Schizophrenia Flashcards
What is schizophrenia?
A long-term mental disorder of a type involving a breakdown in the relation between thought, emotion, and behaviour, leading to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation.
What are the symptoms of schizophrenia?
Symptoms of schizophrenia include hearing voices or seeing things that are not real, unusual beliefs and confused thinking.
Symptoms can be classified as positive and negative.
Positive symptoms are distressing:
Delusions.
Hallucinations.
Interference with thinking.
Lack of insight into illness.
Negative symptoms poor response to medication:
Apathy.
Slowness.
Social withdrawal.
How prevalent is schizophrenia?
Psychosis and Schizophrenia are relatively uncommon with a prevalence of 1%.
Age group approx. 18-30.
Cared for in the community.
What are the consequences of schizophrenia?
Chronicity - 20% of patients fully recover after first episode - 80% never recover / partly recover.
Suicide - 10% risk.
Type 2 diabetes predisposition - people with Schizophrenia are 2-4 times more likely to develop.
Prevalence 15-18% of diabetes in patients with this condition.
Can one set of symptoms occur without the other?
Despite the simplistic differentiation both positive and negative symptoms may commonly occur in the same patient with one or another predominating?
How do you treat schizophrenia?
Physiological therapy - CBT, family.
Pharmacological therapy - antipsychotics.
How do antipsychotics work?
Antipsychotics are thought to work by altering the effect of certain chemicals in the brain, called dopamine, serotonin, noradrenaline and acetylcholine.
These chemicals have the effect of changing your behaviour, mood and emotions.
Dopamine is the main chemical that these medicines have an effect on.
What is the mesolimbic pathway?
A major dopamine pathway that begins in the ventral tegmental area and connects the nucleus accumbens, amygdala, hippocampus, and prefrontal cortex.
The mesolimbic pathway is thought to be especially important to mediating pleasure and rewarding experiences.
Hyperactivity: positive symptoms.
What is the mesocortical pathway?
The mesocortical pathway projects from the ventral tegmental area to the prefrontal cortex (VTA → Prefrontal cortex).
This pathway is involved in cognition and the regulation of executive functions (e.g., attention, working memory, inhibitory control, planning, etc.).
Hypoactivity: negative and cognitive.
What do typical antipsychotics do?
Block D2 receptors but also block in the nigostrigal pathway leading to extrapyramidal side effects.
What are some examples of atypical antipsychotics?
Sulpiride Amisulpiride Clozapine Risperidone Olanzapine Quetiapine Aripiprazole
What is clozapine?
Used when treatment with two or more antipsychotics (including an atypical) unsuccessful.
Can cause agranulocytosis so needs regular wbc monitoring.
Monitoring frequency increased if patients get a red result (dip in wbc or at risk of agranulocytosis).
Extra monitoring if patients develop infection.
What are some other issues with clozapine?
Weight gain.
Constipation.
Can cause drooling.
Be careful when stopping smoking.
What are EPSEs?
EPSE is an umbrella term used to describe a wide. variety of movement disorders.
Examples:
Akathisia.
Acute dystonia.
Pseudo parkinsonism.
Tardive dyskinesia.
What is akathisia?
Akathisia is a movement disorder that makes it hard for you to stay still.
