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Semester 3 > Case 8 - Schizophrenia > Flashcards

Case 8 - Schizophrenia Flashcards

1
Q

what is under the classification of schizophrenia

A

the serious brain disorders that are neither organic brain disorders or severe mood disorders

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2
Q

how many people in the population will have a schizophrenia diagnosis at some point in their life

A

1%
200 per 100000
20 per 100000 - incidence

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3
Q

what is the downward social drift

A

higher incidence in inner city, low socioeconomic environments. however it is thought that schizophrenia itself may cause this socioeconomic depravation - because the average patient has a lower than average status, but the patients usually have an average socioeconomic status

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4
Q

when is the peak incidence in men and women

A

18-25 in men
25-30 in women

equal incidence in men and woman

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5
Q

what are the tendencies of a child who develops schizophrenia in later life

A

withdrawn, eccentric, clumsy

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6
Q

what is the prodromal period

A

for a period, before true symptoms develop, the indiivudl may show other symptoms such as:
- loss of interest
- social withdrawal
- self neglect
- depression
- anxiety
- brief psychotic episodes

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7
Q

what does a long prodromal period mean

A

that the diagnosis is delayed and these situations is when the prognosis is poor

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8
Q

what is the general risk

A

1%

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9
Q

what is the risk if sibling has the condition

A

9%

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10
Q

what is the risk if parent has the condition

A

13%

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11
Q

what is the risk if both parents have condition

A

45%

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12
Q

what have studies shown about women and their children when mother has schizophrenia

A

that environmental factors are negligible. children kept away from their mother are at the same risk of developing the condition as those who grew up with their birth mother

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13
Q

what do obstetric complications show

A

found an increased incidence in those who go onto develop the condition. this suggests that some kind of developmental abnormality may be present

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14
Q

what kind of people may have increased likelihood of developing schizophrenia

A

people with sensitive personalities. some people have a tendency to perceive criticism harshly and to interpret non-critical comments as criticism

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15
Q

what are predisposing factors

A

periods of increased stress
periods of intense emotion
increased levels of criticism from friends and family
drugs

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16
Q

what are the symptoms divided into

A

positive symptoms
negative symptoms
cognitive symptoms
mood disturbance

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17
Q

what are the positive symptoms

A

delusions
hallucinations
thought disorder
disorganised speech and behaviour

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18
Q

what are auditory hallucinations

A

the most common symptoms - can take on several forms:

third person: talking about the individual who heads them. may be single or multiple voices. these are the most common type. the voices are often critical with treatment these voices may not go away, but they become quieter and contain more positive content

thought echo: the individual hears their thoughts spoken out loud, either simultaneously or just afterwards

second person: talking to the individual - can occur in many other mental disorders

NOTE: auditory hallucinations in which the person talks to the voice they hear are most commonly the result of TRUAMA or are fictitious

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19
Q

what are passivity experiences

A

the patient believes that their movements, emotions or will is being altered in a similar way to the thought issues, for example they believe their movements are also being controlled

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20
Q

what is incongruity of affect

A

the patient may burst out laughing or become very angry for no reason, or they may have inappropriate emotional responses

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21
Q

what is neologism

A

they may make up a new word, or hive an existing word a new meaning that is only apparent to the individual and does not make sense. they may keep repeating the word.

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22
Q

what is word salad

A

the form of the sentences makes no sense at all. the words are mixed up, in the wrong place

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23
Q

what is flight of thought

A

this is where the patient moves quickly form one idea to another, often half way through a sentence, with no apparent association between ideas

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24
Q

what is knights move thinking

A

patient moves from one idea to another with strange illogical associations between ideas

25
Q

what is pressure of speech

A

the patient speaks at a faster rate than normal

26
Q

what is catatonia

A

a state where the person may not respond to stimuli and inhibits strange physical behaviour. the state may involve a particular movement or posture that a patient often performs

27
Q

examples of catatonia

A

stupor
strange postures
negativism
automatic obedience
waxy flexibility

28
Q

what is stupor

A

the patient is unable to move or speak except for moving their eyes

29
Q

what is negativism

A

the patient does the exact opposite of what they are asked

30
Q

what is waxy flexibility

A

the patient has strange muscle tone that allows the doctor to put the patient into physical position that would otherwise be very difficult or painful

31
Q

what are Schneider’s first rank symptoms

A

these are a subclass of positive symptoms and include:
delusions - an unshakeable belief that is not in keeping with the persons social, cultural or educational background, for which there is no logical evidence basis

32
Q

what are primary delusions

A

these appear with no apparent precipitating event. the indivudal may enter a state of being perplexed for several days or months, and as the perplexity disappears, the delusion develops.

