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Charis & Ellie VS Psych > Schizophrenia > Flashcards

Schizophrenia Flashcards

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1
Q

What is schizophrenia?

A

Disorder that causes a broad range of perceptual, cognitive and behavioural disturbances

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2
Q

Who gets schizophrenia?

A
  • Can begin at any age but is rare after puberty
  • Peak age of onset is early twenties
  • Risk of schizo 50% increased by childhood infection (viral)
  • Drug use is a RF
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3
Q

ICD 10 uses what to classify symptoms of schizo?

A

First rank symptoms

  • Delusions
  • Auditory hallucinations
  • Thought interference
  • Passivity phenomena
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4
Q

Subtypes of schizophrenia?

A
  • Paranoid:
  • Catatonic:
  • Movement disorder predominates
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5
Q

Aetiology of shcizo?

A
  • No single cause identified
  • Daily cannabis use is RF
  • Some genetic factors
  • Dopamine XS is thought to explain positive symptoms
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6
Q

Examples of first rank symptoms?

A
  1. Thought insertion
  2. Delusions of control, influence or passivity, delusional perception
  3. Hallucinatory voices giving running commentary on the patient’s behaviour or discussing them
  4. Persistent delusions of other kinds that are culturally inappropriate and completely impossible
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7
Q

Summary of what first rank symptoms are?

A

Abnormalities in though possession, delusional perception, 3rd person auditory hallucinations, impossible delusions

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8
Q

Second rank symptoms?

A
  1. Persistent hallucinations in any modality, every day at least for a month when accompanied by delusions
  2. Neologisms, incoherent/irrelevant speech
  3. Catatonic behaviour eg waxy flexibility, negativism
  4. Negative symptoms eg marked apathy, poverty of speech, blunting, incongruent emotions
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9
Q

Summary of 2nd rank symptoms?

A

Any type of hallucination
Abnormalities of speech
Catatonic behaviour
Negative symptoms

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10
Q

Interpolations?

A

Insertion of something unrelated/different in the middle of the conversation

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11
Q

Excitation posturing?

A

Actively holding a posture against gravity

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12
Q

Positive symptoms?

A

Hallucinations
Delusions
Passivity phenomena
Disorder of thought form

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13
Q

Negative symptoms?

A 
Reduced amount of speech 
Reduced motivation/drive 
Reduced interest and pleasure 
Reduced social interaction 
Blunting of affect
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14
Q

Paranoid schizo?

A

80% of schizos

Characterized by first rank symptoms

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15
Q

Hebephrenic Schizophrenia?

A
  • Affective changes are prominent, delusions and hallucinations are fleeting and fragmentary
  • Behaviours is irresponsible and unpredictable
  • Mannerisms are common
  • Tend to gave shallow and inappropriate mood
  • Thoughts disorganized
  • Speech is incoherent
  • Social isolatey tendency + negative symptoms
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16
Q

Catatonic schizophrenia?

A
  • Movement disorder predominates
  • Alternating between stupor and hyperkinesis
  • Automatic obedience, posturing and waxy flexibility
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17
Q

General vibe of management of schizo?

A

Obtain best results with drug and social treatments

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18
Q

Antipsychotics in schizo?

A

-Used for reduction of symptoms and relapse prevention

-

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19
Q

What is schizo meant to be partially due to?

A

Firing of aberrant dopaminergic neurons

So theoretically if you block the receptors and reduce effect of firing, this will treat the symptoms

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20
Q

What are you trying to do with anti=psychotics?

A

Block 60-80% of dopamine

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21
Q

Examples of 1st generation anti-psychs?

A

Haloperidol

Chloropromazine

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22
Q

Examples of 2nd generation anti-sychotic?

A

Clozapines
Olanzapine
Quietiapine
Risperidone

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23
Q

1st generations generally cause more?

A

EPSE

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24
Q

second generation anti-psychs thought to be worse for

A

Weight gain
Central adiposity
T2DM

25
Q

What causes EPSE?

A

Disruption of substantia nigra

26
Q

EPSE examples

A

Acute dystonia
Tardive dyskinesia
Parkinsonism

27
Q

Torticollis?

