Psychosis Flashcards
Schizophrenia: prevalence
1%
more common in men
Schizophrenia: risk factors
FHx
Stressful life events
Childhood ACE
Migration
Cannabis use
Poverty
Living in inner city
Substance misuse
Schizophrenia: Stages
Prodromal stage (days-18mths)
- social withdrawal
- intermittent delusions/hallucinations
- problems with sleep, cognition, memory, communication and affect
Acute stage
- positive features + agitation/distress
Chronic stage
- +negative features
Schizophrenia: positive features
Delusions
Hallucinations (auditory/somatic)
Disorganised thoughts or speech
Catatonic behaviour - posturing, mutism
Schizophrenia: negative features
Avolition
Alogia
Anhedonia
Blunted affect
Schizophrenia: cognitive features
Memory loss
Social withdrawal + unable to understand social cues
Schizophrenia: Diagnostic criteria
ICD-11
2+ of following, for ≥1 months, not explained by substance abuse:
- PersistentDelusions
- Persistent Hallucinations
- Thought insertion/deletion/broadcasting
- Disorganised behaviour (bizarre)
- Thought disorder - knights move, tangential, word salad, neologisms
- Catatonic Behaviour
- Negative symptoms
Schizophrenia: Management (biopsychosocial)
Bio:
- Antipsychotics
-Physical health - diet, exercise, stop smoking
Psycho:
- Individual CBT
- Family CBT - 10 sessions, amelrioate effects of high-expressed emotion
- Concordance therapy - pt considers pros and cons of tx
Social:
- Psychoeducation - reduces relapse rate
- ?admission
- Housing, benefits, school support
- Skills
- Support for carers - their right to a carer’s assessment (via social services) + education + support programmes
- Early Intervention system can do all of BPS in one place
Schizophrenia: Prevention/Early Intervention
EIP Service
- aim to keep DUP <3months
- >14yrs
If urgent - use crisis resultion team or HTT
Schizophrenia: Which antipsychotics are used and how do they work?
First line: Second-generation antipsychotics - quietiapine, olanzapine, risperidone (depot) - D2R and 5HT2a antagonist
Second line: First-generation antipsychotics - chlorpromazine, haloperidol - D2R antagonist
Third line: Third-generation antipsychotics - aripiprazole - D2 partial agonist
Schizophrenia: What are the common side effects with FGA and how are they combatted?
EPSE
Parkinsonism - lower dose or switch to SGA
Dystonia - onset w/i hrs - IV benztropine (anticholinergic)
Tardive Dyskinesia - reduce/stop/switch
Akathisia - add propanolol
Schizophrenia: Common side effects of all antipsychotics
EPSE
Hyperprolactinaemia - galactorrhea, amenorrhoea, gynaecomastia, hypogonadism
Sexual fysfunction
Osteoporosis
Weight gain
Sedation
DM
Dyslipidaemia
Anticholinergic - dry mouth, blurry vision, constipation, urinary retention
Arrhythmias
Seizures
Neuroleptic malignant syndrome
Schizophrenia: What are the baseline measurements before starting an antipsychotic?
BW + waist circum.
BP + HR
FBG, HbA1c, lipids, PRL
Assessment of movement fdisorders
Assessment of nutrition, diet, exercise
ECG - for specific medication
Children - measure heigh every 6 months
Schizophrenia: What are the monitoring requirements for antipsychotics?
Response to TX and SE
Adherence
Movement disorders screening
Waist circum.
BW - weekly for 6wks, @ 12 wks, @ 1yr, every 1yr
BP + HR - @ 12wks, @ 1yr, every 1yr
Schizophrenia: How is treatment resistant Schizophrenia managed?
Clozapine
- tried 2+ AP, 1 which is atypical, for at least 6 weeks,
- risk of agranulocytosis (0.7%)
- need weekly blood test to detect neutropenia
if unresponsive –> augmentation with another AP
Schizophrenia: What side effects are more common with olanzapine
weight gain
DM
Schizophrenia: prognosis
1 in 5 will have NO further episodes in 5 years
5% suicide risk (lifetime)
15 years premature death
poor prognostic factors:
- longer duration of untreated psychosis
- earlier onset
- male
- negative symptoms
- FHx
- low SES
- substance abuse
- sudden onset