33
Q

what are persistent delusions

A

these arise with the period of perplexity. if other symptoms of schizophrenia are present, this can be a diagnosis for schixphrenai. if they are not, then it can be diagnostic for delusional disorder

34
Q

what are secondary delusions

A

these arise when other symptoms have been present fora period just before the delusion and arise from strange experiences the individual has as a result of their schizophrenia

35
Q

What is thought insertion

A

the patient believes somebody or something is planting thoughts into their mind. this happens against the persons will

36
Q

what is thought broadcast

A

the patient believes their thoughts are broadcast to others against their will

37
Q

what is thought withdrawal

A

the patient believes thoughts are being removed from their mind against their will and this leaves their mind blank

38
Q

what are negative symptoms

A

these are present in most patients. they tend to lead to reduced function and they are a very poor prognostic sign. a lack of stimulation makes the symptoms worse. they are often difficult to distinguish from symptoms of depression and you may only be able to do so by taking a fulll depression history

39
Q

what are the notable absences of a depression history in schizophrenia

A

weight change
sleep problems
guilt or low self worth
social withdrawal

40
Q

what is alogia

A

this is a general impoverished level of thinking usually seen in the form of poverty of speech - whereby the patient will give very short answers, and will not voluntarily give any input into a conversation. they are unable to elaborate on their thoughts. the patient feels as though their mind is empty

41
Q

what is poverty of content of thoughts

A

less extreme version of alogia - the patient is able to answer questions but their thought process is not properly utilised and they cannot explain their answers.

42
Q

what is blunting of affect

A

the person has a lack of emotion

43
Q

what is avolition

A

the patient has a general lack of interest in life, self care, social activites and motivation

44
Q

what criteria is used to diagnose schizophrenia

A

the DSM-V criteria

45
Q

diagnosis criteria for schizophrenia

A

two or more of the following, present for at least one month, for most days
- hallucinations
- delusions
- disorganised speech
- negative symptoms
- grossly disorganised and catatonic behaviour

at least one of the first three must be present, PLUS
- social or occupational dysfunction
- no evidence of other cause for psychosis
- not attributable to medicine

46
Q

what is seen on CT or MRI

A

increased size of lateral ventricles
reduced brain size in temporal lobes
negative symptoms - often correlated with reduced blood flow and other abnormalities in frontal cortex
reduced connections between brain area

47
Q

what is first line treatment in an acute attack

A

antipsychotics

48
Q

what are the first line recommend atypical antipsychotics

A

risperidone, olazapine, queitpaine , aripprazole

49
Q

if adherence is an issue, how should medication be given

A

IV every 2-4 weeks

50
Q

what are the main affects

A

sedation, weight gain and increased risk fo diabetes

51
Q

what are the typical antipsychotics

A

haloperidol and chlorpromazine

52
Q

what agents are affective at improving positive and negative spyomts

A

atypical agents

53
Q

what is second line treatment

A

clozapine which is atypical.

54
Q

why is clozapine not a first line

A

requires close monitoring as it has a tendency to cause aplastic anaemia which can be fatal.

55
Q

how affective is clozapine

A

30% effective in patients

56
Q

what is CPMS

A

the clozapine monitoring system. a national service in the UK, that gives advice on the drug dosage to use, depending on the blood test results you send to them. compulsory for anyone on clozapine. only consultant psychiatrists can prescribe clozapine

57
Q

what is the prognoses

A

20% make a full recovery with treatment
further 35% have long periods of remission
35% will have persistent mild positive and negative symptoms that can be managed in community
10% will have severe schizophrenia that is unresponsive to treatment, and these people will require institutionalised care
smalll number require forensic care due to high risk

58
Q

what is the lifetime suicide risk

A

2%

59
Q

what factors decrease the change of a positive outcome

A

delayed diagnosis and management
pre morbid factors
drug and alcohol abuse
features of the condition
current social and living situation

Semester 3 (94 decks)

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