Case 8 - Schizophrenia Flashcards
what is under the classification of schizophrenia
the serious brain disorders that are neither organic brain disorders or severe mood disorders
how many people in the population will have a schizophrenia diagnosis at some point in their life
1%
200 per 100000
20 per 100000 - incidence
what is the downward social drift
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
when is the peak incidence in men and women
18-25 in men
25-30 in women
equal incidence in men and woman
what are the tendencies of a child who develops schizophrenia in later life
withdrawn, eccentric, clumsy
what is the prodromal period
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
what does a long prodromal period mean
that the diagnosis is delayed and these situations is when the prognosis is poor
what is the general risk
1%
what is the risk if sibling has the condition
9%
what is the risk if parent has the condition
13%
what is the risk if both parents have condition
45%
what have studies shown about women and their children when mother has schizophrenia
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
what do obstetric complications show
found an increased incidence in those who go onto develop the condition. this suggests that some kind of developmental abnormality may be present
what kind of people may have increased likelihood of developing schizophrenia
people with sensitive personalities. some people have a tendency to perceive criticism harshly and to interpret non-critical comments as criticism
what are predisposing factors
periods of increased stress
periods of intense emotion
increased levels of criticism from friends and family
drugs
what are the symptoms divided into
positive symptoms
negative symptoms
cognitive symptoms
mood disturbance
what are the positive symptoms
delusions
hallucinations
thought disorder
disorganised speech and behaviour
what are auditory hallucinations
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
what are passivity experiences
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
what is incongruity of affect
the patient may burst out laughing or become very angry for no reason, or they may have inappropriate emotional responses
what is neologism
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.
what is word salad
the form of the sentences makes no sense at all. the words are mixed up, in the wrong place
what is flight of thought
this is where the patient moves quickly form one idea to another, often half way through a sentence, with no apparent association between ideas
what is knights move thinking
patient moves from one idea to another with strange illogical associations between ideas
what is pressure of speech
the patient speaks at a faster rate than normal
what is catatonia
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
examples of catatonia
stupor
strange postures
negativism
automatic obedience
waxy flexibility
what is stupor
the patient is unable to move or speak except for moving their eyes
what is negativism
the patient does the exact opposite of what they are asked
what is waxy flexibility
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
what are Schneider’s first rank symptoms
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
what are primary delusions
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.
what are persistent delusions
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
what are secondary delusions
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
What is thought insertion
the patient believes somebody or something is planting thoughts into their mind. this happens against the persons will
what is thought broadcast
the patient believes their thoughts are broadcast to others against their will
what is thought withdrawal
the patient believes thoughts are being removed from their mind against their will and this leaves their mind blank
what are negative symptoms
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
what are the notable absences of a depression history in schizophrenia
weight change
sleep problems
guilt or low self worth
social withdrawal
what is alogia
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
what is poverty of content of thoughts
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.
what is blunting of affect
the person has a lack of emotion
what is avolition
the patient has a general lack of interest in life, self care, social activites and motivation
what criteria is used to diagnose schizophrenia
the DSM-V criteria
diagnosis criteria for schizophrenia
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
what is seen on CT or MRI
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
what is first line treatment in an acute attack
antipsychotics
what are the first line recommend atypical antipsychotics
risperidone, olazapine, queitpaine , aripprazole
if adherence is an issue, how should medication be given
IV every 2-4 weeks
what are the main affects
sedation, weight gain and increased risk fo diabetes
what are the typical antipsychotics
haloperidol and chlorpromazine
what agents are affective at improving positive and negative spyomts
atypical agents
what is second line treatment
clozapine which is atypical.
why is clozapine not a first line
requires close monitoring as it has a tendency to cause aplastic anaemia which can be fatal.
how affective is clozapine
30% effective in patients
what is CPMS
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
what is the prognoses
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
what is the lifetime suicide risk
2%
what factors decrease the change of a positive outcome
delayed diagnosis and management
pre morbid factors
drug and alcohol abuse
features of the condition
current social and living situation
