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Y4 - Medicine - Psychiatry > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

CLINICAL FEATURES

Positive symptoms

A
  • Delusions
  • Hallucinations
  • Formal thought disorder
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2
Q

CLINICAL FEATURES

Delusions

A
  • Commonly persecutory, thought interference or passivity delusions
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3
Q

CLINICAL FEATURES

Hallucinations

A
  • Usually auditory commenting on subject or refering to them in third person
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4
Q

CLINICAL FEATURES

Formal thought disorders

A
  • Loss of normal flow of thinking usually shown in subjects speech or writing
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5
Q

CLINICAL FEATURES

Negative symptoms

A
  • Impairment or loss of volition, motivation and spontaneous behaviour
  • Loss of awareness of socially appropriate behaviour and social withdrawal
  • Flattening of mood, blunting of affect and anhedonia
  • Poverty of thought and speech
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6
Q

DIAGNOSTIC CRITERIA

A
  • At least one of
    • Thought echo, insertion, withdrawal or broadcasting
    • Delusions of control, influence or passivity
    • Hallucinatory voices giving running commentary
    • Persistent delusions of other kinds that are culturally inappropriate or implausible
  • Or two of
    • Persistent hallucinations in any modality
    • Breaks in train of thought causing incoherence or irrelevant speech
    • Catatonic behaviour
    • Negative symptoms

Duration of >= 1 month

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7
Q

Categories of schizophrenia

A
  • Paranoid schizophrenia
  • Hebephrenic schizophrenia
  • Catatonic schizophrenia
  • Undifferentiated schizophrenia
  • Post-schizophrenic depression
  • Residual schizophrenia
  • Simple schizophrenia
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8
Q

Paranoid schizophrenia - key symptoms

A
  • Delusions and hallucinations
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9
Q

Hebephrenic schizophrenia - key symptoms

A
  • Disorganised speech behaviour and flat affect
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10
Q

Catatonic schizophrenia - key symptoms

A
  • Psychomotor disturbance
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11
Q

Undifferentiated schizophrenia - key symptoms

A
  • Meeting general criteria but no specific symptom subtype predominates
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12
Q

Post-schizophrenic depression - key symptoms

A
  • Some residual symptoms, but depressive picture dominates
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13
Q

Residual schizophrenia - key symptoms

A
  • Previous positive symptoms less marked, prominent negative symptoms
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14
Q

Simple schizophrenia - key symptoms

A
  • No delusions or hallucinations - a defect state (negative symptoms)
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15
Q

DIFFERENTIALS

A
  • Substance induced psychotic disorder
  • Psychotic disorder due to general medical conditions
  • Mood disorders with psychotic features
  • Acute/transient psychotic disorder
  • Sleep related disorders
  • Delusional disorder
  • Dementia and delirium
  • Body dysmorphic disorder
  • Pervasive development disorder
  • OCD
  • Hypochondriasis
  • Paranoid personality disorder
  • Schizotypical personality disorder
  • Misidentification syndromes
  • Anxiety disorder
  • Factitious disorder
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16
Q

Examples of substance induced psychotic disorder

A
  • Alcohol
  • Stimulants
  • Hallucinogens
  • Steroids
  • Antihistamines
  • Sympathomimetic
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17
Q

AETIOLOGY

Hypothesis

A
  • Neurochemical abnormality hypothesis
  • Neurodevelopmental hypothesis
  • Disconnection hypothesis
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18
Q

AETIOLOGY

Neurochemical abnormality hypothesis

A
  • Dopaminergic overactivity
  • Glutaminergic hypoactivity
  • Serotonergic (5-HT) overactivity
  • a-adrenergic overactivity
  • GABA hypoactivity
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19
Q

AETIOLOGY

Disconnection hypothesis

A
  • Frontal-temporal/parietal connectivity may be final common pathway for the development of schizophrenia
20
Q

EPIDEMIOLOGY

Incidence (x/100000)

A

15/100,000

21
Q

EPIDEMIOLOGY

M:F

A

1:1

22
Q

EPIDEMIOLOGY

Prevalence - lifetime risk (x/100,000)

A

15-19/100,000

23
Q

PROGNOSIS

Reduction in life expectancy

A

20% reduction

24
Q

PROGNOSIS

Most common cause of death

A

Suicide (10-38% all deaths)

25
Q

AETIOLOGY

Genes

A
  • Neuregulin - NRG1
  • Dysbindin - DTNBP1
  • DISC1
  • Catecholamine O-methyl transferase (COMT)
26
Q

AETIOLOGY

Environmental factors

A
  • Complication of pregnancy, delivery and neonatal period
  • Delayed walking and neurodevelopmental difficulties
  • Early social services contact and distored childhood behaviour
  • Severe maternal malnutrition
  • Maternal influenza in pregnancy and winter births
  • Degree or urbanisation at birth
  • Use of cannabis
27
Q

