Psychosis and Schizophrenia

What’s the treatment for first episodes of psychosis

1.) give oral antipsychotic medications and CBT

List examples of second gen antipsychotics

1.) Amisulpride

2.) Aripiprazole

3.) Clozapine

4.) Risperidone

5.) Olanzapine

6.) Quetiapine

What are the groups of antipsychotic drugs that are 1st gen

1.) Phenothiazines

2.) Butyrophenes

3.) Thioxanthenes

4.) Pimozide sulpiride

List examples of Butyrophenes

1.) Benperidol

2.) Halopiderol

List examples of Thioxanthenes

1.) flupentixol

2.) zuclopenthixol

Phenothiazine groups

group 1(Pros come first)= Chlorpromazine, promazine, levomepromazine

group 2= pericyazine

group 3= fluphenazine, prochloroperazine, trifluoperazine

What antipsychotic drugs have the highest risk of sedation

1.) Clozapine

2.) Chlorpromazine

What antipsychotic drugs have the highest risk of EPSEs

1.) Halopiderol

2.) Zuclopenthixol

3.) Fluphenazine

What antipsychotic drugs have the highest risk of Anticholingeric side effects

Clozapine

What antipsychotic drugs have the highest risk of QT prolongation

Halopiderol

Pimozide

What antipsychotic drugs have the lowest risk of sedation

1.) amisulpride

2.) aripripazole

What antipsychotic drugs have the lowest risk of EPS

1.) clozapine

2.) quetiapine

3.) Aripiprazole

What antipsychotic drugs have the lowest risk of anticholingeric

1.) Amisulpride

2.) Aripiprazole

What antipsychotic drugs have the lowest risk of QT prolongation

1.) Aripripazole

2.) Zuclopenthixol

What antipsychotic meds cause postural hypotension(ARCQ)

Aripiprazole

Risperidone

Clozapine

Quetiapine

What antipsychotic drugs cause hypertension

Clozapine

What antipsychotic drugs cause stroke

Risperidone

Olanzapine

What antipsychotic drugs cause hyperglycaemia

Risperidone

Olanzapine

Quetiapine

Clozapine

What antipsychotic drugs cause weight gain

Olanzapine

Clozapine

What are some other antipsychotic side effects

1.) Galactohorrea

2.) Sexual dysfunction

3.) QT prolongation

Antipsychotic interactions

1.) drugs with a sedative action

2.) drugs with a hypotensive effect

3.) drugs that cause a QT prolongation

4.) CYP450 enzymes

5.) smoking reduces conc of olanzapine+clozapine

Antipsychotic monitoring

1.) ECG before intiation

2.) Prolactin 6 months after, then yearly

3.) FBC, U+Es/ eGFRs/LFTs: start then yearly

4.) Weight: weekly for 6 weeks, 12 weeks for 1 year, yearly

5.) Lipid/BP/Glucose: 12 weeks for a year, then yearly

When would you use a long acting depot injection

if patient is struggling with adherence

When do you start Clozapine

1.) when 2 antipsychotics including one second generation has been used

What’s the MHRA warning about Clozapine

1.) monitor for toxicity if patient stops smoking/switches to e-cig

2.) patient has pneumonia

3.) other risk of toxicity

Monitoring clozapine leucocytes

weekly for 18 weeks then fortnighly from 18-52 weeks and then monthly after 52 weeks.

What are the side effects of Clozapine

1.) agranuctylosis and thrombocytopenia

2.) intestinal peristalisis impairment

3.) myocarditis, pericarditis/pericardial effusion/cardiomyopathy

Clozapine and pregnancy

1.) caution in pregnancy

2.) avoid in breastfeeding