CPTP 3.2 Case 38 Launch Flashcards Preview

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Flashcards in CPTP 3.2 Case 38 Launch Deck (25)
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1

What are the symptoms of paranoid schizophrenia?

Auditory hallucinations (which discuss the patient in a derogatory way)

Disorders of thought:
• Delusional perception (e.g. "I'm king of the world because that red car drove past me")
• Idea that thoughts are being controlled or broadcast
• Persecutory delusions

Catatonic behaviour (stupor):
• Apathy
• Social withdrawal
• Blunted emotions

2

What makes prescribing difficult with paranoid schizophrenic patients?

Lack of insight (knowledge or understanding that a disease is present)

Compliance

3

How is dose decided with treatment for paranoid schizophrenics?

Start with minimum effective dose for 4-6 weeks then titrate up.

Use a single antipsychotic

4

What is monitored during antipsychotic treatment?

Response

Adherence

Side effects:
• Extrapyrimidal side effects (EPSEs)
• Weight, pulse, BP
• Glucose and lipid levels

5

When are glucose and lipid levels tested for patients undergoing antipsychotic treatment?

at 12 weeks and then annually

6

Which antipsychotic has the most evidence for effective use against schizophrenia?

Haloperidol

7

What are the extrapyrimidal side effects?

Parkinson-like symptoms:

Tremor at rest
Bradykinesia
Rigidity

8

What are the non-extrapyrimidal (normal) side effects of antipsychotics?

Weight gain & diabetes

Cardiovascular (Prolonging QT interval)

Hormonal

9

What are the causes of non response to antipsychotics?

Inadequate dose

Incorrect diagnosis

Noncompliance

Need to switch antipsychotic

10

What is depot medication and why is it used?

Injectable forms of slow release medication (that is usually also available as a tablet).

The idea is that in an injectable form, it only needs to be administered fortnightly (due to the slow release), so it can be used for antipsychotics to combat noncompliance long enough for the patient to gain insight into their condition.

11

List the antipsychotics in the student formulary

What are the routes of administration for these, and which are available in depot form?

Oral Route Allows Calm And Quiet Humans

• HALOPERIDOL
• OLANZAPINE
• Risperidone
• Quetiapine
• Clozapine

Alternatives:
• Aripiprazole
• Amisulpiride

All oral, the following are available as DEPOTS:
• Haloperidol
• Risperidone

12

When is drug treatment considered for depression?

When moderate to severe

Subthreshold for more than 2 years

Subthreshold that persists after other interventions

When subthreshold depression complicated care of physical health problem

13

What is the greatest risk with prescribing TCAs for depression?

Overdose, causing death through cardiotoxicity

14

Which antidepressive class of drugs has the least side-effects?

SSRIs

15

Name the SSRIs in the student formulary

FLUOXETINE
Sertraline
Citalopram

16

Name the classes of antidepressants

TCAs
SSRIs
Monoamine oxidase inhibitors
Noradrenergic/Serotonin-related ones

17

Name the TCAs

AMITRIPTYLINE
Trazodone

18

Name a monoamine oxidase inhibitor

Phenelzine

19

Name the NaSSA & SNRI (ATYPICAL) antidepressants (which affect norepinephrine and serotonin)

Mirtazapine NaSSA
Venlafaxine SNRI

20

Outline how you would review antidepressant treatment

Review after 4 weeks

If there is no response, change antidepressant

If there is minimal response, increase dose

If there is improvement continue treatment for another 4 weeks

21

How long must antipsychotic treatment be continued for and what is the risk if this isn't met?

2 years otherwise there is a risk of relapse

22

How long must antidepressant treatment be continued for?

Stay on antidepressants for 6 months after patient is well, to avoid relapse. After this, reduce dose over a period of 4 weeks to avoid withdrawal effects.

23

How long must antidepressant treatment be continued for if the patient is experiences recurrent depression or is at high risk?

2 years

24

What proportion of paranoid schizophrenics recover after their first episode?

80%

25

What proportion of recovered paranoid schizophrenics never experience another episode?

20%