antipsychotic with the highest rate of anticholinergic side effects

A

Clozapine

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81
Q

Comparisons made in the CATIE trial

A

Olanzapine, quetiapine, risperidone, ziprasidone, and perphenazine against each other in phase one
Clozapine against olanzapine, quetiapine, risperidone, and ziprasidone in phase two

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82
Q

Antipsychotic used in phase one of the CATIE study but not in phase two

A

Perphenazine

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83
Q

Blindedness of the CATIE study

A

Double blind

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84
Q

Antipsychotic added part way through the CATIE study

A

Ziprasidone

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85
Q

Antipsychotics compared in the CUtLASS study

A

First generation antipsychotics vs. second generation antipsychotics in the first phase
Clozapine vs. second generation antipsychotics in the second phase

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86
Q

Blindedness of the CUtLASS study

A

Unblinded

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87
Q

Primary outcome of the CUtLASS study

A

Quality of life at one year

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88
Q

Second generation antipsychotics studied in the CUtLASS study

A

Amisulpride
Olanzapine
Quetiapine
Risperidone

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89
Q

Findings of phase one of the CUtLASS trial

A

Slight advantage to first generation antipsychotics over second generation antipsychotics

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90
Q

Findings of phase two of the CUtLASS trial

A

Significant advantage to clozapine over second generation antipsychotics

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91
Q

Two antipsychotics shown to reduce suicidality among patients with schizophrenia

A

Olanzapine
Clozapine

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92
Q

Antidepressant which has shown to be effective among patients with body dysmorphic disorder

A

Fluoxetine

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93
Q

Most effective intervention for antipsychotic related weight gain

A

Lifestyle modifications

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94
Q

Most effective interventions to reduce waist circumference in schizophrenia

A

Aripiprazole augmentation
Topiramate

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95
Q

Most effective interventions to reduce glucose levels in schizophrenia

A

Switch antipsychotic to aripiprazole
Metformin

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96
Q

Most effective interventions to reduce insulin resistancein schizophrenia

A

Metformin
Rosiglitazone

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97
Q

Risk of tardive dyskinesia for depot antipsychotics compared with oral antipsychotics

A

Equal

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98
Q

Antipsychotics most associated with weight gain

A

Olanzapine
Clozapine

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99
Q

Antipsychotics least associated with weight gain

A

Asenapine
Amisulpride
Aripiprazole
Lurasidone
Ziprasidone
Haloperidol

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100
Q

Most effective antipsychotic at reducing suicidality

A

Clozapine

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101
Q

Dose of antipsychotic which should be used for a first episode of psychosis compared to in a patient with longstanding psychosis

A

Lower doses should be used for first episode psychosis

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102
Q

Effect of ketamine given to stable patients with schizophrenia

A

Transient relapse of psychosis

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103
Q

First generation antipsychotic used in the CATIE study

A

Perphenazine

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104
Q

NICE guidelines on switching from FGA to SGA

A

No routine switch needed if patient is responding and happy with current FGA

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105
Q

Antipsychotic with the best evidence for reducing aggression in patients with schizophrenia

A

Clozapine

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106
Q

Number of hours contact per week with a family member with high expressed emotions which increases the risk of relapse for a patient with schizophrenia

A

> 35

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107
Q

Psychosocial interventions with the best evidence for the management of schizophrenia

A

Vocational rehabilitation
CBT
Family therapy
Psychoeducation

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108
Q

Complications of pregnancy which increase risk of schizophrenia in the offspring

A

Bleeding
HTN
Pre-eclampsia
Diabetes
Rhesus incompatibility
Placental abruption
Premature rupture of membranes

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109
Q

Foetal abnormalities of growth/development which increase risk of schizophrenia later in life

A

Low birth weight
Prematurity
Congenital malformations
Small head circumference

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110
Q

Delivery complications which increase risk of schizophrenia in the offspring

A

Hypoxia
Uterine atony
Forceps delivery
EMCS
Resuscitation
Use of an incubator

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111
Q

Single most important factor which increases the risk of hospitalisation among mentally unwell patients

A

Treatment non-adherence

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112
Q

Positive components in the PANSS scale for schizophrenia

A

Delusions
Conceptual disorganisation
Hallucinations
Excitement
Grandiosity
Suspiciousness/persecution
Hostility

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113
Q

Negative components in the PANSS scale for schizophrenia

A

Blunted affect
Emotional withdrawal
Poor rapport
Social withdrawal
Poor abstract thinking
Lack of spontaneity
Stereotyped thinking

