Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

m4 psych > 3. Schizophrenia & Related Disorders > Flashcards

3. Schizophrenia & Related Disorders Flashcards

1
Q

What is schizophrenia?
What is it characterised by?

A

Mental illness that affects cognition, emotion and perception

It is characterised by 4 types of symptoms.
1. Positive symptoms (presence of mental features not normally present)
- delusions and hallucinations
2. Negative symptoms (reflects diminished or loss of normal emotional and psychological function)
- affective flattening
- alogia
- avolition
- anhedonia
- asociality
- apathy
3. cognitive symptoms
- impairment in attention, reasoning and judgement
4. disorganised symptoms
- disturbances in thinking, speech, behaviour and incongruous affect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Risk factors of schizophrenia

A
  1. Family history of schizophrenia (most important risk factor)
    - neuregulin 1 gene on chromosome 8
    - dysbindin gene on chromosome 8 and chromosome 22q11
  2. Antenatal/Perinatal
    - influenza infection
    - maternal measles
    - rubella infection
    - premature rupture of membranes
    - preterm labour
    - low birth weight
    - usage of resuscitation during delivery
    - foetal hypoxia during delivery
  3. Biological
    - head injury (a/w paranoid schizophrenia)
    - epilepsy
    - temporal lobe disease
    - misuse of cannabis
  4. Demographics
    - male patients have more severe disease
    - advanced paternal age at the time of birth
  5. Physiological
    - stressful life events (tends to ppt first episode psychosis)
    - high expressed emotions in the family (Over-involvement, Critical comments, Hostility from family members more than 33h/week)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Prevalence of schizophrenia among relatives of schizo patients:

Child of 1 affected parent

A

13%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Prevalence of schizophrenia among relatives of schizo patients:

Child of 2 affected parents

A

46%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Prevalence of schizophrenia among relatives of schizo patients:

Siblings

A

10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Prevalence of schizophrenia among relatives of schizo patients:

General population

A

0.5-1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Prevalence of schizophrenia among relatives of schizo patients:

Parents of affected child

A

5.6%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Prevalence of schizophrenia among relatives of schizo patients:

Grandchild

A

3.7%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Prevalence of schizophrenia among relatives of schizo patients:

Dizygotic twin of other affected twin
Monozygotic twin of other affected twin

A

14%
46%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is a protective factor of schizophrenia?

A

Rheumatoid arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Gross pathological changes in schizophrenia

A

Atrophy of the prefrontal cortex and temporal lobe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Neurochemical abnormalities

A

Increased dopamine in the mesolimbic pathway and the increased levels of dopamine cause schizophrenia

2 serotonin pathways are affected in schizophrenia
Excess serotonin produced by the 2 pathways causes a reduction in the availability of dopamine which can give rise to negative symptoms of schizophrenia

Second generation antipsychotics:
1. 5HT2A antagonist -> causing an increase in dopamine -> relieves negative symptoms
2. D2 antagonist -> relieves positive symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Schneider’s First Rank Symptoms of Schizophrenia

A

ABCD
Auditory hallucinations
- 2nd (voices speak to YOU) or 3rd person (voices speak among themselves)
- Thought echo, running commentary, voices discussing patient
- Somatic (bodily, tactile) hallucinations
- Command hallucinations (not part of the FRS but please rmb to ask)

delusions of thought interference
- Thought Broadcasting, insertion and withdrawal

delusion of Control and passivity
- A person believes others are trying to control their impulses, feelings, thoughts or behaviours

Delusion perception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

DSM-5 Diagnostic Criteria: Schizophrenia

Presence of >/= ___ of the following symptoms (at least 1 of which must be 1, 2 or 3)

Continuous impairment over a period of at least ___ months

A
  1. Delusions
  2. Hallucinations
  3. Incoherent and disorganised speech
  4. Disorganised or catatonic behaviour
  5. Negative symptoms/diminished emotional expression

Presence of >/= 2 of the following symptoms (at least 1 of which must be 1, 2 or 3)

Continuous impairment over a period of at least 6 months

Symptoms must not be due to substance use or underlying medical condition

Deterioration in occupational and social function is compulsory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Schizophreniform Disorder

