TBL - identifying and managing psychosis Flashcards
What are the positive symptoms of psychosis?
Delusions, hallucinations, thought disorders.
What are the negative symptoms of psychosis?
Amotivation, social withdrawal, restricted affect (reduced emotional expression) and poverty of thought (reduced speech, not much content).
What is refractory schizophrenia?
Schizophrenic symptoms that have not responded to >2 types of antipsychotic drugs.
Refractory schizophrenic occurs in what percentage of patients?
30%
Which drug is the most effective in treating refractory schizophrenia?
Clozapine
Is psychosis more common in rural or urban areas?
Urban
Which antipsychotic increases the risk of extra-pyramidal side effects?
Chlorpromazine - a first generation antipsychotic, not routinely used.
Which drug would be most suitable in the management of first episode psychosis?
Olanzapine - a second generation antipsychotic.
Which dopaminergic pathway when hyper activated, contributes to the manifestation of positive symptoms of psychosis?
Mesolimbic pathway.
Which dopaminergic pathway when hyper activated, contributes to the manifestation of negative symptoms of psychosis?
Mesocortical pathway.
What is the ‘manic switch’ in bipolar?
The switch to manic symptoms from an episode of depressive symptoms. Increased risk of triggering this switch with treating depressive symptoms in bipolar.
In bipolar disorder, which mood stabiliser is given alongside an antidepressant, to reduce the risk of a manic switch?
Lithium
What type of side effects can occur if the nigrostriatal pathway is blocked?
Extrapyramidal
What is tardive dyskinesia?
A late onset movement disorder of lips and mouth. Can be a side effect of anti-psychotics.
What term describes sharp muscle spasms in the face and neck?
Acute dystonia
What is akathisia?
A sense of inner restlessness.
Which term describes spasms of the extra ocular muscles leading to an upward deviation of the eye?
Oculogyric crisis.
What are some risk factors for developing psychosis?
Childhood trauma
Substance misuse
Male
Urbanicity
1st/2nd trimester infection of malnutrition
Late winter/early spring baby
Paternal age >35
Maternal stress of influenza
Obststric complications
Poorer socioeconomic status
Childhood CNS infections
What are the three main symptoms groups when assessing mental disorders?
Positive symptoms
Negative symptoms
Cognitive symptoms
Which dopaminergic pathways are affected in psychosis?
Mesolimbic system
Mesocortical system
How does psychosis affect the mesolimbic system?
Mesolimbic system involved in reward processing (pleasure) and salience (threat evaluation).
Psychosis causes dysfunction in the salience pathway, typically becoming hyperactive, resulting in positive symptoms.
How does psychosis affect the mesocortical system?
Mesocortical system regulates the pre-frontal cortex (involved in cognition, motivation and social engagement).
Dysfunction makes it hypoactive and therefore reduced stimulation to pre-frontal cortex causes negative symptoms.
What is the MOA of typical/1st generation anti-psychotics?
Dopamine antagonists
What is the MOA of typical/1st generation anti-psychotics?
Dopamine antagonists
What is the MOA of atypical/2nd generation anti-psychotics?
Dopamine and serotonin antagonists
What is the MOA of atypical/3rd generation anti-psychotics?
Partial dopamine agonist
Which type of antipsychotic produces less extrapyramidal side effects?
Atypical as they do not block the post-synaptic receptors for as long as 1st generation/typical.
Which type of antipsychotic has an increased risk of cardio-metabolic symptoms?
Atypical
What drug is an example of a atypical/third generation antipsychotic?
Aripiprazole
Which symptoms do antipsychotics usually reduce?
Positive symptoms - they suppress pleasure and threat evaluation.
Which non-pharmacological treatments can be used for psychosis?
CBT
Art therapy
Family intervention
Why does clozapine need frequent blood monitoring?
There is an increased risk of neutropenia.
Apart from neutropenia, which other major side effect can be caused by clozapine?
Constipation - caused by colonic hypomotility from the anticholinergic effect.
Can be serious and life-threatening.
