Psychosis and Schizophrenia Review - RevisePharma

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Questions and Answers

What are the symptoms categorized as negative in psychosis?

  • Social withdrawal and neglect (correct)
  • Disorganization and hallucinations
  • Delusions and hallucinations
  • Increased energy and poor hygiene

Which group of antipsychotics is known for the highest risk of extrapyramidal side effects (EPS)?

  • Group 2 Phenothiazines
  • Group 3 Phenothiazines and Butyrophenones (correct)
  • 2nd generation antipsychotics
  • Group 1 Phenothiazines

Which antipsychotic is least likely to cause hyperprolactinaemia?

  • Risperidone
  • Aripiprazole (correct)
  • Clozapine
  • Olanzapine

What is a primary side effect associated with Clozapine and Quetiapine?

<p>Weight gain (A)</p> Signup and view all the answers

What monitoring is required for patients starting antipsychotics?

<p>Multiple parameters including weight, blood glucose, and ECG (B)</p> Signup and view all the answers

Clozapine is indicated for use in which circumstance?

<p>After trying 2+ antipsychotics including one 2nd gen for 6-8 weeks each (D)</p> Signup and view all the answers

Which antipsychotics carry the highest risk for causing hypotension?

<p>Clozapine and Quetiapine (C)</p> Signup and view all the answers

Which of the following correctly describes the sedation properties of Group 2 Phenothiazines?

<p>Moderate sedation with least EPS (B)</p> Signup and view all the answers

Flashcards

Positive symptoms of psychosis

Symptoms that are present but not normally there, such as delusions and hallucinations.

Negative symptoms of psychosis

Symptoms that represent a reduction or absence of normal functions, such as social withdrawal and poor hygiene.

Antipsychotics

A group of medications used to treat psychotic disorders, often used in conjunction with therapy.

First generation antipsychotics

A group of antipsychotics that were developed earlier and are known for their higher risk of extrapyramidal side effects (EPS).

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Second generation antipsychotics

A group of antipsychotics that were developed later and are often associated with fewer extrapyramidal side effects (EPS).

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Neuroleptic Malignant Syndrome

A serious adverse reaction to antipsychotic medications, characterized by high fever, muscle rigidity, and altered mental status.

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Clozapine for resistant schizophrenia

The use of clozapine, a second-generation antipsychotic, in cases where other antipsychotics have been ineffective.

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Antipsychotic Monitoring

Regular monitoring of patients on antipsychotics to identify and manage potential side effects.

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Study Notes

Psychosis and Schizophrenia RevisePharma

  • Positive Symptoms: Delusions, hallucinations, disorganized thoughts

  • Negative Symptoms: Social withdrawal, neglecting personal hygiene

  • First-Generation Antipsychotics (Phenothiazines): Commonly cause sedation, moderate antimuscarinic effects, and extrapyramidal side effects (EPS).

    • Group 1: Chlorpromazine, levomepromazine, promazine – high sedation, moderate EPS.
    • Group 2: Pericyazine – moderate sedation, least EPS
    • Group 3: Fluphenazine, prochlorperazine, trifluoperazine- moderate sedation, high EPS
    • Butyrophenones (e.g., Benperidol, Haloperidol) – moderate sedation, high EPS
    • Thioxanthenes (e.g., Flupentixol, Zuclopenthixol) – moderate sedation, antimuscarinic effects, EPS
    • Others (e.g., Primozide, Sulpride) – reduced sedation, antimuscarinic effects, EPS

  • Second-Generation Antipsychotics: Generally, lower risk of EPS compared to first generation.

    • Amisulpride
    • Apriprazole
    • Clozapine
    • Olanzapine
    • Quietiapine
    • Risperidone
    • Olanzapine and Clozapine have a higher risk of weight gain.

Antipsychotic Side Effects

  • Hyperprolactinemia: Lowest risk with aripiprazole
  • Extrapyramidal Symptoms (EPS): Highest risk with some first-generation drugs (group 3 phenothiazines and butyrophenones)
  • Sexual dysfunction: Possible with all antipsychotics
  • Cardiovascular effects (QT prolongation): Most common with pimozide and haloperidol
  • Hypotension: Common with clozapine and quetiapine
  • Hyperglycemia: Common with Clozapine, Risperidone, Olanzapine, and Quetiapine (CIROQ)
  • Weight Gain: Clozapine and olanzapine (COW)
  • Neuroleptic Malignant Syndrome (NMS): Requires treatment with bromocriptine, and stopping the medication quickly to avoid life-threatening complications
  • Antipsychotic Monitoring:
    • Weight: Weekly for 6 weeks, then monthly up to a year.
    • Fasting blood glucose, HbA1c and blood lipid concentrations: Start at 12 weeks, then yearly
    • ECG: Before initiation
    • Blood pressure: Start at 12 weeks, then yearly
    • FBC, U&E's and LFTs: Initially and then yearly

Clozapine Specifics

  • Used in treatment-resistant schizophrenia when 2 or more antipsychotics have been ineffective.
  • Requires regular monitoring of blood counts (frequent CBCs) for the first 18 weeks, then fortnightly for a year and monthly after that.
    • Requires specialist input for restarting treatment if more than 48 hours of dose is missed.
  • Side effects:
    • Myocarditis and Cardiomyopathy (report and stop if tachycardia occurs)
    • Agranulocytosis and neutropenia (monitor leucocyte and differential blood counts)
    • Gastrointestinal disturbances (report and stop if constipation occurs)

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