Schizophrenia: A Case Study

These flashcards cover key terminology and concepts related to schizophrenia based on the lecture notes.

Schizophrenia

A complex mental disorder characterized by a range of symptoms, including positive (hallucinations, delusions) and negative symptoms (lack of emotion, social withdrawal).

Positive Symptoms

Symptoms that add to the person's experience, such as hallucinations, delusions, and disorganized behavior.

Negative Symptoms

Symptoms that reflect a decrease or loss of function or ability, including alogia, avolition, and loss of emotional connectedness.

Hallucinations

Sensory experiences that appear real but are created by the mind, commonly auditory or visual in schizophrenia.

Delusions

Strongly held false beliefs that are resistant to reason or confrontation with actual fact.

Alogia

A deficiency in the amount or content of speech—common negative symptom of schizophrenia.

Avolition

A decrease in the motivation to initiate and sustain meaningful activities; a negative symptom seen in schizophrenia.

First Generation Antipsychotics (FGAs)

Older class of antipsychotic medications primarily used to manage positive symptoms of schizophrenia.

Second Generation Antipsychotics (SGAs)

Newer class of antipsychotic drugs that can treat both positive and negative symptoms of schizophrenia with fewer side effects.

Extrapyramidal Symptoms (EPS)

Drug-induced movement disorders that can occur with antipsychotic medications, including tardive dyskinesia, akathisia, and dystonia.

Clozapine

An atypical antipsychotic used for treatment-resistant schizophrenia and associated with a risk of agranulocytosis.

Pharmacokinetics

The study of how drugs are absorbed, distributed, metabolized, and excreted in the body.

Monitoring Parameters for Antipsychotics

Health metrics to track in patients on antipsychotic treatment, including BMI, blood pressure, fasting glucose, and lipids.

CYP450 Enzymes

A family of enzymes involved in drug metabolism, affecting how different individuals process medications such as antipsychotics.

Randomized Controlled Trial (RCT)

A study design that randomly assigns participants to receive different interventions for comparing effects, seen in clinical drug trials.

At what age does schizophrenia commonly present?

Early adulthood typically in the early 20s

What are positive symptoms in schizophrenia?

New experiences such as hallucinations delusions or disorganised speech

What are negative symptoms in schizophrenia?

Reductions or losses in normal function such as reduced speech motivation or emotional response

What is a hallucination?

A perception of something in the absence of an external stimulus

Name three types of hallucinations

Visual auditory and olfactory

What is a delusion?

A falsely held belief that is not true and not based in reality

What is a paranoid delusion?

The belief that someone or something is trying to harm or control the individual

What is a delusion of reference?

The belief that neutral events have special personal meaning

What is a delusion of grandeur?

The belief that one is exceptionally important powerful or famous

What is thought broadcasting?

The belief that others can hear or know one's thoughts

What is thought insertion?

The belief that one's thoughts have been placed in their mind by someone else

What is thought withdrawal?

The belief that one's thoughts are being removed from their mind by an external force

What is disorganised speech in schizophrenia?

Speech that is difficult to follow due to disorganisation of thoughts

What is derailment in speech?

Suddenly switching to an unrelated topic in the middle of a sentence

What is tangentiality in speech?

Speech that responds to a question but does not address the point

What is incoherence in speech?

Speech that is so disorganised it becomes nonsensical or incomprehensible

What is alogia?

Poverty of speech where answers are brief and lack detail

What is avolition?

Reduced motivation and inability to initiate or maintain goal-directed activities

What is blunted affect?

Reduced emotional expression or response

What is loss of executive function?

Difficulty performing complex tasks such as planning or organising

Are antipsychotics better at treating positive or negative symptoms?

Positive symptoms

What is the goal in the acute phase of schizophrenia treatment?

Rapid control of positive symptoms and ensuring patient safety

What is the goal in the stabilisation phase of schizophrenia treatment?

Maintain symptom control and plan long-term management

What is the goal in the maintenance phase of schizophrenia treatment?

Prevent relapse and manage any ongoing negative symptoms

What are the two main generations of antipsychotic drugs?

First-generation antipsychotics and second-generation antipsychotics

What is the primary receptor targeted by all antipsychotics?

Dopamine D2 receptor

What is the main mechanism of action of antipsychotics at D2 receptors?

D2 receptor antagonism

Are first-generation antipsychotics less effective than second-generation?

No they are similarly effective overall

Name two commonly used first-generation antipsychotics

Haloperidol and chlorpromazine

Name two commonly used second-generation antipsychotics

Risperidone and olanzapine

What is chlorpromazine known for in terms of receptor profile?

Strong H1 M1 and alpha-1 antagonism contributing to sedation and hypotension

What is haloperidol known for in terms of receptor profile?

High D2 antagonism with minimal histamine or anticholinergic activity

Which FGA has strong sedative and anticholinergic effects?