CLINICAL FEATURES

Key features in systematic review

A
  • Neurological
    • Headache, head injury, abnormal mvements of mouth or tongue, diplopia, hearing or visual impairment, fits/faints, altered consciousness or memory problems, stroke, coordination problems, marked tremor or muscle stiffness
  • Resp
    • Dyspnoea, orthopnoea
  • CVS
    • Chest pain, palpitations
  • GI
    • Constipation, nausea, vomiting
  • Genitourinary
    • Urinary hesitancy, sexual problems
28
Q

CLINICAL FEATURES

Physical examination

A
  • Full neurological most important
    • Gait inspection, weakness/altered sensation, hand-eye coordination, cranial nerves
29
Q

INVESTIGATIONS

A
  • Blood tests
    • U&Es, LFT, calcium, glucose
  • Radiological
    • CT or MRI with neurological abnormality
    • CXR where examination suggests resp/CVS condition
  • Urine
    • Urinary drug screen
    • Microscopy and culture
  • EEG if seizure
  • 24 hour collection for cortisol if Cushings disease suggested
  • 24 hour catechlamine collection if phaeochromocytoma/carcinoid syndrome suggested
30
Q

MANAGEMENT

Issues affecting initial management decisions

A
  • Risk to themselves and others
  • Risk of violence
  • Insight
  • Hospital admission required
  • Urgent treatment required
  • Current social circumstances
31
Q

MANAGEMENT

Need for hospital admission

A
  • High risk suicide or homicide
  • Behaviour endangers relationships, reputation or assets
  • Severe psychotic, catatonic or depressive symptoms
  • Lack of capacity to cooperate with treatment
  • Lack of psychosocial supports
  • Failure of outpatient treatment
  • Non-compliance with treatment plan for patients detained under MHA
  • Need to address comorbidities
32
Q

MANAGEMENT

Treatment plan for acute psychosis

A
  • Emergency treatment of behaviour disturbance
  • Antipsychotic treatment
33
Q

MANAGEMENT

Acute - antipsychotic options

A
  • Option 1
    • Commence on atypical antipsychotic
    • Long acting BDZ to control anxiety/behaviour disturbance
  • Option 2
    • Low potency typical antipsychotic
    • Increase dose if needed over time
34
Q

MANAGEMENT

Example of low potency typical antipsychotic

A

Chlorpromazine

35
Q

MANAGEMENT

Choices of atypical antipsychotic for acute management

A
  • Olanzepine
  • Amisulpride
  • Risperidone
  • Quetiapine
36
Q

MANAGEMENT

Examples extra-pyramidal SE

A
  • Dystonias
  • Parkinsonism
  • Akathisia
37
Q

MANAGEMENT

Which class of antipsychotics are extra-pyramidal SE more common

A

Typical, less likely with atypical

38
Q

MANAGEMENT

Prescribe for extra-pyramidal SE

A

Procyclidine

39
Q

MANAGEMENT

Maintanence phase - general plan

A
  • With emergence of stability establish simplication of medicine regime and minimal effective dose
  • Minimise side effects
  • Rehabillitation
  • Possible need to manage depression
  • Address comorbid substance misuse
40
Q

MANAGEMENT

Discharge planning principles

A
  • Medication
  • Psychological - family therapy and psychoeducation reduce relapse
  • Social - social work and housing involvement, community psychiatric nurses
41
Q

PROGNOSIS

Poor prognostic factors

A
  • Poor premorbid adjustment
  • Insidious onset
  • Onset in childhood or adolescene
  • Cognitive impairment
  • Enlarged ventricles
42
Q

PROGNOSIS

Good prognostic factors

A
  • Marked mood disturbance, especially elation, during initial presentation
  • Family history of affective disorder
  • Female sex
  • Living in developing country
43
Q

MANAGEMENT

Acute psychosis first episode treatment algorithm

A
  • 1st - ensure safety patient and self
    • Adjunct oral benzodiazepine
    • Adjunct rapid tranquillisation
    • Plus referal to specialist to start antipsychotic
44
Q

MANAGEMENT

Acute psychosis relapse known schizophrenia algorithm

A
  • 1st - ensure safety of patient and self
    • Adjunct oral benzodiazepine
    • Adjunct rapid transquillisation
    • Plus refer to specialist for review of antipsychotic medication
45
Q

MANAGEMENT

Long term treatment algorithm

A
  • 1st - continue oral non-clozapine antipsychotic
    • Plus psychosocial intervention
    • Plus monitor physical health
  • 2nd - switch to alternative non-clozapine antipsychotic
    • Plus psychosocial intervention
    • Plus monitor physical health
  • 3rd - clozapine
    • Plus psychosocial intervention
    • Plus monitor physical health

Y4 - Medicine - Psychiatry (27 decks)

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