Psychosis and Schizophrenia Review

Study Notes

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.

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

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)