Schizophrenia

Question 1

cluster A PDs

Answer 1

• paranoid
• schizoid
• schizotypal

Question 2

cluster B PDs

Answer 2

• anti-social
• borderline
• histrionic
• narcissistic

Question 3

cluster C PDs

Answer 3

• avoidant
• dependent
• obsessive-compulsive

Question 4

def: schizophrenia

Answer 4

long term MH problem affecting thinking, perception and affect
* M diagnosed 15-25
* F diagnosed 25-35
at least 1 month

Question 5

aetiology: schizophrenia

Answer 5

• unknown
• ?consequence of combination of psychological, environmental, biological and genetic factors
• illness triggered by emotional life experinces

Question 6

neurodevelpmental hypothesis: schizophrenia

Answer 6

higher risk if:
* experienced hypoxic birth injury
* viral illness in-utero
* temporal lobe epilepsy
* smoke canabis

imaging shows: enlgarged vernticles, small amount grey matter loss, smaller and lighter brains

Question 7

neurotransmitter hypothesis: schizophrenia

Answer 7

• excess dopamine and overactivity in mesocorticolimbic system causing +ve symptoms
• hence why doapmine antagonists used in tx but more successful treating +ve symptoms
• loss of dopamine activity in mesocorticolimbic tracts causing -ve symptoms

other neurotransmitters in schizophrenia:
* increased serotonin
* decreased glutamate

Question 8

psychotic symptoms: parkinson’s patients

Answer 8

use of dopamine agonists (Levodopa) over treatment causes increased amounts of dopamine in brain causing psychosis

Question 9

6 types: schizophrenia

Answer 9

Please Help Carol Really Understand Schizophrenia

Question 10

6 types: schizophrenia

Answer 10

Please Help Carol Really Understnad Schizophrenia
1. paranoid
2. hebrphrenic
3. catatonic
4. residual
5. undifferentiated
6. simple

Question 11

def: paranoid schizophrenia

Answer 11

• most common
• characterised by auditory hallucinations and paranoid dellusions

Question 12

def: hebephrenic schizophrenia

Answer 12

• diagnosed in adolescents and young adults
  characterised by mainly negative symptoms:
• mood changes
• unpredictable behaviour
• shallow affect
• fragmentary hallucinations

Question 13

def: simple schizophrenia

Answer 13

characterised by negative symptoms
NEVER positve symptoms

Question 14

def: catatonic schizophrenia

Answer 14

psychomotor features:
* posturing
* rigidity
* stupor

Question 15

def: undifferentiated schizophrenia

Answer 15

symptoms do not fit neatly into one of the other catagories

Question 16

def: residual schizophrenia

Answer 16

characterised by negative symptoms whrn +ve symptoms have “burtn out”

Question 17

RFs: schizophrenia

Answer 17

• family hx and genetics (esp twins - 50% if monozygotic)
• 48% chance if both parents affected
• > increased risk if father >55
• pregnancy: malnutrition and viral infections, pre-eclampsia and EMCS
• drug abuse: cannabis (esp in teenage use) also cocaine, LSD and amphetamines
• social environment: lower socioeconimic classes and stressful life experiences
• ethnicity: afrocarribean men more affected

Question 18

clinical features: schizophrenia

Answer 18

HD BS Network
* hallucinations
* delusions (broadcasting/insertion/withdrawal/control)
* behaviour disorganisation (loosening/clang associations
* speech disorganisation (neologisims/echolalia/perseveration/word salad)
* negative symptoms (5As)

Question 19

schizophrenia: negative symptoms

Answer 19

5As
1. affect (no affect)
2. ambivalence (can’t make decisions)
3. alogia (reductions in amount of speech/mute for months or years)
4. anhedonia (amotivation - no goals, can’t hold job, can’t take care of basic needs)
5. asociality (difficult to relate to people/disinterested)

