Psychotic Disorders Flashcards
Schizophrenia
DSM
≥2 of the following in a 1-month period:
- delusions
- hallucinations
- disorganised speech
- grossly disorganised or catatonic behaviour
- negative symptoms (flat/blunt affect, marked apathy, lack of motivation, poverty of speech, thought blocking, social withdrawal)
Lowered level of functioning
Signs persist for at least 6 months, with ≥1 month of active symptoms
Schizophrenia
Causes
Genetic
Birth complications - trauma and foetal hypoxia
Children born in winter - maternal influenza
Psychosocial stress
Low SE class
Schizophrenia
Pathophysiology
Dopamine hyperactivity (positive symptoms)
Serotonin increase (hallucinations, positive and negative symptoms)
Decreased size of limbic system
Increased ventricular size
Neurodegenerative
Classic course of exacerbations and remissions
Schneiderian 1st Rank Symptoms - Schizophrenia
3 types of auditory hallucinations (third person, running commentary, thought echo)
3 types of thought disorder (thought insertion, thought withdrawal, thought broadcasting)
Passivity
Delusional perception
Schizophrenia
Clinical Presentation
+ symptoms: delusions, hallucinations, catatonia, formal thought disorder
- symptoms: social withdrawal, flattened mood, blunted affect, anhedonia, poverty of thought and speech
Blunt, flat, inappropriate or labile affect
Formal thought disorder
Poor judgement
Typical Antipsychotics
e.g. Chlorpromazine, haloperidol
Treat the positive symptoms by blocking D2 receptors in the mesolimbic area
A/E: EPSEs, elevated PRL, neuroleptic malignant syndrome, prolonged QT, arrhythmias
Do not use in Parkinson’s or Lewy Body Dementia
EPSEs
Acute dystonia (muscular spasms of the neck, eyes, tongue or jaw)
Akathesia (restlessness)
Parkinsonism (cogwheel rigidity, bradykinesia, resting tremor)
Tardive dyskinesia (later - involuntary asymmetrical movements of the muscles)
Use anticholinergics to treat EPSEs
Neuroleptic malignant syndrome
Fever Severe rigidity Elevated CKP level Increased pulse rate Sweating Altered conscious state
Atypical antipsychotics
E.g. olanzapine, paliperidone, seroquel, quetiapine, risperidone
Treatment of first-episode of psychosis
Treat negative and positive symptoms
A/E: fewer EPSEs, favourable compared to FGA, increased risk of CVD, metabolic side effects - diabetes, weight gain, etc.
Olanzapine S/E
Weight gain
Diabetes
Can also be used in depression due to 5HT activity
Seroquel S/E
Sedative
EPSE’s due to decrease in dopamine levels
Used in schizophrenia, bipolar, GAD and treatment-resistant MDD
Risperadone
Mixture of a typical and atypical
Causes EPSEs and increased PRL but also treats the negative symptoms
A/E: pain at injection site
Clozapine
Treatment resistant schizophrenia or recurring suicidal ideation only
Blocks serotonin 2B receptors, increasing dopamine activity in the prefrontal area
Helps with positive and negative symptoms
Does not cause EPSEs, NMS or increased PRL
A/E: neutropaenia, agranulocytosis, myocarditis, diabetes, weight gain, HTN, hepatitis, priaprism
CI: hx of granulocytosis/agranulocytosis, BM disorders, CNS depression, alcoholic/toxic states, severe renal/cardiac disease, severe hepatic disease, uncontrolled epilepsy, paralytic ileus
Schizophrenia
Management
Psychological and psychosocial therapies: psychoeducation, CBT, behavioural therapy
Anti-psychotics (SGA>FGA), depot antipsychotics
ECT
Schizophreniform
DSM
Episode lasting ≥1 month but <6 months ≥2 of the following, present for a significant portion of time during a 1/12 period: - delusions - hallucinations - disorganised speech - disorganised/catatonic behaviour - negative symptoms
Schizophreniform
Management
Antipsychotics (3-6 months)
Psychotherapy
ECT
Schizoaffective
DSM
Uninterrupted period of illness with a major mood episode concurrent with schizophrenic symptoms
Delusions or hallucinations for ≥2 weeks in the absence of a major mood episode
Mood symptoms are present for the majority of the total duration of the illness
Schizoaffective
Types
Depressive and bipolar types
Schizoaffective
Management
Antipsychotics
Antidepressants or mood stabilisers
Prophylaxis of mood component - lithium, psychological treatment (CBT), maintain physical health, work with family/carers
Mirtazapine
TCA
A/E: increased appetite, weight gain, sedation, agranulocytosis
Schizophrenia
Negative symptoms
Alogia (poverty of speech)
Avolition (lack of initiative/motivation)
Anhedonia (lack of pleasure from activities normally found enjoyable)
Affect flattening (lack of emotional reactivity)
Autochthonous delusion
Primary delusion that arises from the patients mind out of nowhere
Passivity phenomena
The belief that one is no longer in control of their own body
Chlorpromazine
Typical antipsychotic
A/E: increases sun sensitivity