114
Q

Risk of schizophrenia if both parents have schizophrenia

A

40-50%

115
Q

MZ concordance for schizophrenia

A

46%

116
Q

NICE guidelines for managing cognitive symptoms associated with schizophrenia

A

Use the lowest effective antipsychotic dose
No evidence for use of any specific agent

117
Q

Reason why ICD 11 has omitted subtypes of schizophrenia based on descriptive features

A

Lack of longitudinal stability
Lack of prognostic validity
Lack of usefulness in treatment options

118
Q

Antipsychotics likely to be useful to treat negative symptoms of schizophrenia

A

Amisulpride
Cariprazine
Olanzapine
Quetiapine

119
Q

Increase in risk of developing schizophrenia among people who smoke cannabis

A

2x increase

120
Q

Increase in risk of developing schizophrenia among people who smoke cannabis by the age of 15

A

4x increase

121
Q

Compared to the general population, number of years earlier people with schizophrenia die

A

10-20

122
Q

Average age of onset of schizophrenia in men

A

23

123
Q

Average age of onset of schizophrenia in women

A

26

124
Q

Male:female rate of schizophrenia over the age of 45

A

Equal

125
Q

Amber light results for clozapine monitoring

A

WCC 3000-3500/mm3
Neutrophils 1500-2000/mm3

126
Q

Number of times per week blood tests must be taken when a patient has an amber light result

A

Twice weekly

127
Q

Mechanism of action behind QTc prolongation caused by antipsychotics

A

Blocking cardiac potassium channels

128
Q

Neuropathology findings seen in schizohprenia

A

Larger ventricles
Decreased brain volume
Decreased grey matter and white matter
Reduced prefrontal lobe volume
Reduced medial temporal lobe volume

129
Q

Most common symptom of schizophrenia

A

Loss of insight

130
Q

Percentage of patients with a first episode of psychosis who experience remission

A

58%

131
Q

Length of time where improvement is needed for a patient to have experienced recovery from a first episode of psychosis

A

2 years

132
Q

Length of time after which recovery rates stabilise following a first episode of psychosis

A

2 years

133
Q

Percentage of patients with a first episode of psychosis who experience recovery

A

38%

134
Q

Category in which folie-a-deux is found in ICD 11

A

Delusional disorder

135
Q

Sex predominance for folie-a-deux

A

Female

136
Q

Risk of schizophrenia with one affected sibling

A

12-15%

137
Q

Risk of schizophrenia with one affected parent

A

12-15%

138
Q

Risk of schizophrenia with one affected grandparent

A

6%

139
Q

Most important baseline blood test to take before starting clozapine therapy

A

WCC

140
Q

Scale used to measure symptoms of depression in patients with schizopphrenia

A

Calgary scale

141
Q

Antipsychotic which is primarily renally excreted

A

Amisulpride

142
Q

Antipsychotic least likely to cause a dry mouth

A

Amisulpride

143
Q

Feature most traditionally associated with catatonic schizophrenia

A

Mannerisms

144
Q

Percentage of patients with schizophrenia who experience recurrent relapse and continued disability

A

75%

145
Q

Likely minimum effective dose of olanzapine in a first episode of psychosis

A

5mg daily

146
Q

Likely minimum effective dose of risperidone in a first episode of psychosis

A

1-2mg daily

147
Q

Likely minimum effective dose of quetiapine in a first episode of psychosis

A

150mg daily

148
Q

Likely minimum effective dose of amisulpride in a first episode of psychosis

A

400mg daily

149
Q

Likely minimum effective dose of chlorpromazine in a first episode of psychosis

A

200mg

150
Q

Likely minimum effective dose of olanzapine in a relapse of schizophrenia

A

10mg daily

151
Q

Likely minimum effective dose of risperidone in a relapse of schizophrenia

A

3-4mg daily

152
Q

Likely minimum effective dose of quetiapine in a relapse of schizophrenia

A

300mg daily

153
Q

Likely minimum effective dose of amisulpride in a relapse of schizophrenia

A

800mg daily

154
Q

Likely minimum effective dose of chlorpromazine in a relapse of schizophrenia

A

300mg daily

155
Q

Likely minimum effective dose of haloperidol in a first episode of psychosis

A

2mg daily

156
Q

Likely minimum effective dose of haloperidol in a relapse of schizophrenia

A

> 4mg daily

157
Q

Likely minimum effective dose of sulpride in a first episode of psychosis

A

150mg daily

158
Q

Likely minimum effective dose of sulpride in a relapse of schizophrenia

A

800mg daily

159
Q

Antipsychotic least likely to cause conduction problems in a patient with an arrhythmia

