Psychosis - 2 Flashcards
Sleep changes in schizophrenia?
short REM latency
Recuded Slow wave sleep
male to female ration schizo
1:1
international annual prevalence of schizophrenia
0.33%
annual prevalence of psychotic disorders in the UK
.4%
the incidence of schizophrenia internationally
.20/1000/year
what increases risk of psychosis in an individual?
-Person distressed
-Decline in social functioning
in addition to
transient or attenuated psychotic symptoms OR
Family history of psychosis OR
Behaviours suggestive of psychosis
what is 1st line of treatment in acute psychosis?
antipsychotics (1st or 2nd gen)
CBT w/ or w/out family intervention
what assessments to be done before Rx in acute psychosis?
- Weight
- Waist circumstance
- Pulse and blood pressure
- FBG, HbA1c, Lipid profile and Prolactine
-Assess any movement disorder
-Assess any nutritional status
when do we assess ECG too before Rx of acute psychosis?
IF required by medication’s SPC
IF there is a cardiovascular risk
IF a patient is being admitted
is loading dose recommended in acute psychosis?
no?
how long antipsychotic trial takes in acute psychosis?
4-6 weeks
what should you tell patient if you initiate chlorpromazine?
it may cause photosensitivity
so patient might need to apply sun screen
when can you offer clozapine?
if patient did not responded well to adequest dose of two antipsychotic (one at least non-clozapine)
how long Rx should last?
- 1-2 years following initiation or there is resk of relapse
what are options for smoking cessation in acute psychotics?
-Nicotine replacement therapy
-Bupropion
-Varenicline
what non-pharma approach can reduce psychotic symptoms?
CBT
TMS
Family and patient psychoeducation
Social skill training
Early intervention
enumerate negative sympomts one more time?
social withdrawal
apathy
lack of energy
alogia
flattening of affect
anhedonia
which antipsychotic has most robust support for effectiveness with primary negative symptoms?
Amisulpride
low or high social class a risk for schizophrenia?
low
what hypotheses have tried to explain relation between low social class and schizophrenia?
- Environmental exposure higher in low class (workplace conditions, nutrition..)
- Selection drift hypothesis = inability to compete for good jobs etc.
Learning disability and schizophrenia?
LD has 3 times more risk than public
is there any racial difference for schizophrenia prevalence?
no?
what did AESOP study found about ethnic difference in schizophrenia prevalence?
African-Caribbean population has high rates
male : female ratio for schizophrenia
maybe female more
TRUE or False
Male with schizophrenia are more likely to get married.
FALSE
Females are.
Risk of developing schizophrenia in public
1%
Risk of developing schizophrenia in first cousin
2%
Risk of developing schizophrenia in grandchildren
5%
Risk of developing schizophrenia in parents
6%
Risk of developing schizophrenia in siblings
9%
Risk of developing schizophrenia in children
13%
Risk of developing schizophrenia in fraternal twin
17%
Risk of developing schizophrenia in identical twin?
48%
relation between winter and schizophrenia?
born in winter is 5-15% more chance of schizophrenia
urban or rural increase risk of schizophrenia?
Urban
do obstetric complication increase risk of schizophrenia?
yes
relative risk for developing schizophrenia in first generation migrants
2.7
relative risk for developing schizophrenia in 1st and 2nd generation of migrants combined?
2.9
relative risk for developing schizophrenia in immigrant from developing countries
3.3
relative risk for developing schizophrenia in immigrant from countries with majory black vs non whites
4.8
what risk factors have good evidence for schizophrenia?
- Prenatal nutritional deprivation
-Prenatal brain injury
-Prenatal influenza
Protective factors for schizophrenia?
Positive rearing experience
Antipsychotic medication
Education about relapse prevention
factors associated with negative outcomes
- Longer untreated duration
- Early & insidious onset
- Male
- Prom. negative symptoms
- Family Hx
- Low IQ, socioeconomic or social status
- Sign. Pscy. hx
-Continued substance misuse
how many year earlier patients with schizophrenia die?
10-20 years
common cause of premature death in patients with schizphrenia?
suicide
accident
pneumonia
cardiovascular disease
how many fold suicide is increased in schizophrenia?
9 folds
how many folds pneumonia risk is increased in schizophrnia
7 folds
does clozapine & antipsychotics in general reduce mortality rate in schizophrenia?
yes
