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Y5 Psych > Schizophrenia > Flashcards

Schizophrenia Flashcards

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1
Q

Define Schizophrenia

A

Disintegration of the process of thinking, contact with reality, and emotional responsiveness
Characterised by positive and negative symptoms

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2
Q

Describe the paranoid subtype of schizophrenia

A

Most common
Prominent delusions
Prominent hallucinations

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3
Q

Describe the hebephrenic/disorganised subtype of schizophrenia

A

Mainly focused on speech/thought
Disorganised mood and speech
Neologisms, Knights move thinking
Inappropriate affect (laughing at something sad)

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4
Q

Describe the simple subtype of schizophrenia

A

Negative symptoms only
Apathy
Social withdrawal

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5
Q

Describe the catatonic subtype of schizophrenia

A

Psychomotor disturbance
Stupor, waxy flexibility
Automatic obedience
Forced grasping, opposition

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6
Q

Give examples of hypotheses behind the aetiology of schizophrenia

A

Dopamine hypothesis
Serotonin (5-HT) overactivity
Glutamate dysregulation
Stress: people with a vulnerability encounter stressful influences
Neurodevelopmental: enlarged ventricle

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7
Q

What are the risk factors for schizophrenia

A

Family history
Social disadvantage
Urban life
First/second gen immigrants
Black Caribbean/African
Expressed emotion from relaitives
Premorbid personality
Adverse life experiences
Fear of madness
Cognitive behaviour - jumping to conclusions
Cannabis use
Birth in the Winter months

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8
Q

What are the gender differences in schizophrenia presentation

A

Males at a greater risk than females
Females present later than males

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9
Q

What is the UK/worldwide prevalence of schizophrenia

A

1%

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10
Q

What is required for an ICD-10 diagnosis of schizophrenia

A

(A) ≥1 Schneider’s 1st rank symptoms
(B) ≥1 other symptoms (paranoid, hebephrenic, catatonic, simple)
(C) Present for most of the time, ≥1month
(D) Not caused by substance use or organic disease

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11
Q

What are Schneider’s first rank symptoms

A

(1) Thought disorder (delusions):
- Thought insertion thoughts being placed into my mind
- Thought withdrawal thoughts being removed from my mind
- Thought broadcasting everyone knows what you are thinking
(2) Auditory disorder (hallucination):
- Thought echo hearing my thoughts out loud (delusion)
- 3rd person voice ‘no one like’s her, she’s useless’
- Running commentary ‘now he’s falling asleep, and she’s calling a cab’
(3) Passivity (delusions of control - their thoughts/actions are controlled by external forces)
(4) Delusions (false and fixed beliefs)

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12
Q

What are the negative symptoms of schizophrenia

A

Alogia (poverty of speech)
Anhedonia (loss of pleasure)
Avolition (lack of motivation)
Apathy (lack of concern, interest)
Blunting of affect
Catatonia
Poverty of ideation
Social withdrawal

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13
Q

Describe the progression of schizophrenia

A

At risk mental state (ARMS) -ve symptoms dominant - from teens to early 20s
* Social withdrawal
* Loss of interest in work and relationships
* Mild or brief psychotic symptoms
2. Acute phase: +ve symptoms dominant
3. Chronic phase (-ve symptoms dominant)

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14
Q

What % of patients with an at risk mental state will go on to develop psychosis and schizophrenia

A

20-30% will develop psychosis, half of whom meet criteria for schizophrenia

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15
Q

What is residual schizophrenia

A

previous schizophrenia (+ve & -ve S/S) → just -ve symptoms

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16
Q

Give some differentials for schizophrenia

A

Substance misuse: cannabinoids, cocain, amphetamine
Delirium
Functional disorders: BPAD, schizoaffective disorder, acute and transient psychotic disorder
Medicine: steroids, anticholinergics, dopaminergics
Infection: encephalitis, meningitis
Neurological: CVA, SOL, Alzheimer’s, Parkinsons

17
Q

What investigations are done for schizophrenia

A

bedside: urine toxicology, urine MSU, ECG (prior to starting treatment)

Bloods: FBC, U&Es, TFTs, CRP/ESR, anti-NMDA/anti-VGKC, lipid

Other: MRI/CT, EEG, lumbar puncture

18
Q

What is the management for an acute episode of psychosis

A

Urgent emergency: Crisis resolution team and home treatment team

Non-urgent emergency: Early intervention in Psychosis (EIP) team

Bio: Medication - antipsychotics, anxiolytics, sedatives
Psycho: psychoeducation, talking therapies (CBT, family therapy)
Social: education/employment, housing/finance, career

19
Q

What factors would necessitate admission for schizophrenia

A

Suicide/homicide risk
Lack capacity
Significant medication changes
Severe symptoms (Psychotic, depressive, catatonic)
Failure of OPD treatment
Address comorbid conditions

20
Q

What is the biological approach to schizophrenia management

A

First line: Atypical antipsychotic for 6 weeks
1. Aripiprazole, quetiapine
2. Olanzapine, risperidone

Second line: typical antipsychotics e.g. chlorpromazine

Treatment resistance: Clozapine

± lithium for schizoaffective, diazepam for anxiety

21
Q

What defines treatment resistance in schizophrenia

A

failure to respond to >2 antipsychotics, at least one of which is atypical, each given at a therapeutic dose for at least 6 weeks

22
Q

What is the psychological approach to schizophrenia management

A

Individualised CBT for psychosis
* >16 sessions
* Emphasis on testing reality
* Establishing links between thoughts, feelings and actions and their symptoms

Family therapy

Cognitive remediation therapy (CRT)
* Good for negative symptoms
* Aims to improve neurocognitive skills e.g. concentration, memory, problem-solving

23
Q

What is the social approach to schizophrenia management

A

Social skills training e.g. budgeting, cooking, role-play for interpersonal skills
Education, training, employment
Benefits
Housing (supported)
Carer support
MDT: social workers, benefits advisors, occupational therapists

24
Q

What can you do if the patient is non-compliant with antipsychotics

A

IM depot injection, usually every 4 weeks
e.g. zuclopenthixol decanoate

25
Q

What are the complications of schizophrenia

A

Suicidal tendencies
Substance abuse
Tobacco abuse/dependence
Tardive dyskinesia
Depression

26
Q

What is the prognosis for schizophrenia

A

Life expectancy is shortened by 11-15 years
Rule of quarters:
1/4 will not have another episode
1/4 continue to have episodes but are able to function
1/4 continue to have episodes but are unable to function, but can stay out of hospital
1/4 will be in and out of hospital

Early detection and treatment can reduce the duration of psychosis and can predict more favourable outcomes

27
Q

What are the bad prognostic factors for schizophrenia

A

Gradual onset
Early onset
Lack of precipitant stressful event
Family history
Low preceding IQ
Negative symptoms
Longer duration of untreated psychosis (DUP)

28
Q

What is the management for catatonia

A

IM lorazepam

Y5 Psych (46 decks)

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