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YR5 Psychiatry > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

Define schizophrenia.

A

Psychotic disorder in absence of organic disease, substance abuse or withdrawal.

Not secondary to mood changes.

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2
Q

What are the ICD-10 schizophrenia subgroups?

A

Paranoid

Hebephrenic

Catatonic

Simple

Residual

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3
Q

What is paranoid schizophrenia characterised by?

A

Persecutory/ grandiose delusions

Derogatory auditory hallucinations

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4
Q

How is hebephrenic schizophrenia characterised?

A

Disorganised behaviour + speech:

  • Formal thought disorder
  • Neologisms, Knights move thinking
  • Affective flattening/ incongruity
  • Bizarre behaviour
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5
Q

How is catatonic schizophrenia categorised?

A

Multiple motor, volitional + behavioural disorders

Stupor
Excitement
Waxy flexibility

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6
Q

How is simple schizophrenia categorised?

A

Insidious but progressive impoverishment of mental life

Negative Sx only: apathy, social withdrawal

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7
Q

What are 5 risk factors for developing schizophrenia?

A

Family hx
Black Caribbean ethnicity - RR 5.4
Migration - RR 2.9
Urban environment- RR 2.4
Cannabis use - RR 1.4

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8
Q

Describe the risk of schizophrenia based on relatives affected

A

Monozygotic twin 50%
Parent 10-15%
Sibling 10%
No schizophrenic relatives 1%

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9
Q

What are Schneider’s First Rank Symptoms?

A

Auditory hallucinations

Thought disorder: broadcasting, insertion, withdrawal

Passivity phenomena

Delusional perceptions: grandiose, delusions of reference, persecutory

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10
Q

What are 4 positive symptoms of schizophrenia?

A

Hallucinations

Delusions

Disorganised speech

Disorganised/ catatonic behaviour: negativism/ excitement

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11
Q

What are 5 negative symptoms of schizophrenia?

A

Affective flattening

Alogia or paucity of speech

Avolition (decreased motivation)

Asociality

Anhedonia.

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12
Q

What are the cognitive symptoms of schizophrenia?

A

Poor concentration
Difficulty expressing thoughts
Poor memory.

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13
Q

What auditory hallucinations can occur in schizophrenia?

A

> ,2 voices discussing patient in the 3rd person

Thought echo

Voices commenting on the patient’s behaviour

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14
Q

What is passivity phenomena?

A

Bodily sensations being controlled by external influence

Actions/ impulses/ feelings: experiences which are imposed on the individual or influenced by others

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15
Q

What is a delusional perception?

A

Fixed false belief

Normal object is perceived
Then there is a sudden intense delusional insight into the objects meaning for the patient

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16
Q

For how long must symptoms persist for a diagnosis of schizophrenia to be considered?

A

> ,1 month
a/w at least 6m functional decline

17
Q

What is the criteria for diagnosing schizophrenia?

A

> ,2 first rank Sx
,1 other Sx

At least 2 Sx should be delusions, hallucinations, or disorganized speech,
+
should negatively affect the person’s life in terms of work, self-care, or interpersonal relations.

18
Q

Summarise the epidemiology of schizophrenia.

A

1% prevalence.
M > F
Onset 15-45.

19
Q

What are the 3 typical phases that Schizophrenia cycles through?

A

Prodromal: withdrawn, -ve Sx predominate

Active: +ve and -ve Sx

Residual: Cognitive Sx, which worsen with each cycle

20
Q

Give 5 poor prognostic indicators in schizophrenia

A

Strong FH
Gradual onset
Low IQ
Prodromal phase of social withdrawal
Lack of obvious precipitant

21
Q

Give 5 differentials to schizophrenia

A

Organic: substance misuse, delirium, steroids

Acute psychotic episode

Schizoaffective disorder: schizophrenic + affective Sx develop together + are balanced

Persistent delusional disorder: only delusions

Schizotypal disorder: eccentricity + abnormal thoughts

22
Q

What are two grouping systems which can be used to categorise the symptoms of schizophrenia?

A

Schneider’s first rank symptoms

Bleuer’s 4As

23
Q

What are Bleuer’s 4As?

A

Autistic thought: Inner world of fantasy

Affective incongruity: e.g. Smiling when describing sad event

Associations loosened: Thought disorder

Ambivalence: Conflicting feelings

24
Q

What are investigations for schizophrenia?

A

Exclude organic cause:

Frontal space occupying lesion

FBCs

TFTs

Glucose

LFTs

Ca2+

B12/folate

VDRL for syphilis

Urine drugs screen

25
Q

What is the management for schizophrenia?

A

RA: Suicide risk very high. Risk to others + self neglect.

Consider need for hospital tx +/- multi-health systems.

Involve family, carers, GP, community.

Depot given if compliance is a problem.

Antipsychotics mainstay of tx.

Choice depends on SE profile.

Clozapine if heavy resistance.

CBT for persisting delusions + hallucinations.

Social rehabilitation etc.

26
Q

How should schizophrenia be managed initially?

A

Early intervention in psychosis team
Psychosis is toxic, the longer psychotic, the more it will affect them
Early Tx = better prognosis
Aim duration of untreated psychosis <3m

Tx: antipsychotics + psychosocial interventions

27
Q

What can be used for rapid tranquillisation in schizophrenia?

A

1st: Lorazepam PO - IM
2nd: Haloperidol 5mg + Lorazepam 1mg

28
Q

What is the first line treatment of schizophrenia?

A

Bio:
Low dose Aripiprazole
or
High dose Olanzapine
+
Psycho: CBT +/- Family therapy
+
Social: Psychoeducation- education, skills, housing

29
Q

What drug is used in non-compliant schizophrenics?

A

Clopixol
Once monthly IM depot injection

30
Q

What should be done if a patient fails to respond to an atypical antipsychotic after 6 weeks of treatment?

A

Switch to a different Atypical or try a Typical
If no improvement after a further 6w: Clozapine

31
Q

What is schizoaffective disorder?

A

Overlap syndrome with affective + psychotic Sx are prominent

Schizophrenic + Manic Sx develop at the same time
Or
Schizophrenic + Depressive Sx develop at the same time

Treat Sx as for schizophrenia
Add a mood stabiliser if affective component not controlled

32
Q

What is delusional disorder?

A

Persistent/ life-long delusions with few/ no hallucinations
Not schizophrenic Sx: passivity, blunting
No clear auditory hallucinations

Most common persecutory, grandiose, hypochondriacal + jealous.

Age of onset same as schizophrenia ~ >40y.

Tx: antipsychotics e.g. Aripiprazole

33
Q

Give 7 types of delusional disorder

A

Erotomanic: believe someone of higher social/ professional status is in love with them

Grandiose: believe they have a special prominence/ talent/ major achievement

Jealous/ Othello: believes partner is unfaithful

Persecutory: believe they are being persecuted, conspired against or potentially harmed

Somatic/ Hypochondrial: believe something is wrong with their body

Mixed: no one delusion is prominent

Parasitosis: believe they are infested by bugs

34
Q

What is brief psychotic disorder?

A

> ,1 +ve and -ve Sx are present
1 of which has to be 1 of the following: delusions, hallucinations, disorganized speech, + grossly disorganized or catatonic behavior.

Lasting >1 day, but < 1 month.

Tx: Antipsychotics

35
Q

What is schizophreniform disorder?

A

Exact same Sx as in schizophrenia but only for 1-6 months.

Depressive + manic episodes, but they don’t occur during the active-phase of psychotic Sx

Tx: Antipsychotics

YR5 Psychiatry (33 decks)

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