Schizophrenia Flashcards
What is schizophrenia?
Disorder that causes a broad range of perceptual, cognitive and behavioural disturbances
Who gets schizophrenia?
- 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
ICD 10 uses what to classify symptoms of schizo?
First rank symptoms
- Delusions
- Auditory hallucinations
- Thought interference
- Passivity phenomena
Subtypes of schizophrenia?
- Paranoid:
- Catatonic:
- Movement disorder predominates
Aetiology of shcizo?
- No single cause identified
- Daily cannabis use is RF
- Some genetic factors
- Dopamine XS is thought to explain positive symptoms
Examples of first rank symptoms?
- Thought insertion
- Delusions of control, influence or passivity, delusional perception
- Hallucinatory voices giving running commentary on the patient’s behaviour or discussing them
- Persistent delusions of other kinds that are culturally inappropriate and completely impossible
Summary of what first rank symptoms are?
Abnormalities in though possession, delusional perception, 3rd person auditory hallucinations, impossible delusions
Second rank symptoms?
- Persistent hallucinations in any modality, every day at least for a month when accompanied by delusions
- Neologisms, incoherent/irrelevant speech
- Catatonic behaviour eg waxy flexibility, negativism
- Negative symptoms eg marked apathy, poverty of speech, blunting, incongruent emotions
Summary of 2nd rank symptoms?
Any type of hallucination
Abnormalities of speech
Catatonic behaviour
Negative symptoms
Interpolations?
Insertion of something unrelated/different in the middle of the conversation
Excitation posturing?
Actively holding a posture against gravity
Positive symptoms?
Hallucinations
Delusions
Passivity phenomena
Disorder of thought form
Negative symptoms?
Reduced amount of speech Reduced motivation/drive Reduced interest and pleasure Reduced social interaction Blunting of affect
Paranoid schizo?
80% of schizos
Characterized by first rank symptoms
Hebephrenic Schizophrenia?
- 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
Catatonic schizophrenia?
- Movement disorder predominates
- Alternating between stupor and hyperkinesis
- Automatic obedience, posturing and waxy flexibility
General vibe of management of schizo?
Obtain best results with drug and social treatments
Antipsychotics in schizo?
-Used for reduction of symptoms and relapse prevention
-
What is schizo meant to be partially due to?
Firing of aberrant dopaminergic neurons
So theoretically if you block the receptors and reduce effect of firing, this will treat the symptoms
What are you trying to do with anti=psychotics?
Block 60-80% of dopamine
Examples of 1st generation anti-psychs?
Haloperidol
Chloropromazine
Examples of 2nd generation anti-sychotic?
Clozapines
Olanzapine
Quietiapine
Risperidone
1st generations generally cause more?
EPSE
second generation anti-psychs thought to be worse for
Weight gain
Central adiposity
T2DM
What causes EPSE?
Disruption of substantia nigra
EPSE examples
Acute dystonia
Tardive dyskinesia
Parkinsonism
Torticollis?
Head tilted down
Oculogyric crisis?
Prolonged upward gaze of eyes
Acute dystonia?
Increasing muscle toe occurring in minutes from starting drug
Tardive dyskinesia onset?
Comes on within weeks and lasts long time despite treatment
Tardive dyskinesia presnetation?
Involuntary, repetitive oro-facial movement, blinking, grimacing, pouting, lip smacking
Onset of parkinsonism?
Comes on within weeks to months
Presentation of parkinsonism?
Parkinson’s disease with tremor
Rigidity
Bradykinesia
Gait disturbance
Treatment of EPSE?
- Treat side effects with anti-cholinergics which reduce ACh and balance system
- IF very bad switch anti-psychotics
Examples of anti-cholinergics?
Procyclidine
Trihexyphenidyl
Orphenadrine
What is neuroleptic malignant syndrome?
Rare but important SE which is fatal
Neuroleptic means?
Drug that depresses nerve function eg antipsychotics
Symptoms of NMS?
Increasing muscle tone
Hyperthermia
Changing pulse
What does Neuroleptic malignant syndrome cause?
Rhabdomyolysis which can caue AKI leading to coma and death
Treatment of neuroleptic malignant syndrome?
Stop antipsychotic Rapid cooling Renal support Skeletal muscle relaxants May need induced coma Dopamine agonists eg bromocriptine
Antipsychotics do what to prolactin?
Increase in prolactin
What is akathsia?
Feeling of inner restlessness which causes pacing, rocking from foot to foot an inability to stand still, poor sleep
S1st line treatment of akathsia?
Usually propranolol
2nd line treat,ent of akathsia?
Benzodiazepines -Clonazepam
Other side effects of anti-psycotics?
ACH side effects
Action on 5HT receptor causes weight gain
Antiadrenergic side effects = postural hypotension
Hepatotoxicity
Prolonged QT interval
Photosensitivity
Which works best out of all the anti-psychotics for schizophrenia?
Clozapine but causes significant side effects
Significant SE of clozapine?
Agranulocytosis
-Needs very strict monitoring and is therefore not 1st line but used for resistance cases
Usually start with what generation of anti-psychotics?
2nd generation
Compliance issues solution?
Long acting depot medication
Perisistent delusional disorder?
Systemized fixed delusions, don’t tend to have hallucinations
Schizotypal disorder?
Under DSM this is classed as a personality disorder but under ICF it is classed as a type of psychosis
Acute and transient psychotic disorder?
Schizophrenia symptoms lasting less than a month
Induced delusional disorder?
Folie a deux and folie a plusiers a group of people share the same delusions
Schizoaffective disorder?
Episodic disorder in which both affective and schizophrenic symptoms are present but the criteria for neither is met
Neurodevelopmental changes in schizophrenia?
Enlarged ventricles, thinner cortices
Reduced frontal lobe volume, reduced frontal lobe grey matter and enlarged lateral ventricle volume
Neurochemical changes in schizophrenia?
Altered dopamine signalling
What can make symptoms of schizophrenia worse?
Amphetamine
Indicators of poor prognosis in schizophrenia?
Poor pre-morbid adjustment Insidious onset Early onset Long duration of untreated psychosis Cognitive impairment Enlarged ventricles
Indicators of a good prognosis for schizophrenia?
Shorter time of untreated psychosis Older age of onset Female gender Marked mood disturbance especially elation Fam history of mood disorder
