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CNS > Psychosis and Schizophrenia > Flashcards

Psychosis and Schizophrenia Flashcards

1
Q

Positive symptoms

A

Something is actually happening

Delusions
Hallucinations
Disorganisation
Hyperactivity

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2
Q

Negative symptoms

A

The absence of something happening

Social withdrawal
Neglect
Poor hygiene

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3
Q

First generation antipsychotics

A

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

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4
Q

Second generation antipsychotics

A

Amisulpride
Aripiprazole
Olanzapine
Risperidone
Clozapine
Quetiapine

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5
Q

Side effects of Group 1 Phenothiazines

A

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

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6
Q

Side effects of Group 2 Phenothiazines

A

Moderate sedation
Least EPSEs

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7
Q

Side effects of Group 3 Phenothiazines

A

Moderate sedation
Highest EPSEs

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8
Q

Side effects of Thioxanthenes

A

Moderate sedation
Antimuscarinic effects
Reduced levels of EPSEs

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9
Q

Side effects of Butyrophenones

A

Moderate sedations
High EPSEs

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10
Q

Side effects of pimozide and sulpiride

A

Reduced sedation
Reduced antimuscarinic effects
Reduced EPSEs

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11
Q

General side effects of antipsychotics

A

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

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12
Q

Treatment of neuroleptic malignant syndrome

A

Bromocriptine
Should resolve in 5-7 days

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13
Q

Monitoring requirements while on antipsychotics

A

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

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14
Q

Common drug interactions with antipsychotics

A

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

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15
Q

Symptoms of hyperprolactinaemia

A

Low libido
Sexual dysfunction
Menstrual abnormalities
Gynaecomastia
Galactorrhoea

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16
Q

Which antipsychotics are most likely to cause EPSEs?

A

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

17
Q

Possible side effect of all antipsychotics (3)

A

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

18
Q

Which antipsychotics are most likely to prolong the QT interval?

A

QT prolongation - haloperidol, quetiapine and pimozide

19
Q

Which antipsychotics are most likely to cause postural hypotension?

A

Postural hypotension - clozapine and quetiapine

20
Q

Which antipsychotics are most likely to cause hyperglycaemia?

A

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

21
Q

Which antipsychotics are most likely to cause weight gain?

A

Weight gain - olanzapine and clozapine

22
Q

Which antipsychotics is most likely to cause sleep apnoea?

A

Sleep apnoea - quetiapine

23
Q

Which antipsychotic is most likely to reduce the seizure threshold?

A

Reduced seizure threshold - clozapine carries greatest risk

24
Q

Which antipsychotics carry the highest stroke risk?

A

Stroke risk - olanzapine and risperidone

CNS (2 decks)

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