Revision - Schizophrenia Flashcards
What is the % of risk of schizophrenia with one affected parent or sibling
10%
What is the % of risk of schizophrenia if both parents affected or identical twin is affected?
50%
What are the 6 subtypes of schizhophrenia?
1) paranoid
2) hebephrenic
3) catatonic
4) simple
5) residual
6) undifferentiated
What 2 features characterise PARANOID schizophrenia?
1) Paranoid delusions
2) Auditory hallucinations
What type of schizophrenia is typically diagnosed in adolescents/younger adults?
Hebephrenic
Why is the outlook for hebephrenic schizophrenia poor?
As negative symptoms develop rapidly
What 4 characteristics are seen in hebephrenic schizophrenia?
- Mood changes
- Fragmentary hallcuinations
- Shallow affect
- Unpredictable behaviour
What 3 §psychomotor features are seen in catatonic schizophrenia?
1) posturing
2) rigidity
3) stupor
What is posturing?
when a person holds a specific position, which would often be uncomfortable to people who aren’t experiencing catatonia
What is stupor?
a state close to unconsciousness
What is undifferentiated schizophrenia?
When patients’ symptoms do not fit neatly into one of the other categories
What is residual schizophrenia?
The individual has suffered an episode of schizophrenia but there are no longer any delusions, hallucinations, disorganized speech or behavior
- Characterised by negative symptoms
- Positive symptoms have ‘burnt out’
What type of schizophrenia is characterised by negative symptoms and patients have never experienced positive symptoms?
Simple
What is delusional perception?
A true perception to which an individual attributes a false meaning.
What are Schneider’s first-rank symptoms?
(6)
1) Thought insertion or withdrawal
2) Thought echo
3) Thought broadcasting
4) Delusional perception
5) Passivity/somatic passivity
6) 3rd person auditory hallucinations
What are negative symptoms in schizophrenia? Give examples
1) Blunted affect (affect is a person’s expression of their emotional state)
2) Apathy
3) Social isolation / anhedonia (lack of interest/enjoyment from life’s experiences)
4) Poverty of speech (alogia)
5) Poor self-care
6) Avolition (severe lack of motivation/inability to complete purposeful tasks)
How long must symptoms be present for before diagnosis of schizophrenia?
Requires a first rank symptom or persistent delusion to be present for at least one month AND no other cause for psychosis (e.g. drug intoxication).
What class of drug is used in schizophrenia?
D2 (dopamine) receptor antagonists
Give 3 examples of ‘typical’ antipsychotics
1) haloperidol
2) chlorpromazine
3) flupentixol decanoate (depot injection)
Give 5 key side effects of typical antipsychotics
1) EPSEs
2) Raised prolactin
3) Metabolic
4) Anticholinergic
5) Neurological
What extrapyramidal side effects are seen with ‘typical’ D2 receptor antagonist use?
1) parkinsonism
2) akathisia
3) dystonia
4) tardive dyskinesia
What can hyperprolactinaemia due to ‘typical’ D2 receptor antagonist use cause?
Sexual dysfunction, risk of osteoporosis, amenorrhoea in women, galactorrhoea, gynaecomastia and hypogonadism in men
What are the neurological side effects of ‘typical’ D2 receptor antagonist use?
1) seizures
2) NMS
Give some examples of ‘atypical’ D2 receptor antagonists
(6)
1) Olanzapine
2) Risperidone (depot)
3) Clozapine
4) Quetiapine
5) Aripiprazole
6) Amisulpride
Which antipsychotic is less likely to cause EPSEs than others? Why?
Aripiprazole - a partial dopamine agonist and so is less likely to cause EPSEs than others
What 2 side effects are less common with atypical antipsychotics compared to typical?
1) EPSEs
2) Hyperprolactinaemia
Difference between an illusion and a hallucination?
An illusion is based on a real sensory stimulus that is interpreted incorrectly whereas a hallucination is created by the mind without any stimulus
What are the 3 types of illusions?
1) Affect
2) Completion
3) Pareidolia
What is a ‘pareidolia’ illusion?
Seeing shapes in inanimate objects (e.g. faces in clouds)
What is a ‘completion’ illusion?
The mind completes partial images (e.g. triangles optical illusion)
what is an ‘affect’ illusion?
Based on current affect (e.g. see a monster in the cupboard when scared)
What are the 3 clusters of psychotic symptoms?
1) hallucinations
2) delusions
3) thought disorder
What 4 neural pathways can dopamine be implicated in in schizophrenia?
1) Mesolimbic
2) Nigrostriatal
3) Tuberoinfundibular
4) Mesocortical
Positive symptoms of schizophrenia are due to increased dopamine activity in which neural pathway?
Mesolimbic
Stopping an antipsychotic within 6 months increases risk of relapse by how much in schizophrenia?
4x
What is acute psychotic disorder?
Psychotic symptoms last <28 days
What is schizoaffective disorder?
Psychotic and affective symptoms are simultaneously present and equally prominent
What is delusional disorder?
Delusional disorder is a type of psychotic disorder. Its main symptom is the presence of one or more delusions.
Are hallucinations present in delusional disorder?
No, or are only fleeting
Examples of delusional disorders:
(7)
1) Othello syndrome
2) Folie a deux
3) Cotards syndrome
4) Capgras syndrome
5) Fregoli’s syndrome
6) De Clerambault’s syndrome
7) Ekbom’s syndrome
What delusional disorder involves the belief that someone from a higher social standing is in love with them and sends them secret messages to convey their love?
De Clerambault’s aka erotomania
What is Fregoli’s syndrome?
They believe multiple people are actually one individual in disguise who is persecuting them
What delusional disorder involves the belief that a relative has been replaced by an imposter?
Capgras syndrome
Prior to commencing antipsychotics, investigations need to be completed.
What observations need to be completed? Why?
1) BP & BMI –> metabolic side effects
2) ECG –> some can cause QT prolongation
What neural pathway is the intended site of action of antipsychotics?
Mesolimbic
In which neural pathway does dopamine antagonism cause elevated prolactin?
Tuberoinfundibular
In which neural pathway does dopamine antagonism cause EPSEs?
Nigrostriatal
Give 3 examples of ACUTE extra-pyramidal side effects (EPSEs) from antipsychotics
1) Parkinsonism
2) Acute dystonia
3) Akathisia
Give an example of a CHRONIC EPSE from antipsychotics
Tardive dyskinesia
What class of drug is acute dystonia as a result of antipsychotics managed with?
Anticholinergics e.g. procyclidine
What class of drug is parkinsonism as a result of antipsychotics managed with?
An§ticholinergics
What is akathisia as a result of antipsychotics managed with?
Sedatives or medication change
What is tardive dyskinesia?
Tardive dyskinesia (TD) is a condition where your face, body or both make sudden, irregular movements which you cannot control.
I.e. choreoathetoid movements
How do anticholinergics affect tardive dyskinesia as a result of antipsychotics?
Make it WORSE
What is the recurrence rate of postnatal psychosis?
25-50%
What treatment is recommended for ALL people with schizophrenia?
CBT
