Treatment of Schizophrenia

Question 1

name three first generation drugs for schizophrenia

Answer 1

chlorpromazine
haloperidol
sulpride

Question 2

name three second generation drugs for schizophrenia

Answer 2

clozapine
olanazapine
risperidone

Question 3

name a third generation drug for schizophrenia

Answer 3

apiprazole

Question 4

what class of drugs are the vast majority of medications used for schizophrenia?

Answer 4

dopamine antagonists

Question 5

what dopamine pathway is the target of treatment of schizophrenia?

Answer 5

mesolimbic

Question 6

what percentage of dopamine receptors should we aim to block in schizophrenia management and why?

Answer 6

60-80%

minimal side effects but maximum effect

Question 7

what causes extra-pyramidal side effects in schizophrenia management?

Answer 7

interference with the nigrostriatal pathway

Question 8

what group of drugs are extra-pyramidal side effects seen with?

Answer 8

first generation drugs

Question 9

name three extra pyramidal side effects that can arise from use of dopamine antagonists

Answer 9

acute dystonic reaction
Parkinsonism
tardive dyskinesia

Question 10

how long does it take an acute dystonic reaction to come on?

Answer 10

minutes

Question 11

how does an acute dystonic reaction present?

Answer 11

increased tone
energetic
torticollis
tongue protrusion

Question 12

what is torticollis?

Answer 12

a painfully twisted and tilted neck

Question 13

how does tardive dyskinesia present?

Answer 13

involuntary repetitive oro-facial movements

Question 14

how long does tardive dyskinesia last?

Answer 14

long term

often permanent

Question 15

how are extra pyramidal side effects managed?

Answer 15

procyclidine (first line)
trihexyphenidyl
orphenadrine

Question 16

what dose of procyclidine is given for extra pyramidal side effects?

Answer 16

5mg

either PO or IM

Question 17

besides EPSE, name three possible dopaminergic side effects of schizophrenia treatment

Answer 17

neuroleptic malignant syndrome
Hyperprolactinaemia
akathisia

Question 18

what is the duration of onset for neuroleptic malignant syndrome?

Answer 18

24-72 hours

Question 19

what can happen if neuroleptic malignant syndrome is not treated?

Answer 19

lasts days

can be fatal

Question 20

how does neuroleptic malignant syndrome present?

Answer 20

increasing muscle tone
pyrexia
changing pulse and BP

Question 21

how can neuroleptic malignant syndrome result in death?

Answer 21

rhabdomyolysis
acute renal failure coma
death

Question 22

what investigation is done for neuroleptic malignant syndrome?

Answer 22

creatinine kinase

Question 23

how is neuroleptic malignant syndrome managed?

Answer 23

stop causative drug
rapid cooling and renal support
skeletal muscle relaxants
dopamine agonists

Question 24

name a skeletal muscle relaxant that may be given in neuroleptic malignant syndrome

Answer 24

dantrolene

Question 25

name a dopamine agonist that may be given in neuroleptic malignant syndrome

Answer 25

bromocriptine

Question 26

what inhibits prolactin release?

Answer 26

dopamine

Question 27

what effect do dopamine antagonists have on prolactin levels?

Answer 27

blocking dopamine leads to increased prolactin release

Question 28

what are the symptoms of Hyperprolactinaemia in women?

Answer 28

galactorrhea decreased libido amenorrhoea

Question 29

what are the symptoms of Hyperprolactinaemia in men?

Answer 29

gynaecomastia ED oligospermia decreased libido

Question 30

what symptoms are seen in both sexes in Hyperprolactinaemia?

Answer 30

reduced bone mineralisation and bone density - can lead to osteoporosis

Question 31

what is another name for akathisia?

Answer 31

restless legs

Question 32

when does akathisia present after treatment?

Answer 32

days-weeks

Question 33

what is the first line management for akathisia?

Answer 33

beta blocker e.g. propranolol

Question 34

what is the second line management for akathisia?

Answer 34

benzodiazepines e.g. clonazepam

Question 35

what are the possible anti cholinergic effects of schizophrenia management?

Answer 35

dry mouth blurred vision constipation

Question 36

what is a possible 5-HT2 side effect in schizophrenia management?

Answer 36

weight gain

Question 37

what anti-adrenergic side effect can be seen in schizophrenia management?

Answer 37

postural hypotension

Question 38

what is the "best" anti-psychotic agent and why?

Answer 38

clozapine best for non responders and negative syndromes has anti suicidal properties

Question 39

name six possible side effects of clozapine treatment

Answer 39

``` agranulocytosis myocarditis constipation weight gain sedation sialorrhoea ```

Question 40

what can agranulocytosis due to clozapine use lead to?

Answer 40

neutropenic sepsis

Question 41

what is the average weight gain in patients started on clozapine?

Answer 41

10kg

Question 42

what is the first step in the management of schizophrenia?

Answer 42

second generation drug for 6-8 weeks

Question 43

what is the second step in the management of schizophrenia?

Answer 43

1st or 2nd generation drug for 6-8 weeks

Question 44

what is the third step in the management of schizophrenia?

Answer 44

reassess diagnosis consider psychological input check compliance

Question 45

what is the fourth step in the management of schizophrenia?

Answer 45

increase dose | combination therapy

Question 46

what is the last line management for schizophrenia?

Answer 46

clozapine