A

Risperidone

160
Q

Antipsychotic most suitable for a patient with AF

A

Aripiprazole

161
Q

Maximum licensed dose for daily oral administration of haloperidol

A

20mg daily

162
Q

Maximum licensed dose for daily oral administration of chlorpromazine

A

1000mg daily

163
Q

Maximum licensed dose for daily oral administration of olanzapine

A

20mg daily

164
Q

Maximum licensed dose for daily oral administration of quetiapine

A

750-800mg daily

165
Q

Maximum licensed dose for daily oral administration of risperidone

A

16mg daily

166
Q

Maximum licensed dose for daily oral administration of clozapine

A

900mg daily

167
Q

Factors which predict a good short term prognosis in schizophrenia

A

Good initial response to antipsychotics
Good response to placebo

168
Q

Factors which predict a good long term prognosis in schizohprenia

A

Acute onset of symptoms
Female sex

169
Q

Factors which predict a poor short term prognosis in schizophrenia

A

Daily use of substances
Poor treatment compliance

170
Q

Factors which predict a poor long term prognosis in schizophrenia

A

Long duration untreated psychosis
Male sex

171
Q

Factors which do not have a prognostic significance in schizophrenia

A

Family history of schizophrenia

172
Q

Schizophrenia subtype with the earliest age of onset

A

Hebephrenic

173
Q

Antipsychotics least likely to cause dyslipidaemia

A

Aripiprazole
Amisulpride

174
Q

Antipsychotic least likely to cause QTc prolongation

A

Aripiprazole

175
Q

Antipsychotics least likely to cause sexual side effects

A

Quetiapine
Aripiprazole

176
Q

Antipsychotics least likely to cause raised prolactin

A

Quetiapine
Aripiprazole

177
Q

First line antipsychotic in hepatic impairment

A

Haloperidol

178
Q

Second line antipsychotics in hepatic impairment

A

Sulpride
Amisulpride

179
Q

Safest antipsychotics in renal impairment

A

Olanzapine
Haloperidol

180
Q

Antipsychotics which should be avoided in renal impairment

A

Amisulpride
Sulpride
Clozapine

181
Q

Antipsychotics which are safest to use for patients with epilepsy

A

Haloperidol
Sulpride
Trifluoperazine

182
Q

Antipsychotics which should be avoided for patients with epilepsy

A

Clozapine
Chlorpromazine

183
Q

Antipsychotic least likely to cause a dry mouth

A

Amisulpride

184
Q

Antipsychotics most likely to cause weight gain

A

Olanzapine
Clozapine

185
Q

Antipsychotics most likely to cause orthostatic hypotension

A

Risperidone
Clozapine

186
Q

Antipsychotics least likely to cause sedation

A

Aripiprazole
Amisulpride

187
Q

Antipsychotic least likely to cause tardive dyskinesia

A

Clozapine

188
Q

Percentage of patients with treatment resistant schizophrenia who respond to clozapine overall

A

60%

189
Q

Hours after the last dose a clozapine level should be taken

A

12

190
Q

Number of days a patient should be on the same dose of clozapine before a level is taken

A

7

191
Q

Medication usually used as a prophylactic anti epileptic with high doses of clozapine

A

Valproate

192
Q

Clozapine concentration at which a prophylactic anti epileptic should be considered

A

> 500 ng/ml

193
Q

Red light results for clozapine monitoring

A

WCC <3000mm3
Neutrophils <1500mm3

194
Q

Percentage of patients treated with clozapine who develop neutropaenia

A

2.7%

195
Q

Percentage of patients who develop neutropaenia on clozapine who do so in the first 18 weeks

A

50%

196
Q

Risk factors for clozapine induced neutropaenia

A

Afro-Caribbean race
Young age
Low baseline WCC

197
Q

Correlation between clozapine dose and development of neutropaenia

A

None

198
Q

Case fatality rate of clozapine induced agranulocytosis

A

3%

199
Q

Definition of agranulocytosis

A

Absolute neutrophil count <500mm3

200
Q

Percentage of patients on clozapine who develop agranulocytosis

A

0.8%

201
Q

Risk factors for clozapine induced agranulocytosis

A

Asian ethnicity
Older age

202
Q

Recommendation for restarting clozapine after agranulocytosis

A

Should not be restarted

203
Q

Mood stabiliser which can raise WCC and has been used to treat clozapine induced neutropaenia

