Schizophrenia Flashcards
For the diagnosis of schizophrenia to be made, patients must be suffering from a psychotic episode lasting > 1 month with one or more ‘first-rank’ symptoms.
Typical first rank symptoms include:
- Thought echo: auditory hallucination in which the person hears their thoughts spoken aloud
- Thought insertion: thought inserted into your head
- Thought broadcasting: thoughts broadcast so other people know what you are thinking
- Thought withdrawal: thought taken out of your head
- Delusions of perception: a true perception, to which a patient attributes a false meaning
- Auditory hallucinations: third person hallucinations (arguing or talking about the person) or form of commentary
- Delusions of control: false belief that another person (or group) controls the persons thoughts, feelings, impulses, or behaviour
Which mental heath disorders must a patient always notify the DVLA if they drive?
The DVLA must be notified of any mental health disorder that affects a persons ability to drive.
In the case of paranoid schizophrenia and bipolar disorder, the DVLA must be notified regardless of whether the condition affects the persons ability to drive or not. The DVLA will then review each case individually to decide whether the person will be allowed to continue to drive.
Which of the following is a good prognostic factor in schizophrenia?
A Absence of affective symptoms B Male sex C Predominantly negative symptoms D Older age E Insidious onset
There are several good prognostic factors in schizophrenia including older age at onset.
The main good prognostic factors in schizophrenia include:
Older age at onset
Female sex
Rapid onset of symptoms
Predominantly positive symptoms
Prominent affective symptoms
Good premorbid functioning
Stable relationships and personality
Absent family history
What is the recommended duration of antidepressant therapy in patients treated for depression?
A 1 week B 2 months C 6 months D 1 year E 2 years
6 months
Once initiated, it is recommended that antidepressants are continued for a minimum of 6 months after resolution of symptoms.
It is estimated that 50% of patients will develop recurrent depressive symptoms if antidepressants are stopped before six months.
The presence of first rank symptoms (auditory hallucinations) and predominantly negative symptoms with inappropriate emotional responses is typical of … schizophrenia.
The presence of first rank symptoms (auditory hallucinations) and predominantly negative symptoms with inappropriate emotional responses is typical of hebephrenic schizophrenia.
Hebephrenic schizophrenia is typically dominated by … symptoms. One of the hallmarks of this subtype of schizophrenia is inappropriate emotional responses. Overtime, patients can become socially isolated and neglect themselves.
Hebephrenic schizophrenia is typically dominated by negative symptoms. One of the hallmarks of this subtype of schizophrenia is inappropriate emotional responses. Overtime, patients can become socially isolated and neglect themselves.
Due to the predominant negative symptoms, it is important to exclude an affective disorder (e.g. depression) or schizoaffective disorder. Schizoaffective disorder refers to schizophrenia with manic episodes or a significant depressive component. Hebephrenic schizophrenia is sometimes known as disorganised schizophrenia and usually only diagnosed in teenagers and young adults.
A 19-year-old is found on the floor at home by his brother. He is rousable to voice and feels hot to touch. He is sweating profusely and very stiff to move. He was recently started on a new medication by the psychiatrists for schizophrenia.
Which of the following investigations would most help support the diagnosis?
Blood glucose Electrocardiogram FBC CXR CK
This is an example of neuroleptic malignant syndrome that is characteristically associated with a significantly elevated creatine kinase (CK).
A 32 year old male is currently an inpatient at a psychiatric unit for treatment-resistant schizophrenia. The team have tried olanzepine and risperidone without success.
Which of the following medications is the most appropriate in this case?
A Clozapine B Haloperidol C Lithium D Chlorpromazine E Quetiapine
Clozapine
Clozapine is an … antipsychotic, which is predominantly a dopamine-2 receptor antagonist. The drug has also shown to affect other dopamine receptors including D1-D5, as well as histamine, acetylcholine and serotonin receptors.
Clozapine is an atypical antipsychotic, which is predominantly a dopamine-2 receptor antagonist. The drug has also shown to affect other dopamine receptors including D1-D5, as well as histamine, acetylcholine and serotonin receptors.
When is clozapine recommended?
Clozapine is recommend when schizophrenia has failed to response adequately to 2 different antipsychotics (one of which is an atypical antipsychotic that is not clozapine). One of the major side-effects of clozapine is neutropenia and agranulocytosis, so close monitoring with regular full blood counts is required. The neutrophil count must be > 1.5 x10^9/L to initiate clozapine, except in patients with benign ethnic neutropenia. Weekly blood tests are required during the first six months of therapy.
A 32 year old female with a background of schizophrenia is reviewed by the psychiatry team. She has been on antipsychotic medications for the last year and her symptoms are well controlled. She has started to develop a general feeling of restlessness and need to tap her fingers constantly.
What is this describing?
This is classical of akathisia, which describes an inner feeling of restlessness and desire to move.
Antipsychotic symptoms are associated with four major motor side-effects including akathisia, tardive dyskinesia, dystonia and parkinsonism.
Antipsychotic symptoms are associated with four major motor side-effects including akathisia, tardive dyskinesia, dystonia and parkinsonism.
Describe each
Akathisia is an inner restlessness with the desire to move. The restlessness is relieved by movement of the affected part of the body. The desire to move can be resisted.
Tardive dyskinesia describes continuous involuntary movements of the tongue and lower face, which is usually seen after long-term use of antipsychotics.
Parkinsonism describes a classical triad of tremor, bradykinesia and rigidity. Drug-induced parkinsonism is more likely to present with bilateral symptoms compared to idiopathic Parkinson’s disease.
Finally, dystonia refers to a state of abnormal muscle tone from spasm or abnormal posturing.
Which of the B vitamins is thiamine?
Thiamine is vitamin B1, which is an important cofactor for several metabolic processes.
