SCHIZO

Question 1

What are the positive symptoms of schizophrenia?

Answer 1

Delusions hallucinations and disorganisation

Question 2

What are the negative symptoms of schizophrenia?

Answer 2

Social withdrawal neglect and poor hygiene

Question 3

What is first-line treatment for a first episode of psychosis?

Answer 3

Oral antipsychotic plus CBT

Question 4

Which antipsychotic must NEVER be used in first episode psychosis?

Answer 4

Clozapine

Question 5

Which antipsychotics treat both positive and negative symptoms?

Answer 5

Second generation antipsychotics

Question 6

Name second generation antipsychotics

Answer 6

Amisulpride aripiprazole clozapine olanzapine quetiapine risperidone

Question 7

Which antipsychotics have high sedation risk?

Answer 7

Clozapine and chlorpromazine

Question 8

Which antipsychotics have low sedation risk?

Answer 8

Amisulpride and aripiprazole

Question 9

Which antipsychotics have high extrapyramidal side effect risk?

Answer 9

Haloperidol zuclopenthixol fluphenazine

Question 10

Which antipsychotics have low extrapyramidal side effect risk?

Answer 10

Clozapine quetiapine aripiprazole

Question 11

Which antipsychotic has high anticholinergic effects?

Answer 11

Clozapine

Question 12

Which antipsychotics have low anticholinergic effects?

Answer 12

Amisulpride and aripiprazole

Question 13

Which antipsychotics have high QT prolongation risk?

Answer 13

Haloperidol and pimozide

Question 14

Which antipsychotic is favoured due to low risk of most side effects?

Answer 14

Aripiprazole

Question 15

Which class causes extrapyramidal side effects?

Answer 15

First generation antipsychotics

Question 16

Which antipsychotics cause postural hypotension?

Answer 16

Aripiprazole risperidone clozapine quetiapine

Question 17

Which antipsychotic can cause hypertension?

Answer 17

Clozapine

Question 18

Which antipsychotics increase stroke risk?

Answer 18

Risperidone and clozapine

Question 19

Do all antipsychotics prolong QT interval?

Answer 19

Yes all antipsychotics can prolong QT

Question 20

Which antipsychotics cause hyperglycaemia?

Answer 20

Risperidone olanzapine quetiapine clozapine

Question 21

Which antipsychotics cause significant weight gain?

Answer 21

Olanzapine and clozapine

Question 22

Which antipsychotics do NOT usually cause hyperprolactinaemia?

Answer 22

Clozapine olanzapine quetiapine aripiprazole

Question 23

Which antipsychotics cause hyperprolactinaemia?

Answer 23

All others especially risperidone

Question 24

What adverse effects result from hyperprolactinaemia?

Answer 24

Galactorrhoea and sexual dysfunction

Question 25

Which drugs interact with antipsychotics?

Answer 25

Sedatives hypotensive drugs QT prolonging drugs CYP450 inducers and inhibitors

Question 26

How does smoking affect clozapine and olanzapine?

Answer 26

Smoking decreases plasma concentrations

Question 27

What happens when a patient stops smoking while on clozapine?

Answer 27

Increased side effects so dose must be reduced

Question 28

Which tests are required before starting antipsychotics?

Answer 28

ECG FBC U and Es eGFR LFTs weight blood glucose lipids BP

Question 29

What monitoring is required weeks 1 to 6 after starting antipsychotics?

Answer 29

Weight weekly for 6 weeks

Question 30

What monitoring is required at 3 months?

Answer 30

Weight blood glucose lipids BP

Question 31

What monitoring is required at 6 months?

Answer 31

Prolactin

Question 32

What monitoring is required at 1 year?

Answer 32

Weight blood glucose lipids BP FBC U and Es eGFR LFTs prolactin

Question 33

What monitoring is required yearly thereafter?

Answer 33

Weight blood glucose lipids BP FBC U and Es eGFR LFTs prolactin

Question 34

What should be considered if adherence to oral antipsychotics is poor?

Answer 34

Long acting depot injection

Question 35

When is clozapine indicated?

Answer 35

After failure of 2 antipsychotics including 1 second generation

Question 36

What MHRA warning applies to clozapine?

Answer 36

Risk of toxicity especially with smoking changes or infection

Question 37

Which situations increase clozapine toxicity risk?

Answer 37

Smoking cessation pneumonia serious infection e cigarettes

Question 38

What blood monitoring is required for clozapine?

Answer 38

Leukocytes and differential blood counts

Question 39

How often is clozapine monitored initially?

Answer 39

Weekly for 18 weeks

Question 40

How often is clozapine monitored after 18 weeks?

Answer 40

Fortnightly for 1 year

Question 41

How often is clozapine monitored long term?

Answer 41

Monthly

Question 42

How long should monitoring continue after stopping clozapine?

Answer 42

4 weeks

Question 43

Which serious blood disorders are caused by clozapine?

Answer 43

Agranulocytosis and thrombocytopenia

Question 44

Which cardiac conditions are associated with clozapine?

Answer 44

Myocarditis pericarditis cardiomyopathy

Question 45

What action is required if a patient on clozapine has resting tachycardia?

Answer 45

Stop clozapine and report urgently

Question 46

What gastrointestinal risk is associated with clozapine?

Answer 46

Constipation leading to paralytic ileus

Question 47

How should constipation on clozapine be managed?

Answer 47

Report urgently and treat with laxatives

Question 48

Which neurological risks are associated with clozapine?

Answer 48

Seizures neuroleptic malignant syndrome

Question 49

Which metabolic risks are associated with clozapine?

Answer 49

Hyperglycaemia and weight gain

Question 50

What other serious risks are associated with clozapine?

Answer 50

QT prolongation thromboembolism heart attack fever

Question 51

What caution is required when prescribing clozapine in pregnancy?

Answer 51

Use with caution

Question 52

When should clozapine be avoided?

Answer 52

Breastfeeding