Chlorpromazine

Which FGA is more associated with movement disorders such as tardive dyskinesia?

Haloperidol

Why do first-generation antipsychotics cause movement disorders?

Due to potent D2 antagonism in the nigrostriatal pathway

What is acute dystonia?

Painful muscle spasms such as neck stiffness or jaw spasm

What is akathisia?

Inner restlessness and inability to stay still

What is tardive dyskinesia?

Late-onset involuntary movements usually of the face and jaw

How should tardive dyskinesia be managed?

Switch to a different antipsychotic often a second-generation agent

Which antipsychotic is a partial D2 agonist?

Aripiprazole

Which antipsychotic shows the broadest receptor activity including strong 5-HT2 M1 H1 and alpha-1 blockade?

Clozapine

Which antipsychotic is strongly associated with weight gain and metabolic syndrome?

Olanzapine

Which antipsychotic most commonly causes hyperprolactinaemia?

Risperidone

What are symptoms of hyperprolactinaemia?

Amenorrhoea galactorrhoea and sexual dysfunction

Which laboratory test confirms hyperprolactinaemia?

Elevated serum prolactin level

How is hyperprolactinaemia managed in antipsychotic treatment?

Switch to an antipsychotic with lower prolactin-raising potential

Which antipsychotic is most strongly linked to weight gain diabetes and dyslipidaemia?

Clozapine and olanzapine

Name three metabolic side effects associated with second-generation antipsychotics

Weight gain hyperglycaemia and raised cholesterol

Why are metabolic side effects concerning in young patients on lifelong antipsychotic treatment?

Due to increased long-term cardiovascular and diabetes risk

What monitoring is recommended for patients on second-generation antipsychotics?

Weight fasting glucose lipid profile blood pressure

Which enzyme metabolises olanzapine?

CYP1A2

Which antibiotic inhibits CYP1A2 and can raise olanzapine levels?

Ciprofloxacin

What symptoms suggest olanzapine toxicity?

Severe drowsiness and tremor

What defines treatment-resistant schizophrenia?

Failure to respond adequately to at least two antipsychotics at therapeutic doses

What is the most effective antipsychotic for treatment-resistant schizophrenia?

Clozapine

Why is clozapine not a first-line drug?

Due to serious side effects including blood dyscrasias and need for intensive monitoring

What is agranulocytosis?

A severe drop in white blood cells especially neutrophils

Why is agranulocytosis dangerous?

Because it weakens immunity and increases infection risk

How is clozapine-associated neutropenia monitored?

Regular blood tests for white cell and neutrophil counts

What should a patient on clozapine do if they develop a fever?

Seek urgent medical attention for possible neutropenic sepsis

Why are patients on clozapine given a thermometer?

To monitor for fever as an early sign of infection

What is the effect of smoking on clozapine metabolism?

Smoking induces CYP1A2 leading to increased clozapine metabolism

What adjustment is needed if a patient on clozapine stops smoking?

Reduce the clozapine dose by about 20 to 30 percent and monitor closely

What serious gastrointestinal side effect is linked to clozapine?

Severe constipation due to reduced gut motility

Why must clozapine-induced constipation be taken seriously?

It can lead to bowel obstruction and can be fatal

What neurological side effect can occur with high doses of clozapine?

Seizures

What distressing but nonfatal side effect involving saliva is linked to clozapine?

Hypersalivation or drooling

Which receptor blockade causes anticholinergic side effects like constipation or dry mouth?

Muscarinic receptor blockade

Name a muscarinic antagonist patch used to treat clozapine-induced drooling

Hyoscine patch

What kind of extrapyramidal side effects do first-generation antipsychotics commonly cause?

Dystonia akathisia and tardive dyskinesia

What receptor interaction is most associated with orthostatic hypotension in antipsychotics?

Alpha-1 adrenergic blockade

Which second-generation antipsychotic has the longest half-life?

Aripiprazole about 75 to 94 hours

Which second-generation antipsychotic has the shortest half-life?

Quetiapine about 7 hours

In pharmacological decision-making what should guide antipsychotic selection when efficacy is similar?

Side-effect profile and patient-specific risks

Why might haloperidol be given intramuscularly in acute psychosis?

For rapid onset of action especially if the patient is noncompliant

Why is benzodiazepine lorazepam sometimes co-administered with antipsychotics in acute agitation?

To reduce anxiety and help sedate the patient quickly

Which antipsychotic is least likely to cause sedation or weight gain?

Aripiprazole

What is the primary antipsychotic mechanism that leads to hyperprolactinaemia?

D2 blockade in the tuberoinfundibular pathway

What is the common effect of antipsychotics with strong H1 receptor antagonism?

Sedation and weight gain

What routine physical measures should be monitored during SGA treatment?

BMI waist circumference and blood pressure