Treatment of Psychosis

Question 1

Describe the rapid tranquilisation of agitation if the patient is already and not already taking a regular anti-psychotic

Answer 1

Oral Treatment
Already on anti-psychotic
1. Lorazepam 1 to 2 mg
2. Promethazine 25 to 50 mg

Not on anti-psychotic
1. Olanzapine 10mg
2. Risperidone 1-2mg
3. Quetiapine 50-100mg
4. Haloperidol 5mg

Consider IM treatment
>Same doses as Oral treatment

Consider IV treatment
Diazepam 10mg over at least 2 minutes but have Flumazenil on hand(to antagonise Diazepam just in case…)

Question 2

Name the First Generation Antipsychotics

Answer 2

1. Haloperidol
2. Chlorpromazine
3. Sulpride
4. Amisulpride
5. etc

Question 3

Name the second generation Antipsychotics

Atypical antipsychotics have lower propensity to cause extrapyramidal AE

Answer 3

Risperidone
Olanzapine
Quetiapine
Clozapine
Aripiprazole

Question 4

Clearing Confusion of 5HT1 and 5HT2

Describe the effects of 5ht1 agonists and 5ht2 antagonists on depression and anxiety

Answer 4

5HT1 agonists= Relieve anxiety and Depression

5HT2 Antagonists= Improve Clinical Symptoms of Depression and Anxiety(meaning 5ht2 agonists would cause depression and anxiety)

Question 5

Describe the Principles of Prescribing *Antipsychotics

Answer 5

1. Use the lowest possible dose
2. If poor response, ONLY increase dose after 2 weeks.
3. The use of a single antipsychotic is recommended.
4. Close monitoring of physical health

Question 6

Describe Anticholinergic Side Effects

Antidepressants with Anticholinergic A/E include Clozapine and Quetipine

Answer 6

Anti-ACh effects:
1. Dru Mouth
2. Hypersalivation
3. Blurred vision
4. Constipation
5. Urinary retention(remember this is ass. with Proctate hypertrophy)
6. Sexual Dysfunction.

Question 7

Describe Extrapyramidal Side Effects and how each is managed

Answer 7

1. Neuroleptic-Induced Parkisonsim (tremor, rigidity and bradykinesia)
   Reduce dose/Switch Antipsychotic and add an ACh oral agent.
2. Acute Dystonia(involuntary sustained contraction on both agonist/antagonist muscle groups)
   Reduce dose/Switch Antipsychotic and add an ACh oral agent.
3. Akithisia (inability to sit still)
   Reduce dose/Switch Antipsychotic and add Propranolol, ACh agents, etc.
4. Tarditive Dyskinesia(Involuntary repititive body movements, eg, sticking out tongue, smaking of lips etc)
   Switch Antipsychotic and Add a benzodiazepine, propanolol.

Question 8

Describe the metabolic side effects

Drugs with these are ALL Second-Gen Antipsychotics* eg, Olanzapine, Clozapine etc.

Answer 8

*Includes
1. Weight gain
2. Dyslipidaemia
3. Diabetes Mellitus
4. CVS disease
5. Death

Question 9

Describe Treatment-Resistant Schizophrenia and Drug used in such cases

Answer 9

Treatment resistance=failed two adequate trials of antipsychotic treatments(one which is Olanzapine)

Clozapine has the strongest evidence for efficacy for treatment-resistant Schizophrenia.

Question 10

Describe the Contraindications of CLOZAPINE

Answer 10

1. Significant abuse of Alcohol
2. History of Seizures, Significant Cardiac Disease, Unstablr Diabetes, Paralytic Ileus, Neuroleptic Malignant syndrome
3. Unreliable chaotic lifestyle(that may affect adherence)