A

Lithium

204
Q

Main form of clozapine available in the UK

A

Clozaril

205
Q

Length of time after starting clozapine that bloods should be taken weekly

A

18 weeks

206
Q

Length of time after starting clozapine that bloods should be taken fortnightly

A

From week 18-52

207
Q

Minimum frequency FBC should be checked while on clozapine

A

Monthly

208
Q

Action that must be taken after a red light result from clozapine monitoring

A

Clozapine must be stopped immediately

209
Q

Percentage of patients taking clozapine who develop hypersalivation

A

31%

210
Q

Medications which may be used to treat clozapine induced hypersalivation

A

Hyoscine hydrobromide
Amisulpride

211
Q

Percentage of cases of clozapine related myocarditis which develop within the first four weeks of starting treatment

A

80%

212
Q

Antipsychotics most often used to augment clozapine efficacy

A

Amisulpride
Sulpride

213
Q

Mood stabiliser most often used to augment clozapine efficacy

A

Lamotrigine

214
Q

Antipsychotics which should be avoided in augmenting clozapine efficacy

A

Olanzapine
Sertindole
Pimozide

215
Q

Muscles most likely to be affected in tardive dyskinesia

A

Face

216
Q

Factors which cause an increase in symptoms in tardive dyskinesia

A

Emotional arousal
Distraction

217
Q

Factors which cause a decrease in symptoms in tardive dyskinesia

A

Relaxation
Sleep (disappear in sleep)
Using the affected muscles for voluntary tasks

218
Q

Length of time after starting an antipsychotic when tardive dyskinesia usually develops

A

Months to years

219
Q

Non-modifiable risk factors for tardive dyskinesia

A

Older age
Female sex
White or African ethnicity
Longer duration of illness
Learning disability
Negative symptoms of schizophrenia
Mood disorders

220
Q

Non-modifiable risk factors for tardive dyskinesia

A

Older age
Female sex
White or African ethnicity
Longer duration of illness
Learning disability
Negative symptoms of schizophrenia
Mood disorders

221
Q

Modifiable risk factors for tardive dyskinesia

A

Diabetes
Smoking
Alcohol misuse
Substance misuse
Higher antipsychotic dose
Anticholinergic co-treatment

222
Q

Treatment options for tardive dyskinesia

A

Stop any anticholinergic drugs
Lower the dose of the antipsychotic
Switch the antipsychotic
Tetrabenazine

223
Q

Only licensed treatment for tardive dyskinesia in the UK

A

Tetrabenazine

224
Q

Prevalence of dystonia with first generation antipsychotic use

A

10%

225
Q

Prevalence of Parkinsonian symptoms with first generation antipsychotic use

A

20%

226
Q

Prevalence of akathisia with first generation antipsychotic use

A

25%

227
Q

Prevalence of tardive dyskinesia with first generation antipsychotic use

A

5% per year of antipsychotic exposure

228
Q

Risk factors for antipsychotic related dystonia

A

Young age
Male sex
Being neuroleptic naive
Use of potent drugs e.g. haloperidol

229
Q

Risk factors for antipsychotic related Parkinsonism

A

Old age
Female sex
Pre-existing neurological damage

230
Q

Time after starting antipsychotics when dystonia develops

A

Minutes to hours

231
Q

Time after starting antipsychotics when Parkinsonism develops

A

Days to week after starting or increasing dose

232
Q

Time after starting antipsychotics when Parkinsonism develops

A

Days to week after starting or increasing dose

233
Q

Time after starting antipsychotics when akathisia develops

A

Hours to weeks

234
Q

Treatment options for antipsychotic induced dystonia

A

Anticholinergic drugs e.g. procyclidine
Switch antipsychotic
Botulinum toxin

235
Q

Treatment options for antipsychotic induced Parkinsonism

A

Reduce the dose
Anticholinergics e.g. procyclidine
Switch antipsychotic

236
Q

Treatment options for antipsychotic induced akathisia

A

Reduce the dose
Switch antipsychotic - quetiapine/olanzapine suggested
Propranolol
Mirtazapine
Mianserin
Anticholinergic drugs e.g. procyclidine
Cyproheptadine
Benzodiazepines e.g. diazepam or clonazepam
Clonidine

237
Q

Likely therapeutic range for D2 receptor occupancy in antipsychotic treatment

A

65-80%

238
Q

D2 receptor occupancy in antipsychotic treatment at which EPSEs are likely to develop

