Schizophrenia RevisePharma Notes PDF

Psychosis and Schizophrenia RevisePharma Positive symps – delusions, hallucinations, disorganisation Negative symps – social withdrawal, neglect, poor hygiene (mostly now use 2nd gen antipyshcs) (avoid antipsychotics with Parkinson’s as further reduce dopamine (and EPSEs)) 1st gen – Phenothiazines...

Psychosis and Schizophrenia RevisePharma Positive symps – delusions, hallucinations, disorganisation Negative symps – social withdrawal, neglect, poor hygiene (mostly now use 2nd gen antipyshcs) (avoid antipsychotics with Parkinson’s as further reduce dopamine (and EPSEs)) 1st gen – Phenothiazines Group 1 – Chlorpromazine, levomepromazine and promazine. Most sedation, moderate antimuscarinic and EPSEs. (pro means first) Group 2 – Pericyazine. Moderate sedation, least EPSEs Group 3 – Fluphenazine, prochlorperazine and trifluoperazine. Moderate sedation, high EPSEs. Butyrophenones – Benperidol, Haloperidol. Moderate sedation, high EPSEs (similar to group 3 phenothiazines) Thioxanthene’s – Flupentixol and Zuclopenthixol. Moderate sedation, antimuscarinic effects and EPSEs. Others – Primozide and Sulpride. Reduced sedation, antimuscarinic effects and EPSEs 2nd Gen Antipsychotics Amisulpride Apriprazole Clozapine Olanzapine Quietiapine Risperidone (Olanzapine and Clozapine highest risk of weight gain) Antipsychotic side-effects EPS SEs – most in group 3 phenothiazine and butrophenones Hyperprolactinaemia – least in Aripiprazole Sexual dysfunction – all antipsychotics Cardiovascular side effects – QT prolongation, most common with Pimozide and Haloperidol Hypotension – Clozapine and Quetiapine Hyperglycaemia – Clozapine, Risperidone, Olanzapine and Quetiapine (CiROQ) Weight gain – Clozapine and Olanzapine (COW) Neuroleptic Malignant Syndrome – stop treatment, treat with bromocriptine, should resolve in 5-7 days. Antipsychotics Monitoring Weight – start, weekly for first 6 weeks, 12 weeks, 1 year then yearly Fasting blood glucose, HbA1c and blood lipid concs – start, at 12 weeks, at 1 year, then yearly ECG – before initiation Blood pressure – start, at 12 weeks, at 1 year, then yearly FBC, U&E’s and LFTs – starts, then yearly Clozapine Used in resistant schizophrenia – only when 2+ antipsychs including one 2nd gen has been used for 6-8 weeks each. If missed more than 48 hours of doses - specialist reinitiation Monitor leucocyte and differential blood counts – weekly for 18 weeks, fortnightly till one year, monthly Clozapine Side-Effects Myocarditis and Cardiomyopathy – report and stop on tachycardia Agranulocytes and Neutropenia – monitor leucocyte and differential blood counts as previously mentioned GI disturbances – report and stop on constipation – intestinal block