A

Head tilted down

28
Q

Oculogyric crisis?

A

Prolonged upward gaze of eyes

29
Q

Acute dystonia?

A

Increasing muscle toe occurring in minutes from starting drug

30
Q

Tardive dyskinesia onset?

A

Comes on within weeks and lasts long time despite treatment

31
Q

Tardive dyskinesia presnetation?

A

Involuntary, repetitive oro-facial movement, blinking, grimacing, pouting, lip smacking

32
Q

Onset of parkinsonism?

A

Comes on within weeks to months

33
Q

Presentation of parkinsonism?

A

Parkinson’s disease with tremor
Rigidity
Bradykinesia
Gait disturbance

34
Q

Treatment of EPSE?

A
  • Treat side effects with anti-cholinergics which reduce ACh and balance system
  • IF very bad switch anti-psychotics
35
Q

Examples of anti-cholinergics?

A

Procyclidine
Trihexyphenidyl
Orphenadrine

36
Q

What is neuroleptic malignant syndrome?

A

Rare but important SE which is fatal

37
Q

Neuroleptic means?

A

Drug that depresses nerve function eg antipsychotics

38
Q

Symptoms of NMS?

A

Increasing muscle tone
Hyperthermia
Changing pulse

39
Q

What does Neuroleptic malignant syndrome cause?

A

Rhabdomyolysis which can caue AKI leading to coma and death

40
Q

Treatment of neuroleptic malignant syndrome?

A 
Stop antipsychotic 
Rapid cooling 
Renal support 
Skeletal muscle relaxants 
May need induced coma 
Dopamine agonists eg bromocriptine
41
Q

Antipsychotics do what to prolactin?

A

Increase in prolactin

42
Q

What is akathsia?

A

Feeling of inner restlessness which causes pacing, rocking from foot to foot an inability to stand still, poor sleep

43
Q

S1st line treatment of akathsia?

A

Usually propranolol

44
Q

2nd line treat,ent of akathsia?

A

Benzodiazepines -Clonazepam

45
Q

Other side effects of anti-psycotics?

A

ACH side effects
Action on 5HT receptor causes weight gain
Antiadrenergic side effects = postural hypotension
Hepatotoxicity
Prolonged QT interval
Photosensitivity

46
Q

Which works best out of all the anti-psychotics for schizophrenia?

A

Clozapine but causes significant side effects

47
Q

Significant SE of clozapine?

A

Agranulocytosis

-Needs very strict monitoring and is therefore not 1st line but used for resistance cases

48
Q

Usually start with what generation of anti-psychotics?

A

2nd generation

49
Q

Compliance issues solution?

A

Long acting depot medication

50
Q

Perisistent delusional disorder?

A

Systemized fixed delusions, don’t tend to have hallucinations

51
Q

Schizotypal disorder?

A

Under DSM this is classed as a personality disorder but under ICF it is classed as a type of psychosis

52
Q

Acute and transient psychotic disorder?

A

Schizophrenia symptoms lasting less than a month

53
Q

Induced delusional disorder?

A

Folie a deux and folie a plusiers a group of people share the same delusions

54
Q

Schizoaffective disorder?

A

Episodic disorder in which both affective and schizophrenic symptoms are present but the criteria for neither is met

55
Q

Neurodevelopmental changes in schizophrenia?

A

Enlarged ventricles, thinner cortices

Reduced frontal lobe volume, reduced frontal lobe grey matter and enlarged lateral ventricle volume

56
Q

Neurochemical changes in schizophrenia?

A

Altered dopamine signalling

57
Q

What can make symptoms of schizophrenia worse?

A

Amphetamine

58
Q

Indicators of poor prognosis in schizophrenia?

A 
Poor pre-morbid adjustment 
Insidious onset 
Early onset 
Long duration of untreated psychosis 
Cognitive impairment 
Enlarged ventricles
59
Q

Indicators of a good prognosis for schizophrenia?

A 
Shorter time of untreated psychosis 
Older age of onset 
Female gender 
Marked mood disturbance especially elation 
Fam history of mood disorder

Charis & Ellie VS Psych (23 decks)

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