Question 20

ix: schizophrenia

Answer 20

• basline bloods: FBC, LFTs, U+E, CRP, TFTs and fasting glucose
• urine culture: UTI causing delirium
• urine drug screen: intoxication
• HIV testing
• syphilis serology
• serum lipids before antipsychotics

(ruling out other causes)

Question 21

ix: before commencing antipsychotics

Answer 21

serum lipids

Question 22

diagnosis: schizophrenia

Answer 22

1. first rank symptoms for at least one month: delusional perception, passiity, delusions of thought interference, auditory hallucinations
2. no other cause for psychosis

Question 23

rx: schizophrenia

Answer 23

• early intervention team (after 1st episode), community mental health team, and crisis resolution team
• CPA - care programme approach 4 stages 1. assessing health and social needs, 2. creating care plan 3. appointing key worked as POC and 4 reviewing tx
• antipsychotic medication
• psychological tx

Question 24

tx: schizophrenia summary

Answer 24

atypical dopamine receptor antagonist 1st line - risperidone
2nd line add typical D2 antagonist - olanzapine
if both fail - clozapine

Question 25

tx: antipsychotic medication schizophrenia

Answer 25

typical and atypical D2 (dopamine) receptor antagonists
typical - haloperidol, chlorpromazine and flupentixol deconoate (depot inj)
atypical - block dopamine and serotonin 5HT2 receptors = olanzapine, resperidone (depot inj), clozapine, quetiapine

Question 26

clozapine use: schizophrenia

Answer 26

• both typical and atypical dopamine antagonists ineffective
• regular blood tests to check neutrophil levels (can cause agranulocytosis - can be life threatening)

Question 27

psychological tx: schizophrenia

Answer 27

• CBT
• family therapy

Question 28

SEs: typical antipsychotics schizophrenia

Answer 28

• EPSE - extra-pyramida side effects: parkinsonism, akathisia, dystonia, dyskinesia
• hyperprolactinaemia - sexual dysfunction, increased risk osteoporosis, amenorrhoea in women, galactorrhoea, gynaecomastia and hypogonadism in men
• metabolic - weight gain, increased risk T2DM, hyperlipidaemia, increased risk metabolic syndrome
• neuro - seizures, neuroleptic melignant syndrome

Question 29

SEs: atypical antipsychotics schizophrenia

Answer 29

still cause EPSE and hyperprolactinaemia but more metabolic effects

Question 30

first and second generation antipsychotics: schizophrenia

Answer 30

zine - 1st gen
pine and done - 2nd gen

Question 31

APA guidelines for tx: schizophrenia

Answer 31

• acute phase - prevent harm to self and others, control distubred behaviour, reduce psychosis severity, address precipitating factors, formulate care plan, develop alliance with pt and family
• stabilisation phase - reduce stress of pt, minimise relapse liklihood, promote recovery
• stable phase: sustain symptoms control, ensure pt maintaining/improve QoL, treat exacerbating symptoms, monitor for tx SEs

Question 32

SEs: clozapine

Answer 32

agranulocytosis
myocarditis
hypersalivation
sedation
weight gain

Question 33

SEs: aripiprazole

Answer 33

akathisia and agititation
no EPSE, weight gain, sedation on hyperprolactinaemia

Question 34

metabolic SEs: antipsychotics

Answer 34

weight gain
dyslipidaemia
T2DM

Question 35

other side effects: antipsychotics

Answer 35

sedation
dry mouth
constipation
postural hypotension
sexual dysfunction
QTc prolongation
NMS

Question 36

QTc prolongation: antipschotics

Answer 36

quetiapine
chlorpromazine
haloperidol
amisulpride

Question 37

testing: antipsychotics

Answer 37

BMI (first 6 weeks and then 3 months then yearly)
HbA1c baseline 3 months and yearly
lipids baseline, 3 months and yearly
FBC yearly
U+E yearly
ECG after dose changes and yearly
pulse and BP at each dose change
prolactin baseline 6 months and yearly
LFTs baseline and yearly
clozapine - baseline troponin