Psychosis and Schizophrenia

Question 1

Positive symptoms

Answer 1

Something is actually happening

Delusions
Hallucinations
Disorganisation
Hyperactivity

Question 2

Negative symptoms

Answer 2

The absence of something happening

Social withdrawal
Neglect
Poor hygiene

Question 3

First generation antipsychotics

Answer 3

Phenthiazines
- Group 1; chlorpromazine, levopromazine and promazine
- Group 2; periciazine
- Group 3; fluphenazine, prochlorperazine, and trifluoperazine

Thioxanthene’s - flupentixol and zuclopenthixol

Butyrophenones - benpeidol and haloperidol

Question 4

Second generation antipsychotics

Answer 4

Amisulpride
Aripiprazole
Olanzapine
Risperidone
Clozapine
Quetiapine

Question 5

Side effects of Group 1 Phenothiazines

Answer 5

Most sedation
Moderate antimuscarinic
Extrapyramidal side effects (EPSEs) - never give antipsychotics to someone with PD because of this (as it reduces levels of dopamine)

Question 6

Side effects of Group 2 Phenothiazines

Answer 6

Moderate sedation
Least EPSEs

Question 7

Side effects of Group 3 Phenothiazines

Answer 7

Moderate sedation
Highest EPSEs

Question 8

Side effects of Thioxanthenes

Answer 8

Moderate sedation
Antimuscarinic effects
Reduced levels of EPSEs

Question 9

Side effects of Butyrophenones

Answer 9

Moderate sedations
High EPSEs

Question 10

Side effects of pimozide and sulpiride

Answer 10

Reduced sedation
Reduced antimuscarinic effects
Reduced EPSEs

Question 11

General side effects of antipsychotics

Answer 11

EPSEs - most common in group 3 penothiazine and butyrophenones and least common in second generation
Hyperprolactinaemia - aripiprazole can reduce this
Sexual dysfunction
QT prolongation - haloperidol and pimozide
Postural hypotension - clozapine and quetiapine
Hyperglycaemia - clozapine, risperidone, olanzapine, and quetiapine (CiROQ - Ciroc has sweet flavour)
Weight gain - olanzapine and clozapine
Neuroleptic malignant syndrome - STOP treatment
Sleep apnoea - quetiapine
Reduced seizure threshold - clozapine carries greatest risk
Stroke risk - olanzapine and risperidone

Question 12

Treatment of neuroleptic malignant syndrome

Answer 12

Bromocriptine
Should resolve in 5-7 days

Question 13

Monitoring requirements while on antipsychotics

Answer 13

Weight/BMI: start, weekly for the first 6 weeks, at 12 weeks, at 1 year, then yearly

Fasting blood glucose, HbA1c and blood lipid concentrations: start, at 12 weeks, at 1 year and then yearly (REPEAT AFTER FIRST MONTH WITH OLANZ+CLOZ)

ECG: haloperidol causes QT prolongation; before initiation

Blood pressure and pulse (due to cardiovascular risk): start, 12 weeks, at 1 year then yearly

Prolactin - start, 6 months, then yearly

FBC, U&Es, and LFTs: start, then yearly

Creatinine kinase if neuroleptic malignant syndrome suspected

Question 14

Common drug interactions with antipsychotics

Answer 14

Drugs with sedative action
Drug with hypotensive effect
Drugs that prolong QT interval
Diuretics - may cause hypokalaemia increasing risk arrhythmias
Carbamazepine - reduces plasma levels of most antipsychotics and carbamazepine levels are increased with haloperidol, quetipaine, risperidone, chlorpromazine

Azole antifungals + aripiprazole/haloperidol - increased antipsychotic effects
SSRIs + haloperidol/risperidone/sertindole/clozapine/olanzapine - increased antipsychotic effects

Smoking - clozapine and olanzapine

Question 15

Symptoms of hyperprolactinaemia

Answer 15

Low libido
Sexual dysfunction
Menstrual abnormalities
Gynaecomastia
Galactorrhoea

Question 16

Which antipsychotics are most likely to cause EPSEs?

Answer 16

EPSEs - most common in group 3 penothiazine and butyrophenones and least common in second generation

Question 17

Possible side effect of all antipsychotics (3)

Answer 17

Hyperprolactinaemia - aripiprazole can reduce this
Sexual dysfunction
Neuroleptic malignant syndrome - STOP treatment

Question 18

Which antipsychotics are most likely to prolong the QT interval?

Answer 18

QT prolongation - haloperidol, quetiapine and pimozide

Question 19

Which antipsychotics are most likely to cause postural hypotension?

Answer 19

Postural hypotension - clozapine and quetiapine

Question 20

Which antipsychotics are most likely to cause hyperglycaemia?

Answer 20

Hyperglycaemia - clozapine, risperidone, olanzapine, and quetiapine (CiROQ - Ciroc has sweet flavour)

Question 21

Which antipsychotics are most likely to cause weight gain?

Answer 21

Weight gain - olanzapine and clozapine

Question 22

Which antipsychotics is most likely to cause sleep apnoea?

Answer 22

Sleep apnoea - quetiapine

Question 23

Which antipsychotic is most likely to reduce the seizure threshold?

Answer 23

Reduced seizure threshold - clozapine carries greatest risk

Question 24

Which antipsychotics carry the highest stroke risk?

Answer 24

Stroke risk - olanzapine and risperidone