Schizophrenia Flashcards
Define schizophrenia.
Psychotic disorder in absence of organic diseas,e substance abuse or withdrawal. Not secondary to mood changes.
What are the ICD-10 schizophrenia subgroups?
Paranoid
Hebphrenic
Catatonic
Simple
Residual
How is paranoid schizophrenia characterised?
Characterised by persecutory/grandiose delusions
Derogatory auditory hallucinations
How is hebephrenic schizophrenia characterised?
Disorganisation syndrome:
- Formal thought disorder
- Affective flattening/incongruity
- Bizarre behaviour
How is catatonic schizophrenia categorised?
Multiple motor, volitional and behavioural disorders
Stupor and excitement
How is simple schizophrenia categorised?
Insidious but progressive impoverishment of mental life
Without development of florid symptoms
What is the aetiology of schizophrenia?
Genetic basis: Twin studies and 10% risk with 1st degree relative.
Hypoxic brain injury at birth higher chance
Cannabis use theory: Neurochemical theories of excess/low D2 in different brain areas.
Schizophrenic symptoms more common in those with Huntington’s and temporal epilepsy.
Summarise the epidemiology of schizophrenia.
1% prevalence. Onset in 20-30s.
What is the natural history of schizophrenia?
Minimum of 1 month of symptoms including:
Minimum of 1 of:
- Thought echo/insertion/withdrawal broadcast
- Delusions of control
- Running commentary or voices in patient speaking within themselves
- Persistent delusions
OR Minimum 2 of:
- Persistent hallucinations in any modality
- Thought disorder
- Catatonic behaviour
- Negative symptoms
What are the positive signs and symptoms of schizophrenia?
Appearance: Normal or inappropriate dress
Behaviour: Withdrawn or restless and noisy
Mood: Incongruent, guarded
Speech: Reflects underlying thought disorder
Thought: Formal disorder, derailment, loosen associations, thought blocking, thought alienation, withdrawal/broadcasting
Delusions: Persecutory etc.
Perception: Third person hallucinations, running commentary
Cognition: normal orientation, impaired attention
Insight: Poor
What are the negative signs and symptoms of schizophrenia?
Appearance: Poor self care/unkempt
Behaviour: Tardive dyskinesias/poor eye contact/apathy
Mood: Flattened and blunted
Speech: Poor speech
Thought: May be formal thought disorder, may be persistent delusions
Perceptions: May have persistent auditory hallucinations
Cognition: Specific cognitive defects
What are two grouping systems which can be used to categorise the symptoms of schizophrenia?
Schneider’s first rank symptoms
Bleuer’s 4As
What are Schneider’s first rank symptoms?
Auditory hallucinations (3 person, running commentary, hearing thoughts spoken aloud)
Passive phenomena (somatic passivity, actions influenced by others, thought withdrawal, thought insertion, thought broadcast)
Delusional perception
What are Bleuer’s 4As?
Autistic thought: Inner world of fantasy
Affective incongruity: e.g. Smiling when describing sad event
Associations loosened: Thought disorder
Ambivalence: Conflicting feelings
What are investigations for schizophrenia?
Exclude organic cause: Frontal space occupying lesion, FBCs, TFTs, glucose, LFTs, Ca2+, B12/folate, VDRL)
?CT
What is the management for schizophrenia?
Risk assess: Suicide risk very high. Risk to others and self neglect.
Consider need for hospital treatment with or without multi-health systems. Involve family, carers, GP, community. Depot given if compliance is a problem.
Antipsychotics mainstay of treatment. Choice depends on side effect profile. Clozapine if heavy resistance.
CBT for persisting delusions and hallucinations. Social rehabilitation etc.
What are complications associated with schizophrenia? What is the prognosis of schizophrenia?
10% chronic course, 20% only one episode, 35% functional impairment, 35% increase impairment over episodes, 15% risk of suicide.
Good prognostic factors: Old, female, married, no FHx, no other comorbidities, high IQ, positive symptoms, precipitants clear, treatment compliance, low expressed emotion, presence of mood component, acute onset.
What is schizoaffective disorder?
Overlap syndrome with bipolar and schizophrenic disorder. Patient must satisfy criteria both for bipolar AND schizophrenic disorder at the same time, but where psychosis is not secondary to mood disturbance.
First degree relative of patients with schizoaffective disorder have significantly higher risk of both.
Treat symptoms as for schizophrenia (i.e. mood symptoms improve with psychotic tx). Prognosis better than schizophrenia alone but worse than bipolar alone.
What is delusional disorder?
Delusional idea without persistent hallucinations and not fitting criteria or diagnosis of schizophrenia.
Most common persecutory, grandiose, hypochondriacal and jealous. Age of onset same as schizophrenia, usually >40y.
More common in those with hearing impairment. Tx with antipsychorics, prognosis poor.
