Schizophrenia and psychosis

Question 1

Risk factors for schizophrenia

Answer 1

viral infections, low birth weight/hypoxia, substance misuse, genetic link

Question 2

Describe the positive symptoms of schizophrenia

Answer 2

visual and auditory hallucinations, delusions, lack of awareness of illness, vagueness of speech, social awkwardness, mood abnormailty

Question 3

Describe the negative symptoms of schizophrenia

Answer 3

Apathy, social withdrawal, lack of motivation, poverty of speech

Question 4

How long should an antipsychotic be given to work until it is deemed ineffective?

Answer 4

4-6 weeks

Question 5

How long should a therapy regime consisting of clozapine augmented with another antipsychotic be given to work until it is deemed ineffective?

Answer 5

8-10 weeks

Question 6

Describe the licensing for Clozapine

Answer 6

Psychosis associated with Parkinson’s disease.
If 2 antipsychotics have been deemed ineffective, one being a second generation antipsychotic, clozapine indicated.

Question 7

In what exceptional circumstances can more than one antipsychotic be used?

Answer 7

If augmenting clozapine therapy OR if antipsychotics are being cross-tapered

Question 8

What generation of antipsychotic is Clozapine?

Answer 8

Second-generation (atypical)

Question 9

Which generation of antipsychotics is associated with a higher risk of EPSEs?

Answer 9

First generation (typical)

Question 10

Which generation of antipsychotics is associated with a higher risk of hyperprolactinaemia?

Answer 10

First generation (typical)

Question 11

Which generation of antipsychotics is associated with a higher risk of glucose intolerance?

Answer 11

Second generation (atypical)

Question 12

Which generation of antipsychotics is associated with a higher risk of weight gain?

Answer 12

Second generation (atypical)

Question 13

Which second generation antipsychotics have a lower risk of acute and late-onset EPSEs?

Answer 13

Olanzapine, Quetiapine, Aripiprazole, Clozapine

Question 14

Describe acute dystonia

Answer 14

Involuntary muscle contractions causing repetitive movements/ posture twisting

Question 15

Who is more likly to experience acute dystonias?

Answer 15

Males

Question 16

From what point in treatment can acute dystonias present?

Answer 16

Within hours of starting antipsychotic

Question 17

Describe tardive dyskinesia

Answer 17

involuntary movements of face and mouth e.g., lip smacking

Question 18

At what point in treatment is tardive dyskinesia likely to develop?

Answer 18

After months/ years of treatment or if treatment is discontinued

Question 19

Which EPSE is likely to be irreversible?

Answer 19

Tardive dyskinesia

Question 20

Describe Akathisia

Answer 20

Internal restlessness often mistaken for psychotic agitation

Question 21

How is tardive dyskinesia managed?

Answer 21

Reduce antipsychotic dose and discontinue procyclidine

Question 22

How is acute dystonia managed?

Answer 22

Can be managed with procyclidine

Question 23

How are Parkinsonism’s managed?

Answer 23

Procyclidine can be used

Question 24

Which EPSE does procyclidine worsen?

Answer 24

Akathisia

Question 25

Which patient group are parkinsonism EPSEs most likely to effect?

Answer 25

elderly females with previous neurological damage

Question 26

When is akathisia likely to develop?

Answer 26

Can develop within hours to weeks

Question 27

Which antipsychotic can LOWER prolactin concentrations?

Answer 27

Aripiprazole

Question 28

What are the symptoms of hyperprloactinaemia?

Answer 28

galactorrhea, breast enlargement, increased risk of breast cancer, menstrual probelms, sexual dysfunction, reduced bone mineral density

Question 29

How long should antipsychotics be stopped for after suspected neuroleptic malignant syndrome?

Answer 29

5 days

Question 30

What are the symptoms are neuroleptic malignant syndrome?

Answer 30

Labile BP, tachycardia, hyperthermia, fever, sweating, muscle rigidity

Question 31

Which second generation antipsychotics are more likely to be associated with weight gain?

Answer 31

Olanzapine and Clozapine

Question 32

How often should a patient's vital signs be monitored when using antipsychotics for rapid tranquilisation?

Answer 32

Every hour until stable

Question 33

How often should a patient's vital signs be monitored when using high-dose antipsychotics for rapid tranquilisation?

Answer 33

Every 15 minutes until stable

Question 34

How often should antipsychotic use in the elderly be reviewed?

Answer 34

Every 6 weeks

Question 35

What monitoring needs to take place when reviewing antipsychotics?

Answer 35

BP, weight, HbA1c, lipids, FBC, LFTs, U&Es, sometimes an ECG

Question 36

What advantage does zuclopenthixol depot use have in comaprison to other first-generation antipsychotics?

Answer 36

Shown to be more effective in preventing relapses

Question 37

What cardiovascular side effects are likely to occur with antipsychotic use?

Answer 37

Tachycardia, hypotension, and QT prolongation

Question 38

Which serious side effect is most likley to occur betweek weeks 6-18 of Clozapine therapy?

Answer 38

Neutropenia/ agranulocytosis

Question 39

When is cardiomyopathy at the highest risk with clozapine therapy?

Answer 39

In the first 2 months

Question 40

What is the desired clozapine level?

Answer 40

0.35-0.5mg/L

Question 41

When should clozapine levels be measured?

Answer 41

Trough level (12 hours post-dose)