Schizophrenia Flashcards
Define schizophrenia.
Psychotic disorder in absence of organic disease, substance abuse or withdrawal.
Not secondary to mood changes.
What are the ICD-10 schizophrenia subgroups?
Paranoid
Hebephrenic
Catatonic
Simple
Residual
What is paranoid schizophrenia characterised by?
Persecutory/ grandiose delusions
Derogatory auditory hallucinations
How is hebephrenic schizophrenia characterised?
Disorganised behaviour + speech:
- Formal thought disorder
- Neologisms, Knights move thinking
- Affective flattening/ incongruity
- Bizarre behaviour
How is catatonic schizophrenia categorised?
Multiple motor, volitional + behavioural disorders
Stupor
Excitement
Waxy flexibility
How is simple schizophrenia categorised?
Insidious but progressive impoverishment of mental life
Negative Sx only: apathy, social withdrawal
What are 5 risk factors for developing schizophrenia?
Family hx
Black Caribbean ethnicity - RR 5.4
Migration - RR 2.9
Urban environment- RR 2.4
Cannabis use - RR 1.4
Describe the risk of schizophrenia based on relatives affected
Monozygotic twin 50%
Parent 10-15%
Sibling 10%
No schizophrenic relatives 1%
What are Schneider’s First Rank Symptoms?
Auditory hallucinations
Thought disorder: broadcasting, insertion, withdrawal
Passivity phenomena
Delusional perceptions: grandiose, delusions of reference, persecutory
What are 4 positive symptoms of schizophrenia?
Hallucinations
Delusions
Disorganised speech
Disorganised/ catatonic behaviour: negativism/ excitement
What are 5 negative symptoms of schizophrenia?
Affective flattening
Alogia or paucity of speech
Avolition (decreased motivation)
Asociality
Anhedonia.
What are the cognitive symptoms of schizophrenia?
Poor concentration
Difficulty expressing thoughts
Poor memory.
What auditory hallucinations can occur in schizophrenia?
> ,2 voices discussing patient in the 3rd person
Thought echo
Voices commenting on the patient’s behaviour
What is passivity phenomena?
Bodily sensations being controlled by external influence
Actions/ impulses/ feelings: experiences which are imposed on the individual or influenced by others
What is a delusional perception?
Fixed false belief
Normal object is perceived
Then there is a sudden intense delusional insight into the objects meaning for the patient
For how long must symptoms persist for a diagnosis of schizophrenia to be considered?
> ,1 month
a/w at least 6m functional decline
What is the criteria for diagnosing schizophrenia?
> ,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.
Summarise the epidemiology of schizophrenia.
1% prevalence.
M > F
Onset 15-45.
What are the 3 typical phases that Schizophrenia cycles through?
Prodromal: withdrawn, -ve Sx predominate
Active: +ve and -ve Sx
Residual: Cognitive Sx, which worsen with each cycle
Give 5 poor prognostic indicators in schizophrenia
Strong FH
Gradual onset
Low IQ
Prodromal phase of social withdrawal
Lack of obvious precipitant
Give 5 differentials to schizophrenia
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
What are two grouping systems which can be used to categorise the symptoms of schizophrenia?
Schneider’s first rank symptoms
Bleuer’s 4As
What are Bleuer’s 4As?
Autistic thought: Inner world of fantasy
Affective incongruity: e.g. Smiling when describing sad event
Associations loosened: Thought disorder
Ambivalence: Conflicting feelings
What are investigations for schizophrenia?
Exclude organic cause:
Frontal space occupying lesion
FBCs
TFTs
Glucose
LFTs
Ca2+
B12/folate
VDRL for syphilis
Urine drugs screen
What is the management for schizophrenia?
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.
How should schizophrenia be managed initially?
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
What can be used for rapid tranquillisation in schizophrenia?
1st: Lorazepam PO - IM
2nd: Haloperidol 5mg + Lorazepam 1mg
What is the first line treatment of schizophrenia?
Bio:
Low dose Aripiprazole
or
High dose Olanzapine
+
Psycho: CBT +/- Family therapy
+
Social: Psychoeducation- education, skills, housing
What drug is used in non-compliant schizophrenics?
Clopixol
Once monthly IM depot injection
What should be done if a patient fails to respond to an atypical antipsychotic after 6 weeks of treatment?
Switch to a different Atypical or try a Typical
If no improvement after a further 6w: Clozapine
What is schizoaffective disorder?
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
What is delusional disorder?
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
Give 7 types of delusional disorder
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
What is brief psychotic disorder?
> ,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
What is schizophreniform disorder?
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