A

Presence of >/= 2 of the following symptoms (at least 1 of which must be 1, 2 or 3) for a duration of between 1-6 months:

  1. Delusions
  2. Hallucinations
  3. Incoherent and disorganised speech
  4. Disorganised or catatonic behaviour
  5. Negative symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Brief Psychosis

The individual should be able to…

A

Presence of >/= 2 of the following symptoms (at least 1 of which must be 1, 2 or 3) for a duration of between 1 day to 1 month:

  1. Delusions
  2. Hallucinations
  3. Incoherent and disorganised speech
  4. Disorganised or catatonic behaviour

The individual should be able to return to premorbid functional level after the course of the illness.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Brief psychosis could occur…

A

either in the presence or absence of stressors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Differentials for psychogenic polydipsia

A

Nephrogenic DI (serum sodium will be high)
SIADH (low urine output)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Difference between schizophrenia, schizophreniform disorder and brief psychosis is

A

Duration and impairment of function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Poor prognosticating factors of schizophrenia

A

Male
Single
Past psychiatric history
Family history of schizophrenia
Early onset
Negative symptoms
Poor response to treatment
Long duration of untreated psychosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Favourable prognosticating factors of schizophrenia

A

Female
Married
Precipitated by stressful life events
Family history of mood disorders
Paranoid type
Positive symptoms
Good response to treatment
Short duration of untreated psychosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Differentials of Schizophrenia
TRO psychoses that could be 2’ to physical morbidity or substance use

A
  1. Misuse of substances (alcohol, stimulants, hallucinogens, glues or sympathomimetics)***
  2. Medications (steroids, anticholinergics, anti-parkinson drugs)***
  3. Organic causes
  4. Severe depression or mania with psychotic features***
  5. Delusional disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

2 types of anti-psychotics and examples

A

1st generation antipsychotics:
Haloperidol
Chlorpromazine
Trifluoperazine

2nd generation antipsychotics:
Risperidone
Quetiapine
Olanzapine
Clozapine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

MOA of the anti-psychotics

A

1st generation anti-psychotics: dopamine receptor antagonists in mesolimbic pathway (good relief of +ve sx)

