Psychosis And Schizophrenia

Question 1

What receptors do typical vs atypical antipsychotics work on

Answer 1

Typical: D2 receptor antagonist (block)
Atypical: D2, D3, D4 and 5-HT antagonists

(Clozapine has high affinity to D4)

Question 2

What type of antipsychotics are hyperprolactineamia more common in

Answer 2

Typical (haloperidol and chlorpromazine)

Question 3

3 types of symptoms in schizophrenia

Answer 3

Positive - delusions and hallucinations
Negative - self neglect, apathy, anergia, alogia
Disorganised - disorganised thinking and speech

Question 4

What is the commonest type of schizophrenia?

Answer 4

Paranoid

Question 5

What is hebephrenic schizophrenia

Answer 5

Disorganised

Prominent mood changes - often inappropriate and accompanied by giggling
Disorganised thought, speech rambling
Behaviour empty of purpose

Question 6

What is catatonic schizophrenia

Answer 6

Psychomotor disturbances - sudden jerky movements (hyperkinesis) followed by states of stupor (almost unconscious in movements)

Now very rare

Question 7

What is undifferentiated schizophrenia

Answer 7

Patients that meet general diagnostic criteria but not a subtype

Question 8

What is post schizophrenia depression

Answer 8

Patient has had schizophrenia in last 12 months

Now has depressive symptoms

Question 9

What is residual schizophrenia

Answer 9

Patient had schizophrenia

Now has ONLY NEGATIVE symptoms

Question 10

What is simple schizophrenia

Answer 10

Dominated by negative symptoms

Hard to define

Question 11

What is avolition

Answer 11

Lack of energy or ambition to do tasks with an end goal

Negative schizophrenia symptom

Question 12

What is apathy

Answer 12

Lack of feeling or emotion

Negative schizophrenia symptom

Question 13

What is affective flattening

Answer 13

Flat affect

Reduction in range of emotions and feelings

Question 14

Is affective flattening a positive or negative schizophrenia symptom

Answer 14

Negative

Question 15

What is a labile mood

Answer 15

Unstable and changes lots

Question 16

How long must schizophrenia symptoms be present for, for a diagnosis

Answer 16

At least 1 month with signs of disturbance for 6 months

Question 17

For a diagnosis of schizophrenia a person must have two of what five key symptoms

Answer 17

Delusions
Hallucinations
Disorganised thought/ speech
Disorganised behaviour
Negative symptoms

Question 18

Concordance rate of schizophrenia in monozygotic twins

Answer 18

50%

Question 19

Why may lorazepam be initially used in a patient who was diagnosed with schizophrenia

Answer 19

Antipsychotics can take several days to work

Question 20

When may clozapine be used in a pt with schizophrenia

Answer 20

After two other antipsychotic drugs have been tied for 6-8 weeks each

Question 21

Common atypical antipsychotic that doesn’t end in -apine

Answer 21

Risperidone

Aripriprazole

Question 22

Key risk with clozapine

Answer 22

Angrolocytosis (1%) 18 weeks of weekly FBC

Question 23

5 receptors that antipsychotics act on

Answer 23

Dopamine
Serotonin
Histamine 
Adrenergic
Cholinergic

Question 24

5 groups of side effects from antipsychotics

Answer 24

Linked to receptor they act on:

Antidopaminergic - EPSE, negative symptoms, hyperprolactinaemia, NMS, weight gain
Serotonergic - anxiety, insomnia, diabetes
Antihistamine - sedation (may be good)
Antiadrenergic - postural hypotension, ejection failure
Anticholinergic - dry mouth, blared vision, constipation, urinary retention

Question 25

What receptor do antipsychotics work on that helps negative symptoms and what helps positive symptoms

Answer 25

Positive - antidopaminergic

Negative - serotnergic

Question 26

Cardiac condition associated with clozapine

Answer 26

Myocarditis and QTC prolongation (risk of TDP)

Question 27

When should patients on clozapine have an ECG

Answer 27

At initiation and then yearly

Question 28

4 key EPSE’s

Answer 28

Acute dystonias - painful spastic contractions of muscles
Akathisia - inner feeling of restlessness
Parkinson like - tremor, rigidity, bradykinesia
Tardive dyskinesia - involuntary movements of face and tongue

Question 29

What is akathisia

Answer 29

Inner feeling of restlessness

Fidgeting leg movements, pacing