Case 8 - Clinical Handout Flashcards
what is the criteria for schizophrenia
2 of:
- delusions
- hallucinations
- disorganised speech
- disorganised or catatonic behaviour
- negative symptoms
must include one of first 3 for most of the time for at least 1 month within an episode of illness lasting at least 6 months
what is illness under six months classed as
schizophreniform disorder
what is ICD10 and what is it based on
based on ‘core symptoms’ of;
- persistent delusions
- persistent hallucinations
- thought disorder
- experiences of influence, passivity or control
so must have persisted for a month or more to make the diagnosis without being caused by something else
what passivity/influence experiences
impulses
sensations
intentions
emotions
thoughts
influenced directly by some kind of external agent
what are control experiences
delusions that a particular agent is the cause
N.B thought alienation would be included somewhere under persistent bizarre delusions, passivity or control experiences but are not properly specified
when is risk higher for schizophrenia
2nd generation ethnic minorities
commonest age of onset is 20
females outnumber males over age of 40
what is genetic risk in 1st degree
7%
what is risk in second degree
2-3%
what’s risk for dizygotic co twins
10%
what is risk for monozygotic twins
455
what are the 3 groups of genes that affect risk of schizophrenia
- connected to glutamate, dopamine or GABA neurotransmitter function
- to neurone structure, plasticity or general synaptic function
- to inflammatory or immune response
environmental factors
child sexual abuse or being taken into carte
cannabis misuse
being 2nd generation of UK ethnic minority
migration
peri-natal oxygen deprivation, maternal starvation
urban living, parental separation
what is schziophrenia often precessed by
subtle social and cognitive impairment, even from infancy, so people with Sz often present with disability already present
how does Sz symptoms progress
over years from negative symptoms to vague symptoms of depression, anxiety, insomnia, to vague but psychotic symptoms, then full psychosis
substance misuse increases risk of persistent psychotic symptoms
what happens when the dose of treatment is too high
Parkinsonism
what are the other adverse effects of treatment
akathisia - restless and constant movement, legs
tardiye dyskinesia - gradual developmental of abnormal movements, often chewing, often months or years after onset
hyperprolactinamyia at high doses causes sexual side effects and affects periods in women
neuroplectic malignant syndrome - rapid onset of coma, high temp, rigidity and death. often follows initiation or rapid increase in dose
what is the treatment effect
begins to work as soon as dose is high enough, enough D2 receptors are blocked in the brain. symptoms start to reduce a little from day 1, more and more each day. mostly after two weeks some improvement is clear
what is clozapine
used if two antipsychotics fail or can’t be tolerated at full doe
substantial symptoms reduction in 30-50% and maybe 75% after first episode.
appears to enable people to engage in rehab ability
what are the side effects of clozapine
sedation, hunger and hyper salivation are the main side effects
what happens if someone response poorly to clozapine
then a second anti psychotic is added - clozapine binds best to D4 so a clean D2/3 antagonist like sulpiride or amisulrpide ‘fills’ in the gap and 50% respond
what does the early intervention services aim to do
intervene in a. non-stigmatising way as soon as possible after first episode, to minimise delay in first treatment and then concentrate on return to training and work; and reconstructing family relationships and social networks cover first 3 years of treatment 14-065yrs old
after EIS service, where do patients go next
thereafter generally under community mental health teams with periods under home based treatment teams for home treatment of acute exacerbations
what does individualised placement support do
helps chronic sufferers return to work
who will have the worst prognosis
men and the young more likely to present with negative and disorganised symptoms, which predict poor outcome
what is life expectancy of someone with Sz
60 years. 15-25 year reduction due to physical ill heath, limited effect of suicide. high rates of obesity, high cholesterol, substance misuse and inactivity
what is section 2 of MHA
allows 2 doctors and an approved mental health professional to detain someone in hospital for 28 days for assessment if they believe they might have a mental illness of sufficient nature and degree and are not at risk of harming themselves or others.
what is section 3 of MHA
allows the same progressional to detain someone in hospital for 6 months for treatment if they definitely have a specific mental illness that causes a risk to others or their own health and safety and there is appropriate treatment available
what is a community treatment order
allows someone to be discharged from section 3 to be readmitted if they don’t obey specific conditions - adherence to mediation