2nd generation anti-psychotics: serotonin and dopamine receptor antagonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Indications for 1st/2nd generation anti-psychotics
Schizophrenia Schizoaffective disorder Substance-induced psychosis Personality disorder with psychotic features Mood disorders with psychotic features
25
Contraindications of first gen anti-psychotics
PARKINSON disease Lewy body dementia Elderly prone to developing extrapyramidal side effects
26
Side effects of first gen anti-psychotics
1. Extrapyramidal side effects (due to blockade of D2 receptors in basal ganglia - mesolimbic pathway): - Acute Dystonia - Pseudo-parkinsonism - Akathisia 2. Tardive Dyskinesia (due to D2 receptor hypersensitivity): - Abnormal involuntary muscle movements 3. Sedation (due to antihistamine activity) 4. Secondary negative symptoms (due to blockade of D2 receptors in mesocortical pathway) 5. Sexual - Galactorrhea, Amenorrhea, Gynecomastia, no libido (due to dopamine blockade in tuberoinfundibular pathway -> hyperprolactinemia) 6. QTc prolongation 7. Neuroleptic Malignant Syndrome (rare)
27
Haloperidol MOA Indications S/E
MOA: potent D2 blocker -> lowers level of activity within the nigrostriatal pathway Indications: Schizo (+ve sx), delirium, rapid tranquillisation (IM) S/E: ESPEs
28
Chlorpromazine S/E
Cholestatic jaundice Cataract Postural hypotension ST depression on ECG Increase in seizure Skin rashes
29
MOA for 2nd gen antipsychotics
D2 blockade in mesolimbic pathway & 5HT2A receptor blockade
30
Side effects of 2nd gen anti-psychotics
Lower risks of EPSEs Higher risks of metabolic syndrome/obesity/diabetes/weight gain
31
Risperidone S/E
@ higher doses: Prone to EPSEs and hyperprolactinaemia but ok at lower doses - most common due to most balanced in terms of cost, S/E profile and efficacy
32
Olanzapine C/I S/E
C/I: stroke, diabetes, obesity, narrow angle glaucoma S/E: Weight gain (highest risk), anticholinergics S/Es
33
Quetiapine S/E
Lower risks of EPSEs Less weight gain (but still does cause) Sedation Postural hypotension**
34
Quetiapine can be given for psychotic symptoms in...
Parkinson's disease
35
Aripiprazole MOA S/E
MOA: - Partial agonist at D2 - 5HT1A partial agonist - 5HT2 blocker S/E (GOOD safety profile) - lower risk of ESPEs - less weight gain/metab syndrome - less prolactin elevation - less QTc prolongation - less sedation - EXPENSIVE - Akathisia
36
Clozapine (super effective) Indication S/E
Indication: Treatment resistant schizophrenia (persistent symptoms despite trials >/= 6 weeks of 2 different antipsychotics, at least 1 first gen and 1 second gen, at adequate therapeutic doses and duration) S/E: - Agranulocytosis (FBC must be repeated at weekly intervals for 6 months) Mnemonic: (5 Cs) - Cells (agranulocytosis) - Cardiomyopathy - Clots (pulmonary embolism) - Convulsions (lower threshold for seizures) - Constipation (anti-cholinergic s/e) + Sedation + Weight gain + Hypersalivation
37
What are the extrapyramidal side effects?
1. Acute Dystonia 2. Pseudo-parkinsonism 3. Akathisia - comes with risk of suicide
38
Which group of patients is at the highest risk for acute dystonia?
Younger men First episode of schizophrenia Drug-related: Potency, Dose, Rate of increment
39
Onset of acute dystonia
Within a few hours of antipsychotic administration
40
Symptoms of acute dystonia
1. Oculogyric crisis (fixed upward/lateral gaze) 2. Torticollis (twisted neck) 3. Spasms of lips, tongue, face, throat muscles 4. Acute dyskinesia (most commonly after the 5th day of initiation) - grimacing - exaggerated posturing - posturing, twisting of neck
41
Onset of pseudo-parkinsonism
Develops gradually after a few weeks of use
42
Symptoms of pseudo-parkinsonism
Mimics parkinson disease: TRAP
43
Onset of akathisia
Most commonly after the 5th day of initiation
44
Symptoms of akathisia
1. Irritability 2. Restlessness (need to move, cannot sit still)
45
Onset of tardive dyskinesia
Years (presents late into treatment ~10-15 years in)
46
Symptoms of tardive dyskinesia
1. Lip smacking 2. "Fly catching" tongue protrusion 3. Chewing 4. Blepharospasm 5. Pill rolling hand movements 6. Pelvic thrusting
47
Dyskinesia = abnormal involuntary movements Acute vs Tardive = duration
-
48
Management of tardive dyskinesia
- Switch to 2nd gen anti-psychotics - Vitamin E NO ANTICHOLINERGICS (worsens condition)
49
Management of acute dystonia
- Switch to 2nd gen anti-psychotics - Fast acting IM anticholinergics (eg IM benztropin)
50
Management of akathisia
- Switch to 2nd gen anti-psychotics - Propranolol first line for chronic mx - Anticholinergics (acute) - Benzodiazepines (chronic - but choose propranolol if patient has no asthma as BZD causes dependence)
51
Management of pseudo-parkinsonism
