Schizophrenia Flashcards
What is schizophrenia?
It as a chronic condition which affects individual’s thinking, perception and affect
It tends to result in psychosis, which is characterised by an inability to distinguish delusions, hallucinations and disordered thinking from reality
What is schizoaffective disorder?
It is a condition in which individuals suffer from a combination of mild affective and schizophrenia features
What are the three neurochemical changes in schizophrenia?
There are increased dopamine levels in the mesocorticolimbic system, which are thought to produce the positive features of schizophrenia
There are decreased dopamine levels in the mesocortical tracts, which are thought to produce the negative features of schizophrenia
Due to the positive feedback systems interacting with dopamine, there are also associated decreased glutamate levels and increased serotonin levels
What are the six classifications of schizophrenia?
Paranoid Schizophrenia
Hebephrenic Schizophrenia
Simple Schizophrenia
Catatonic Schizophrenia
Undifferentiated Schizophrenia
Residual Schizophrenia
What is the most common classification of schizophrenia?
Paranoid Schizophrenia
What is paranoid schizoprehnia?
It is characterised by paranoid delusions and auditory hallucinations
What is hepephrenic schizophrenia?
It is characterised by mood changes, unpredictable behaviour, shallow affect and fragmentary hallucinations
Which patient group tend to be affected by hepephrenic schizophrenia?
Young Adults
What is simple schizophrenia?
It is characterised by negative clinical features, with no experience of positive clinical features
What is catatonic schizophrenia?
It is characterised by psychomotor clinical features, such as posturing, rigidity and stupor
What is undifferentiated schizophrenia?
It is characterised by clinical features that do not fit into one of the other categories of schizophrenia
What is residual schizophrenia?
It is characterised by negative clinical features, which occur when the positive clinical features have ‘burnt out’
What are the eight risk factors associated with schizophrenia?
Male Gender, 18 – 25 Years Old
Female Gender, 25 – 35 Years Old
Black Caribbean Ethnicity
Family History
Pregnancy Complications
Traumatic Life Events
Substance Misuse
Lower Socioeconomic Status
What is the strongest risk factor of schizophrenia?
Family History
What are the three genes associated with schizophrenia?
Neuregulin (chromosome 8p)
Dysbindin (chromosome 6p)
Di George Syndrome (chromosome 22q)
What are the four pregnancy complications associated with schizophrenia?
Malnutrition
Viral Infection
Pre-Eclampsia
Emergency C-Sections
What three traumatic life events are associated with schizophrenia?
Migration
Sexual Abuse
Physical Abuse
What are the four substance misuses are associated with schizophrenia?
Cannabis
Cocaine
Amphetamines
LSD
What main substance misuse is associated with schizophrenia?
Cannabis
What is another term for positive schizophrenia clinical features?
First rank features
What are the seven positive clinical features of schizophrenia?
3rd Person Auditory Hallucinations
Thought Echo
Thought Insertion
Thought Withdrawal
Thought Broadcasting
Delusional Perception
Passivity Phenomena
What are hallucinations?
They are when individuals hear, see, smell, taste or feel things that appear to be real but only exist in their mind
What are three characteristic features of auditory hallucinations in schizophrenia?
There are two or more voices discussing the patient in third person
There are voices commenting on the patient’s behaviour
There is thought echo
What is thought echo?
It is a form of auditory hallucination, in which the patient hears their thoughts spoken aloud
What is thought insertion?
It involves someone experiencing one’s own thoughts as someone else’s
What is thought withdrawal?
It involves someone experiencing one’s thoughts being removed from their mind by other people or forces outside oneself
What is thought broadcasting?
It is a condition that causes a person to believe that their thoughts can be heard or known by people around them
What are delusional perceptions?
It is when individuals abnormally percieve an object and then there is sudden, intense delusional insight into the objects meaning for the patient
For example - ‘The traffic light is green therefore I am the King’
What is passivity phenomena?
It is defined as the belief that an individual’s bodily sensations are being controlled by an external force
What are the six negative clinical features of schizophrenia?
Blunted Affect
Apathy
Anhedonia
Alogia
Avolition
Social Isolation
What is apathy?
It is defined as reduced emotional reaction
What is anhedonia?
It is defined as a lack of interest/enjoyment in activities
What is alogia?
It is defined as poverty of speech
What is avolition?
It is defined as a lack of motivation
What is a somatic clincial feature of schizophrenia?
Insomnia
What are the three investigations used to diagnose schizophrenia?
Blood Tests
Urine Culture
CT Scans
How are blood tests used to diagnose schizophrenia?
They are used to exclude organic causes of the patient’s presentation
What are the seven blood tests used to investigate schizophrenia?
Full Blood Count
Urea & Electrolytes
Liver Function Tests
Thyroid Function Tests
CRP Levels
Lipid Profile
Fasting Glucose
How is a urine culture used to diagnose schizophrenia?
It is used to exclude urinary tract infection, causing delirium, as the cause of the patient’s presentation
How are CT scans used to diagnose schizophrenia?
They are used to exclude an organic neurological cause, if the patient’s presentation is suggestive of this
What are the two diagnostic criteria for schizophrenia?
There should be the presence of a first rank feature for a period of at least one month
The clinical features are not attributable to other organic, or substance causes – dementia, delirium, epilepsy, drug intoxication
What are the three psychological management options for schizophrenia?
Psychoeducation
Cognitive Behaviour Therapy (CBT)
Family Intervention Therapy
What is psychoeducation?
It involves providing patients with information about schizophrenia and ways in which they can control and minimise it
What is CBT?
It is a talking therapy used to manage the way in which patients think, feel and behave
When is CBT used to manage schizophrenia?
It is recommended in all cases of schizophrenia
What is family intervention therapy?
It is a talking therapy used to improve the family’s knowledge of schizophrenia and its management
What are the two pharmacological management options used in schizophrenia?
Atypical Antipsychotics
Typical Antipsychotics
When are atypical antipsychotics used to manage schizophrenia?
They are the first line pharmacological management option
Name six atypical antipsychotics used to manage schizophrenia
Olanzapine
Risperidone
Clozapine
Amisulpride
Quetiapine
Aripiprazole
What is the mechanism of action of atypical antipsychotics?
They selectively inhibit dopamine and serotonin receptors
When are typical antipsychotics used to manage schizophrenia?
They are the second line pharmacological management option
Name three typical antipsychotics used to manage schizophrenia
Haloperidol
Chlorpromazine
Flupentixol
What is the mechanism of action of typical antipsychotics?
They generally inhibit dopamine receptors
What advice should schizophrenia patients recieve about driving?
They should notify the DVLA
They should not drive untile stable and well for a period of three months
They should obtain a psychiatry report which confirms driving eligibility following this period
What are the five poor prognostic factors of schizophrenia?
Strong Family History
Gradual Onset
Low IQ
Prodromal Phase of Social Withdrawal
Lack of Obvious Precipitant
