Schizophrenia Flashcards
Ideas of reference
Psychotic symptom
Misinterpretation of aspects of the external enviromnent as having particular significance for the individual
ex, thinking that the TV or radio is talking to you specifically
If someone is too paranoid to leave the houes to acquired food to eat, . . .
. . . they are a danger to themself and need to be hospitalized
Diagnostic criteria for schizophrenia
- Lasts at least 6 months
- Includes at least 1 month of active phase symptoms with 2 or more of the following:
- Delusions
- Hallucinations
- Disorganized speech or thought
- Disorganized or catatonic behavior
- Negative symptoms
- There must be social/occupational dysfunction associated with symptoms
- Not due to a substance, other medical condition, schizoaffective disorder, or mood disorder with psychotic features
Risk factors for suicide in schizophrenia
- High premorbid functioning
- Depressive symptoms
- Substance abuse
- Unemployment
- Recent psychotic episode or hospital discharge
- Younger age
- Male gender
% of individuals with schizophrenia who will attempt suicide
20%
It is very imporant to screen for suicidal ideation/intent/plan
“3 steps” to approaching psychiatric disorders
- Rule out other substance- or medication-induced diorders
- Rule out identifiable medical disorders (endocrinopathies, neurologic disorders, metabolic disorders)
- Characterize the psychiatric disorder
Timeline of symptoms in relation to diagnosis of psychotic disorder
- 1 day - 1 month: Brief psychotic disorder
- 1 month - 6 months: Schizophreniform disorder
- >6 months: Schizophrenia
2nd generation antipsychotics with the most vs least metabolic side effects
Most: Clozapine, olanzapine
Least: Ziprasidone, aripiprazole
Single most effective antipsychotic in treating schizophrenia
Clozapine
It has also been shown to be the best for reducing suicide risk.
However, the risk of agranulocytosis prevents it from being first-line
Treatment of NMS
- Immediately discontinue the offensive medicaton
- IV hydration to protect kidneys from myoglobin
- Either bromocriptine or dantrolene
Smoking and psychosis
Smoking induces cytochrome p450 enzymes which increase the rate of breakdown of some antipsychotics, most notably clozapine
Unfortunately, nicotine is also the most common drug of abuse among schizophrenic patients
Increased smoking may lead to reduction in antipsychotic effective dosage, thus precipitating a psychotic episode in patients on pharmacotherapy.
Escalating of antipsychotic therapy
If a patient fails a therapeutic trial of an antipsychotic, there is no evidence that switching antipsychotics or addint another antipsychotic will lead to benefit.
Antipsychotics also have a defined therapeutic level, so increaseing the dose is not an option.
Instead, adding ECT in addition to antipsychotic therapy is the best option.
Psychosis in patients with schizotypal personality disorder
These patients will only appear psychotic for brief periods of time under stress, and will have subthreshold symptoms that are more akin to persistent personality features than frank psychosis
DDx for catatonia
While catatonia has historically been associated with schizophrenia, the DDx includes several medical conditions and mood disorders
Hallucinations vs hallucinosis
Hallucination: Experiencing nonexistent perceptual stimuli with lack of clinical insight
Hallucinosis: Experiencing nonexistent perceptual stimuli with intact clinical insight