- Gradual dose reduction can reduce symptoms - Switch to 2nd gen anti-psychotics - Anticholinergics (eg. Benzhexol) -> effective in reducing severity of EPSE
52
Psychosocial Management for Schizos
Psychoeducation Family intervention Support psychotherapy Occupational Therapy Cognitive rehabilitation Cognitive Behavioural Therapy
53
What does prodrome of schizophrenia refer to?
Refers to a range of subjective experience occurring prior to onset of schizophrenia
54
Positive symptoms of prodrome of schizophrenia
- unusual perceptions - odd beliefs - vague and circumstantial speech - pre-occupation with religion - suspiciousness - pre-psychotic anxiety - praecox feeling: clinician’s intuition that the patient is odd
55
Negative symptoms of prodrome of schizophrenia
- Blunted affect - Amotivation - Isolation and social withdrawal
56
Cognitive symptoms of prodrome of schizophrenia
- Worsened academic, work or social functioning - Worsened self care - Reduced attention and concentration
57
General symptoms of prodrome of schizophrenia
- Sleep disturbances - Depressed mood - Irritable mood - Poor hygiene
58
Causes of catatonia
1. Schizophrenia 2. Severe depressive disorder 3. Bipolar disorder 4. Organic disorders (CNS-related)
59
Clinical features of catatonia
Ambitendency Automatic obedience (mitgehen, mitmachen) Wavy flexibility/ catalepsy Negativism Stereotypy Mannerism Echolalia Echopraxia
60
Management of catatonia
Non-pharmaco: hydrate, early mobilisation, close monitoring, ECT is pharmaco fails and severe sx Pharmaco: Benzodiazepine
61
DSM 5 criteria of schizoaffective disorder (schizophrenia + bipolar sx)
1. Solely hallucinations or delusions for at least 2 weeks without an affective episode throughout the entire psychiatric illness AND 2. uninterrupted period with concurrent prominent affective symptoms and symptoms of schizophrenia affective sx = changes in mood
62
Hallmark of young onset schizophrenia
Academic decline
63
When is IM depot used?
When patients are not compliant to their medications When patients are uncooperative and deemed to require immediate administration of drug
64
Mental Health Care & Treatment Act
- treat patients against their will - must be a treatable condition - patients pose harm to self/others - can only be issued in IMH - form 1: 72 hours - form 2: 1 month (signed by a diff psychiatrist) - form 3: 6 months (signed by 2 drs, one must be a psychiatrist)
65
Complications of QTc prolongation
1. Torsades de pointes (originate from ventricles and causes VFib) 2. Palpitations 3. Sudden cardiac death 4. Ventricular fibrillation
66
Which class of antipsychotics does haloperidol belong to?
Butyrophenones
67
Chances of responding to antipsychotics
30% - Complete response 60% - Respond to some degree 10% - Nil response to any anti-psychotics
68
Most important predicting factor for schizophrenia
Family history of schizophrenia
69
Risk factors with higher risks of developing agranulocytosis in schizophrenic patients taking clozapine
- Female gender - Ashkenazi Jewish descent - Older age *Risk of developing agranulocytosis is not proportional to dose and duration of treatment
70
Difference between presentation of schizophrenia and depression
MOOD: Schizophrenia- mood incongruent psychotic features Depression- mood congruent psychotic features AFFECT: Schizophrenia- blunted affect Depression- Reactive affect FUNCTION: Depression- Better global and occupational functioning than in schizophrenic patients
71
Note: Usually schizophrenia no visual hallucinations
-
72
Differences between psychogenic polydipsia, SIADH, nephrogenic DI
URINE VOS (volume, osmolarity, sodium) & Serum sodium Nephrogenic DI: High, Low, Low, High Psychogenic polydipsia: High, Low, Low, Low SIADH: Low, High, High, Low *5-20% of schiz patients suffer from PP
73
Most important factor of maintenance of schizophrenia
Compliance to anti-psychotics therapy
74
Having positive/negative symptoms is more likely to restrict full rehabilitation potential?
Negative symptoms
75
Adjunct for weight gain a/w second gen antipsychotics
Metformin
76
Two age peaks of schizophrenia
20s and 40s
77
Features of a delusion
Untrue Unshared Unshakeable
78
Difference between a delusion and overvalued idea
Degree of conviction? Can it be challenged? In keeping with sociocultural beliefs and background?
79
Which illicit substance has a known association with the development of schizophrenia?
Cannabis
80
Symptoms suggestive of organic causes of psychosis
SPAM Sudden onset Predominant non-auditory hallucinations Altered mental status, Fluctuating Motor autonomic instability
81
What antipsychotics are least likely to cause EPSEs?
Clozapine, quetiapine

m4 psych (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions