SL32112-Lecture 34 - schizophrenia - clinical

What venn diagram components influence mental health

Biological

Psychological

social and environmental

What are the 3 key neurotransmitters

noradrenaline

serotonin

dopamine

Stigma around mental health

Psychosis and schizophrenia has lots of stigma and fear particular in the beginning stages when there is increased risk of suicide

more at risk of being victims not perpetrators risk of being exploited or victims of crime

Schizophrenia

Mind becomes detached from reality around them 

Disturbances in multiple mental modalities

• thinking: delusions, disorganisation

• perception: hallucinations

• self experience: feelings, impulses, thoughts

• cognition: impaired attention

• loss of motivation

• affect: blunt emotional expression 

• bizarre behaviours 

• Has to be persistent for at least 1 month

Psychosis

Not a diagnosis but episodes that form part of schizophrenia

sometimes a preferred term

positive: adding things into reality or experience

Negative: loss of normal responses or experience

can be one off due to OH, drugs, sleep deprivation

What is delusion vs hallucinations

delusion: unshakable belief is something that is untrue isn’t part of person’s culture/subculture

hallucination: false perceptions of sensory experiences with the absence of a stimulus

Bizarre/ non bizarre delusions

Non bizarre: could occur in real life

Bizzare: delusions impossible in out reality

Voices

• heterogeneous male or female

• sometimes cannot distinguish

• derogatory voices

• whispering or shouting 

How is schizophrenia diagnosed

DSM-5

ICD-10 or 11

Diagnosis is flexible and can be disagreed between patient and HCP

What are the aims of treatment

Remission: resolve symptoms

Relapse Prevention: prevent future episodes

Restore function: psychosocial, physical

What are pharmacists roles in psychiatry

• develop and promote rational and appropriate use of medicines

• maximise clinical effectiveness

• minimise ADR

• Shared decision making can be difficult as the patient may not accept the diagnosis 

• May need to treat patient against their will 

What is the mental health act

Individuals can be detained and treated against their will using proportionate force if necessary

Community treatment orders have been introduced: can be treated under supervision of community pharmacist

Pharmacists help with safeguarding

psychosis and schizophrenia guideline

combines oral antipsychotic + physiological interventions

shared decision making choice

discuss benefits and side effects, see which one they are willing to tolerate

What antipsychotics are available

Dopamine blockers

What is the method of action of dopamine blockers

act on D2 blockers and 5-HT2A throughout the CNS

Difference between typical vs atypical

typical: blocks some for therapeutic effect and other receptors can cause side effects. Higher risk of movement disorders, irreversible, prolactin elevation, EPSE, TD

atypicals are more selective. Higher risks of metabolic disorders can be life threatening, stigmatising

Which antipsychotic is not equally effective

Clozapine

What are the side effects of antipsychotics

sedation

anticholinergic effects

cardiac effects

List some antipsychotics and their side effects

How can physical health affect mental health

Poor physical health can lead to an increased risk of developing mental health problems and vice versa

what is neuroleptic malignant syndrome

life threatening reaction to use of dopamine receptor antagonist medication 

What impact can poor mental health and mental health have on

reduction in life expectancy