Psychosis and schizophrenia

Question 1

What does the term “psychosis” refer to?

Answer 1

Significant alterations in perception, thoughts, mood, and behaviour.

Question 2

What are positive symptoms of psychosis?

Answer 2

Disorganised behaviour, disorganised speech/thoughts, delusions, and hallucinations.

Question 3

What are negative symptoms of psychosis?

Answer 3

Emotional blunting, reduced speech, loss of motivation, self-neglect, social withdrawal.

Question 4

What is the prodromal period of psychosis?

Answer 4

A period with early signs like emotional disturbance and deterioration in social functioning before full-blown psychosis.

Question 5

What is the first step in managing anyone with psychotic symptoms or at risk?

Answer 5

Assess the risk of harm to self or others.

Question 6

Can you start antipsychotics before specialist assessment?

Answer 6

No, unless advised by a consultant psychiatrist.

Question 7

What psychological treatments may be offered to people at risk of psychosis?

Answer 7

Individual CBT and/or family intervention.

Question 8

What is the first-line treatment in diagnosed psychotic disorder?

Answer 8

Oral antipsychotic trial + CBT, family intervention, or art therapy.

Question 9

When should clozapine be considered?

Answer 9

After failure of at least two other antipsychotics, including one second-generation.

Question 10

When might depot antipsychotics be appropriate?

Answer 10

To avoid non-adherence in schizophrenia/psychosis.

Question 11

What tests should be included in annual physical reviews?

Answer 11

Fasting glucose, HbA1c, lipids, U&Es, LFTs, FBC, prolactin (if applicable), ECG (in certain cases).

Question 12

Is breastfeeding allowed while on antipsychotics?

Answer 12

Yes, except clozapine. Monitor infant for adverse effects.

Question 13

What is the main mechanism of action of first-generation antipsychotic drugs?

Answer 13

They predominantly block dopamine D2 receptors in the brain.

Question 14

What side-effects are first-generation antipsychotics more likely to cause?

Answer 14

Acute extrapyramidal symptoms and hyperprolactinaemia.

Question 15

What are common suffixes of first-generation antipsychotics?

Answer 15

-zine, -dol, -xol, -zide, -s-ride.

Question 16

Name three first-generation antipsychotics.

Answer 16

Chlorpromazine, haloperidol, fluphenazine.

Question 17

What is the main difference in receptor activity between first- and second-generation antipsychotics?

Answer 17

Second-generation act on a broader range of receptors.

Question 18

What are common suffixes of second-generation antipsychotics?

Answer 18

-pine, -done, -zole, -a-ride.

Question 19

Name four second-generation antipsychotics.

Answer 19

Aripiprazole, clozapine, risperidone, olanzapine.

Question 20

What is the main risk of using antipsychotics in elderly patients with dementia?

Answer 20

Increased risk of mortality and stroke.

Question 21

Which side effects are first-generation antipsychotics more likely to cause?

Answer 21

Extrapyramidal symptoms, hyperprolactinaemia.

Question 22

Which second-generation antipsychotic has the lowest risk of extrapyramidal symptoms?

Answer 22

Clozapine.

Question 23

What are symptoms of extrapyramidal effects?

Answer 23

Parkinsonism, dystonia, akathisia, tardive dyskinesia.

Question 24

What are signs of hyperprolactinaemia?

Answer 24

Sexual dysfunction, menstrual issues, breast changes, galactorrhoea, reduced bone density.

Question 25

Which drugs are most likely to cause hyperprolactinaemia?

Answer 25

Risperidone, amisulpride, sulpiride, and first-gen antipsychotics.

Question 26

Which antipsychotic lowers prolactin levels?

Answer 26

Aripiprazole.

Question 27

Which antipsychotics have the lowest risk of sexual dysfunction?

Answer 27

Aripiprazole and quetiapine.

Question 28

Which antipsychotics are most likely to prolong the QT interval?

Answer 28

Pimozide, especially with IV or high-dose use.

Question 29

Which antipsychotics are most associated with weight gain?

Answer 29

Clozapine and olanzapine.

Question 30

What is neuroleptic malignant syndrome and how is it treated?

Answer 30

A rare, potentially fatal reaction with hyperthermia and rigidity; stop antipsychotic for at least 5 days and consider bromocriptine or dantrolene.

Question 31

Which depot is most effective in preventing relapses?

Answer 31

Zuclopenthixol decanoate.

Question 32

Which depot antipsychotics have fewer extrapyramidal side effects?

Answer 32

Aripiprazole, paliperidone, risperidone, olanzapine embonate.

Question 33

What serious side effects are associated with clozapine?

Answer 33

Agranulocytosis and severe constipation-related complications.

Question 34

What happens when antipsychotics are combined with antihypertensives?

Answer 34

Increased risk of hypotension.

Question 35

How do SSRIs affect antipsychotic levels?

Answer 35

They can increase levels, e.g., fluoxetine raises haloperidol and risperidone levels.

Question 36

How does smoking affect clozapine and olanzapine metabolism?

Answer 36

Smoking induces metabolism; stopping smoking increases drug levels.