A

80%

239
Q

Most difficult EPSE to treat

A

Akathisia

240
Q

Percentage of patients in the CATIE trial with metabolic syndrome

A

40%

241
Q

Percentage of male patients in the CATIE trial with metabolic syndrome

A

36%

242
Q

Percentage of female patients in the CATIE trial with metabolic syndrome

A

51%

243
Q

Antipsychotic most associated with hypertension

A

Clozapine

244
Q

Antipsychotics advised for patients with diabetes

A

Amisulpride
Aripiprazole
Ziprasidone

245
Q

Proportion of patients who stop clozapine due to agranulocytosis or neutropaenia who will develop a blood dyscrasia on re-challenge

A

1/3

246
Q

Antipsychotic most likely to cause sedation

A

Clozapine

247
Q

Length of time acute and transient psychotic disorder lasts

A

Up to three months (usually up to one month)

248
Q

Features of acute and transient psychotic disorder

A

Rapid onset of psychosis with no prodrome
Symptoms change rapidly from day to day or within a day
Absence of negative symptoms

249
Q

Antipsychotic most associated with raised TSH levels

A

Aripiprazole

250
Q

ICD 11 diagnosis for psychotic symptoms that last up to three months

A

Acute and transient psychosis

251
Q

DSM V diagnosis for psychotic symptoms that last up to a month

A

Brief psychotic disorder

252
Q

DSM V diagnosis for psychotic symptoms that last longer than a month but less than six months

A

Schizophreniform disorder

253
Q

Hypothesis which attempts to explain the link between schizophrenia and social class

A

Selection drift hypothesis

254
Q

Antipsychotic which has been shown to have benefit in the treatment of post-operative delirium

A

Haloperidol

255
Q

Sex where expressed emotion has a greater negative impact in schizophrenia

A

Male

256
Q

Sex where neurological soft signs are more prevalent in schizophrenia

A

Male

257
Q

Length of time a trial of clozapine should last

A

8 weeks

258
Q

Percentage of patients with schizophrenia treated with an antipsychotic who will be non-compliant after 24 months

A

75%

259
Q

Antibiotic which has been shown to have effect in treatment resistant schizophrenia

A

Minocycline

260
Q

Sleep impairments often found in schizophrenia

A

Decreased REM latency
Decreased proportion of slow wave sleep

261
Q

Relative risk for schizophrenia among first generation migrants

A

2.7

262
Q

Relative risk for schizophrenia among second generation migrants

A

4.5

263
Q

Percentage of patients non-compliant with antipsychotic treatment who are purposefully non-compliant

A

90%

264
Q

Long term risks of antipsychotic associated hyperprolactinaemia

A

Breast cancer
Osteoporosis

265
Q

Percentage of people with visual impairment who suffer from Charles Bonnet syndrome

A

12%

266
Q

Length of time an antipsychotic should be continued after successful treatment of a first episode of psychosis

A

6 months

267
Q

Most common feature of persistent delusional disorder

A

Non-bizarre delusions

268
Q

Depot medication which requires at least 2 hours’ monitoring after it is given

A

Olanzapine

269
Q

Reason olanzapine depot requires at least 2 hours’ monitoring after being given

A

Small risk of olanzapine post-injection syndrome

270
Q

Features of olanzapine post-injection syndrome

A

Sedation
Delirium
Dizziness
EPSEs
Aggression
Seizures

271
Q

Cognitive deficit most often seen in schizophrenia

A

Working memory

272
Q

Parkinsonian symptom most commonly seen with antipsychotic use

A

Rigidity

273
Q

Average clozapine:norclozapine ratio if the level is taken at the correct time

A

1.3

274
Q

Proportion of people taking clozapine who die from agranulocytosis

A

1 in 10,000

275
Q

Mean standardised mortality ratio of a person with schizophrenia

A

2-3

276
Q

Type of psychosis associated with a dream-like state

A

Oneiroid psychosis

277
Q

Antipsychotic suggested when tardive dyskinesia is an issue

A

Clozapine
Quetiapine

278
Q

Percentage of patients with schizophrenia who are treatment resistant

A

30%

279
Q

Length of time a trial of antipsychotic therapy (except clozapine) should last

A

4-6 weeks

280
Q

Alternative term for a loading dose of antipsychotic therapy

A

Rapid neuroleptisation

281
Q

Advice on loading dose of antipsychotic therapy

A

Advised not to give

282
Q

Antipsychotic which requires advice to be given about risk of sunburn

A

Chlorpromazine

2. General adult psychiatry (9 decks)

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