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Eleni Palazidou MD PhD MRCP FRCPSYCH East London Foundation Trust
<ul><li>Action Programme </li></ul><ul><li>Scaling up care for mental, neurological, and </li></ul><ul><li>substance use d...
<ul><li>Drug/alcohol-induced psychosis </li></ul><ul><li>Organic psychosis </li></ul><ul><li>Schizophrenia </li></ul><ul><...
<ul><li>Schizophrenia is a  chronic  illness </li></ul><ul><li>Onset generally occurs during  young  adulthood (15-25years...
<ul><li>Mental illness is associated with higher mortality rates for physical illness </li></ul><ul><li>50% increased risk...
<ul><li>Positive symptoms  Negative symptoms </li></ul>Delusions Hallucinations Grandiosity Suspiciousness/Persecution Exc...
<ul><li>Primary (?deficit)  Secondary </li></ul><ul><li>Blunted/flat affect  Resulting from +ve s-ms </li></ul><ul><li>Poo...
<ul><li>In-patient care </li></ul><ul><li>Community care  </li></ul><ul><li>?Need for using Mental Health Act </li></ul><u...
<ul><li>Care plan </li></ul><ul><li>Antipsychotic drugs </li></ul><ul><li>Psychoeducation </li></ul><ul><li>Cognitive beha...
<ul><li>Guidelines in the treatment of medical disorders </li></ul><ul><li>Review the literature on efficacy and tolerabil...
<ul><li>1960s-70s  </li></ul><ul><li>First generation – “classical” </li></ul><ul><li>Phenothiazines - chlorpromazine  </l...
<ul><li>Extrapyramidal </li></ul><ul><li>Parkinsonism </li></ul><ul><li>Dystonia </li></ul><ul><li>Akathisia </li></ul><ul...
<ul><li>Electrolyte imbalance ( ↓ K, ↓ Mg) </li></ul><ul><li>Underlying cardiac abnormalities </li></ul><ul><li>Hypothyroi...
<ul><li>Higher risk of QTc prolongation and Torsades de Pointes – iv administration or high doses </li></ul><ul><li>Recent...
<ul><li>Great variation in pharmacological profile! </li></ul><ul><li>In general they have decreased likelihood of extrapy...
First generation Second generation Weight gain Hyperglycaemia, diabetes Insulin resistance Cardiovascular dis Dyslipidaemi...
 
<ul><li>Drug treatment needs to be tailored to the individual taking into consideration: </li></ul><ul><li>clinical presen...
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Palazidou 02

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Transcript of "Palazidou 02"

  1. 1. Eleni Palazidou MD PhD MRCP FRCPSYCH East London Foundation Trust
  2. 2. <ul><li>Action Programme </li></ul><ul><li>Scaling up care for mental, neurological, and </li></ul><ul><li>substance use disorders </li></ul><ul><li>Vision </li></ul><ul><li>Effective and humane care for all with mental, neurological, and substance </li></ul><ul><li>Goal </li></ul><ul><li>Closing the GAP between what is urgently needed and what is currently </li></ul><ul><li>available to reduce the burden of mental, neurological, and substance use </li></ul><ul><li>disorders worldwide by: </li></ul><ul><li>• Reinforcing the commitment of stakeholders to increase the allocation of </li></ul><ul><li>financial and human resources; and </li></ul><ul><li>• Achieving higher coverage of key interventions especially in countries with low and lower middle incomes. </li></ul>
  3. 3. <ul><li>Drug/alcohol-induced psychosis </li></ul><ul><li>Organic psychosis </li></ul><ul><li>Schizophrenia </li></ul><ul><li>Paraphrenia </li></ul><ul><li>Other Paranoid psychoses </li></ul>
  4. 4. <ul><li>Schizophrenia is a chronic illness </li></ul><ul><li>Onset generally occurs during young adulthood (15-25years) </li></ul><ul><li>Lifetime prevalence = 0.7% (300-600,000 people at any one time in UK) </li></ul><ul><li>Economic burden: Can account for up to 1.5% to 3% of healthcare costs </li></ul>
  5. 5. <ul><li>Mental illness is associated with higher mortality rates for physical illness </li></ul><ul><li>50% increased risk of death from physical disease in schizophrenia </li></ul><ul><li>20% decrease in life span for physical disease in schizophrenia </li></ul><ul><li>Cardiovascular mortality increased 1976-1995 </li></ul><ul><li>Greatest increase in SMR(ratio of observed over expected death rate) from 1991-95 </li></ul>
  6. 6. <ul><li>Positive symptoms Negative symptoms </li></ul>Delusions Hallucinations Grandiosity Suspiciousness/Persecution Excitability 1. Kay SR, Fiszbein A, Opler LA. The positive and Negative Syndrome Scale (PANSS). Schizophr Bull 1987;13:261-276. Somatic concern Anxiety / Guilt feelings Mannerisms and posturing Uncooperativeness Disorientation Poor impulse control Preoccupation General Psychopathology Blunted affect Emotional withdrawal Difficulty in abstract thinking Social withdrawal Lack of spontaneity Poor rapport
  7. 7. <ul><li>Primary (?deficit) Secondary </li></ul><ul><li>Blunted/flat affect Resulting from +ve s-ms </li></ul><ul><li>Poor rapport -depression </li></ul><ul><li>Emotional withdrawal -demoralisation </li></ul><ul><li>Passive social withdrawal </li></ul><ul><li>Poor social skills Rx related side effects </li></ul><ul><li>Poor self care -EPS </li></ul><ul><li>Alogia(poverty of speech) </li></ul><ul><li>Anergia </li></ul><ul><li>Apathy </li></ul><ul><li>Avolition </li></ul>
  8. 8. <ul><li>In-patient care </li></ul><ul><li>Community care </li></ul><ul><li>?Need for using Mental Health Act </li></ul><ul><li>Community mental health teams </li></ul><ul><li>Care Programme Approach (CPA) </li></ul><ul><li>Care coordinator </li></ul>
  9. 9. <ul><li>Care plan </li></ul><ul><li>Antipsychotic drugs </li></ul><ul><li>Psychoeducation </li></ul><ul><li>Cognitive behavioural therapy </li></ul><ul><li>Family therapy, psychoeducation </li></ul><ul><li>Monitoring and support </li></ul><ul><li>Rehabilitation – social skills, work, training etc </li></ul>
  10. 10. <ul><li>Guidelines in the treatment of medical disorders </li></ul><ul><li>Review the literature on efficacy and tolerability of drugs as well as cost efficiency </li></ul>
  11. 11. <ul><li>1960s-70s </li></ul><ul><li>First generation – “classical” </li></ul><ul><li>Phenothiazines - chlorpromazine </li></ul><ul><li>Butyrophenones - haloperidol </li></ul><ul><li>Thioxanthines - flupenthixol </li></ul><ul><li>From 1980s </li></ul><ul><li>Second generation – “atypicals” </li></ul><ul><li>Clozapine, olanzapine, quetiapine, </li></ul><ul><li>Sulpiride, amisulpride </li></ul><ul><li>Risperidone, paliperidone </li></ul><ul><li>Aripiprazole </li></ul>
  12. 12. <ul><li>Extrapyramidal </li></ul><ul><li>Parkinsonism </li></ul><ul><li>Dystonia </li></ul><ul><li>Akathisia </li></ul><ul><li>Tardive dyskinesia </li></ul><ul><li>Hyperprolactinaemia </li></ul><ul><li>Amenorrhoea </li></ul><ul><li>Low fertility </li></ul><ul><li>Sexual dysfunction </li></ul><ul><li>Cardiovascular – QT interval </li></ul><ul><li>Haematological </li></ul><ul><li>Weight gain </li></ul><ul><li>Lower seizure threshold </li></ul><ul><li>Drug interactions </li></ul>
  13. 13. <ul><li>Electrolyte imbalance ( ↓ K, ↓ Mg) </li></ul><ul><li>Underlying cardiac abnormalities </li></ul><ul><li>Hypothyroidism </li></ul><ul><li>Familial QT prolongation Σ </li></ul><ul><li>Drugs known to prolong QT </li></ul>
  14. 14. <ul><li>Higher risk of QTc prolongation and Torsades de Pointes – iv administration or high doses </li></ul><ul><li>Recent recommendation an ECG to be performed prior to Rx </li></ul>
  15. 15. <ul><li>Great variation in pharmacological profile! </li></ul><ul><li>In general they have decreased likelihood of extrapyramidal effects or hyperprolactinaemia </li></ul><ul><li>BUT </li></ul><ul><li>Weight gain </li></ul><ul><li>Diabetes </li></ul><ul><li>Metabolic syndrome </li></ul>
  16. 16. First generation Second generation Weight gain Hyperglycaemia, diabetes Insulin resistance Cardiovascular dis Dyslipidaemia Less EPS Less QT prolongation Less hyperprolactinaemia Neurological side effects EPS Tardive dyskinesia Hyperprolactinaemia
  17. 18. <ul><li>Drug treatment needs to be tailored to the individual taking into consideration: </li></ul><ul><li>clinical presentation </li></ul><ul><li>potential efficacy </li></ul><ul><li>potential side effects </li></ul><ul><li>present/previous physical health </li></ul><ul><li>family history </li></ul><ul><li>ethnicity </li></ul><ul><li>gender, age </li></ul><ul><li>patient choice </li></ul>
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