Schizophrenia

Question 1

risk ^ 50% by ?

Answer 1

childhood viral CNS infection

Question 2

what is it assumed that SZP is related to?

Answer 2

over activity of dopamine pathways in the brain

Question 3

positive symptoms

Answer 3

delusions
hallucinations
thought disorder

Question 4

negative symptoms

Answer 4

apathy
lack of volition (will power)
social withdrawal
cognitive impairment

Question 5

1st rank symptoms

Answer 5

passivity phenomena
delusional perception
delusional hallucinations (mainly auditory)
thought interference

Question 6

what is passivity phenomena

Answer 6

belief that they are no longer in control of their own body

Question 7

Time frame after which SZP can be diagnosed

Answer 7

dont diagnose unless symptoms last for >= 6 months and are present much of the time for at least 1m

Question 8

poor prognostic indiactors

Answer 8

male
insidious onset
early onset
cognitive impairment
enlarged ventricles

Question 9

Examples of atypical antipsychotics

Answer 9

risperidone
olanzapine
quetiapine

Question 10

what is more common with the use of atypicals than typicals?

Answer 10

metabolic syndrome

Question 11

What is better about atypicals

Answer 11

less likely to induce EPSE’s

better at tx -ve symptoms

Question 12

why do EPSE’s occur

Answer 12

antipsychotics block D2 receptors in the nigrostriatum

Question 13

examples of typical antipsychotics

HTC

Answer 13

chlorpromazine
thioridazine
haloperidol

Question 14

what is acute dystonia

Answer 14

muscle spasms
can occur within hours of starting antipsychotics
try procyclidine to treat

Question 15

treatment of EPSE’s

Answer 15

decrease dose, change to atypical, or try procyclidine (an Ach antagonist)

Question 16

do antipsychotics increase or decrease seizure threshold

Answer 16

decrease

Question 17

what is tar dive dyskinesia

Answer 17

repetitive involuntary purposeless movements

normally takes years to develop and may be irreversible

Question 18

why can antipsychotics cause hyperprolactinaemia?

Answer 18

secretion of prolactin is under inhibitory control by dopamine

Question 19

symptoms of hyperprolactinaemia

Answer 19

galactorrhea
amenorrhoea
oligomenorrhoea
infertility

Question 20

treatment of symptomatic hyperprolactinaemia

Answer 20

decrease dose or switch to quetiapine (amantadine if not tolerated)

Question 21

how is antipsychotic use related to osteoporosis

Answer 21

hyperprolactinaemia > decreased oestrogen and testosterone > osteoporosis

Question 22

what is akathisia and how is it managed

Answer 22

s/e of antipsychotics > restlessness

if tx needed > propranolol +/- cyproheptadine

Question 23

which antipsychotics increase the risk of stroke in elderly

Answer 23

olanzapine and respiridone

Question 24

what CV effect is common with antipsychotics

Answer 24

postural hypotension

Question 25

what are the purposeless movements that can occur with tardive dyskinesia

Answer 25

grimacing sticking tongue out lip smacking

Question 26

name the antipsychotic that is used ONLY when all others are intolerated

Answer 26

clozapine

Question 27

clozapine s/e's

Answer 27

metabolic syndrome and sedation more than any other hyper salivation AGRANULOCYTOSIS >> FBC even if patient only has a sore throat

Question 28

how is smoking related to clozapine

Answer 28

if smoking its fine if it stays constant | but if a patient smokes then stops, they will start metabolising clozapine much faster

Question 29

cardiac problem assoc with clozapine

Answer 29

myocarditis

Question 30

clozapine FBC monitoring

Answer 30

weekly for 1st 6 months fortnightly for next 6m every 4 weeks thereafter for 1m after cessation

Question 31

examples of acute dystonia

Answer 31

torticollis | oculogyric crisis

Question 32

prolonged involuntary upward deviation of the eyes

Answer 32

oculogyric crisis

Question 33

'crick in the neck'

Answer 33

torticollis

Question 34

poor prognostic indicators in SZP

Answer 34

``` low IQ strong fam hx gradual onset premorbid social withdrawal no obvious precipitant ```