Case 8 - Clinical Management

Question 1

what is the biggest precursor to schizophrenia

Answer 1

substance misuse
- have a greater chance of persistent low grade psychotic symptoms
- have a greater chance of later Sz
- earlier start and heavier use increases risk more
- become ill 2-5 years younger
- then have worse outcomes in every respect

Question 2

how does global function decrease in people with schizophrenia

Answer 2

people who develop schizophrenia usually have a gradual decrease in global function and have slower development from a young age

Question 3

what does at risk mental state mean

Answer 3

you have about an even change of staying the same, getting worse or getting better

Question 4

under aged 40, is schizophrenia more prevalent in women or men

Answer 4

under 40; males outnumber females 2:!

Question 5

over 40, is schizophrenia more prevalent in males or females

Answer 5

pretty much equal

Question 6

who do negative symptoms present more severely in

Answer 6

negative symptoms present more severely the younger you are and men do worse than women and have worse symptoms

Question 7

suicide risk in schizophrenia

Answer 7

almost 1% per year initially, eventually 4-6% some cohort and case control studies say more like 8%

maybe half serious self have occurs before 1st treatment, so 4-6% underestimates.

more likely if substance misuse; recent suicidal ideation; feel hopeless, trapped and alienated, stop mends

Question 8

what are all antipsychotic drugs

Answer 8

all reversible D2 receptor antagonists
dose predicted by affinity for receptor

Question 9

dose given in schizophrenia

Answer 9

> 60% occupancy. of D2 in associative striatum has an antipsychotic effect
75% occupancy of other D2 receptors causes motor SE and hyperprolactinaemia

Question 10

what is given for agitation

Answer 10

benzodiazepines

Question 11

what medication is given for motor side effects

Answer 11

reduce dose or anticholinergics, propranolol

Question 12

what medication is given for depression between episodes

Answer 12

antidepressants

Question 13

what is clozapine used for

Answer 13

Treatment resistant schizophrenia

Question 14

what percentage of people have symptom reduction who take clozapine

Answer 14

substantial symptoms reduction in 30-50% of treatment resistant schizophrenia

prob about 80% under 3 years and 30% after that

Question 15

what percentage of people benefit from a maintenance antipsychotic

Answer 15

40-60%

Question 16

what is the best relapse protector

Answer 16

family intervention

Question 17

what does cognitive remediation

Answer 17

helps improve cognitive function and does have a meaningful effect and also can help with social functioning

Question 18

what percentage is there of non-adherence at any given time with antipsychotics

Answer 18

40%

Question 19

what percentage of people miss over a week at some point

Answer 19

60%

Question 20

what is non adherence predicated by

Answer 20

don’t see a medical benefit
don’t think will relapse
don’t like medication and internal LoC
poor insight, poor relationship with prescriber

Question 21

summary:

Answer 21

often premorbid decline and vague symptoms
treatment delay worsens response
up to 95% respond initially, 60% remit
about 80% relapse, most develop persistent symptoms
about 15-20 years 15-20% improve again