psychoses and schizophrenia Flashcards
(45 cards)
what is the most common psychotic disorder
schizophrenia
symptoms of psychosis and schizophrenia are usually divided into …
positive symptoms e.g. hallucinations, delusions
negative symptoms e.g. emotional apathy, social withdrawal
typically patients will present with prodromal period which is characterised by
deterioration in personal functioning and emergence of negative symptoms
what type of symptoms do you get in the prodromal phase
negative e.g. emotional apathy, social withdrawal
what is the prodromal phase followed by
acute phase marked by positive symptoms e.g. hallucinations and delusions
these may resolve or reduce following treatment, but in some cases negative symptoms can remain and interfere with daily functioning
will treatment get rid of symptoms
positive symptoms may resolve or reduce following treatment
in some cases negative symptoms can remain and interfere with daily functioning
what is the initial aim of treatment
reduce acute phase symptoms (this is when there is marked positive symptoms) and return pt to their baseline level of functioning
once treated does schizophrenia go
many pt who have one episode will go on to have further episodes and generally require maintenance antipsychotics to prevent relapses
in which phase of schizophrenia are antipsychotics effective in
acute episodes - more effecting at alleviating positive than negative symptoms
which type of symptoms are antipsychotics more effective at alleviating
positive e.g. hallucinations, delusions
what needs to be offered to all pt with schizophrenia (2)
oral antipsychotic drug + psychological therapy
choice of antipsychotic drug depends on …
pt/carer choice
potential to cause extrapyramidal symptoms e.g. akathisia
CV adverse effects
metabolic adverse effects e.g. weight gain and diabetes
hormonal adverse effects e.g. increase in prolactin conc
what is akathisia
inability to remain still
sense of inner restlessness
how long should a pt receive an antipsychotic before it is deemed ineffective?
4-6 weeks at an optimum dose
prescribing more than one antipsychotic at a time should be avoided except in exceptional circumstances e.g.
clozapine augmentation
changing medication during titration
prescribing more than one antipsychotic at a time should be avoided except in exceptional circumstances e.g. clozapine augmentation or changing medication during titration because….
increased risk of adverse effects e.g. extrapyramidal, QT interval prolongation, sudden cardiac death
when should clozapine be offered
if schizo is not controlled despite sequential use of at least 2 different antipsychotics (one of which has to be a 2nd gen), each for adequate duration (i.e. 4-6 weeks at optimum dose before considered ineffective)
what to do if symptoms do not respond adequately to an optimised dose of clozapine
consider other causes of non response e.g. adherences concurrent use of other drugs
review diagnosis
check plasma-clozapine conc before adding a second antipsychotic to augment clozapine; allow 8-10 weeks treatment to assess response
check plasma clozapine conc before adding a second antipsychotic to augment clozapine and allow …. weeks treatment to assess response
8-10 weeks
in which pt may you consider long acting depot injectable antipsychotic drugs
pt with psychosis and schizo where it is a clinical priority to avoid non adherence
how do the 1st gen (conventional, typical) antipsychotics work & what are the typical SE
predominantly by blocking D2 receipts in the brain
more likely to cause a range of SE, esp acute extrapyramidal symptoms and hyperprolactinaemia
which generation of antipsychotics are more likely to cause hyperprolactinaemia and acute extrapyramidal symptoms
1st gen
Which gen of antipsychotics consists of the following drugs PHENOTHIAZINE derivatives (chlorpromazine hydrochloride, fluphenazine decanoate, levomepromazine, pericyazine, prochlorperazine, promazine hydrochloride, and trifluoperazine), the BUTYROPHENONES (benperidol and haloperidol), the THIOXANTHENES (flupentixol and zuclopenthixol), the DIPHENYLBUTYLPEPERIDINES (pimozide) and the SUBSTITUTED BENZAMIDES (sulpiride)
1st gen
sulpiride is 1st gen or 2nd gen
1st
