Schizophrenia Flashcards
what is a hallucination
perceived in absence of stimuli
what is a delusion
fixed false beliefs that no amount of proof to the contrary will alter
what is schizophrenia characterised by
range of cognitive, emotional and behavioural problems
- symptoms are classified into positive and negative
what are the positive symptoms of schizophrenia
- hallucinations, delusions
- disorganised speech/formal thought disorder
- disordered/catatonic behaviour
what are the negative symptoms of schizophrenia
relate to loss of normal functions
- flattening or blunting of affect
- alogia (Reduced production of speech)
- emotional apathy
- social withdrawal
- lack of motiviation
- loss of pleasure
how is schizophrenia diagnosed
at least 1 of the following 3 domains for a duration of 1 months
1. positive symptoms
2. negative symptoms
3. reduced social functioning
describe the aetiology of schizophrenia
heterogenous
give examples of putative causes of schizophrenia
- genetic disorders
- neurodevelopment problems
- neurochemical imbalances (drug misuse)
- pyschosocial stressors
- influenced by psychosocial environment of individual
describe the prevelence of schizophrenia
ranges between 0.015-0.1%
- peak incidence of onset in males 15-25 years
- females 25-35 years
- cumulated risks for development are equal in men and women
describe the prognosis of schizophrenia
- most common presentation is an initial acute epidote with florid positive symptoms followed by the emergence and persistence of negative symptoms
- 20% of patients recover fully
- 70% have relapsing/remitting disease
- 10% seriously disabled by disease
outline the symptoms presenting in the acute phase
- lack of insight
- auditory hallucinations
- ideas for reference
- suspiciousness
- flattening of affect
- voices speaking to patient
- delusional mood
- delusions of persecution
- thoughts spoken aloud
describe the management of schizophrenia
- needs to be holistic for optimal response to ensure best prognosis
- following components should be addressed
- psychological
- social
- emotional - pharmacological management should be considered as a 1st line intervention in all cases
describe the use of antipsychotics in schizophrenia
- response after 2-4 weeks
- equal efficacy against positive symptoms
- second generation antipsychotics initially thought to show greater efficacy against negative symptoms
- clozapine is the only antipsychotic licensed for treatment resistant illness
describe the dopamine theory
- increased dopaminergic neurotransmission is a pathogenic factor of schizophrenia
what does dopamine blockade lead to
- antipsychotic effect
- extrapyramidal side effects in striatum
- parkinsonism
- dystonia
- akathisia - risk factor for tardive dyskinesia
- hyperprolactinaemia in hypothalamus
give examples of first generation antipsychotics
- chlorpromazine
- haloperidol
- trifluoperazine
- sulpiride
how do first generation antipsychotics work
- non selective dopamine D2 blockade
- but this leads to EPSE and hyperprolactinaemia
give examples of second generation antipsychotics
- clozapine
- risperidone
- olanzapine
- quetiapine
how do second generation antipsychotics work
- selective dopamine D2 blockade
- variable receptor occupancy of 5HT and alpha 1 sub types
- fewer or no EPSEs
- less or no hyperprolactinaemia
what are predictable adverse effects (type A)
- predictable from pharmacology of drug
- common
- dose dependent
- decreased severity with time
- high morbidity
- low mortality
give examples of predictable adverse effects
- histamine blockade
- anticholinergic
- alpha blockade
what are unpredictable adverse effects
- not predictable from pharmacology
- not dose dependent
- not common
- severity doesn’t decrease with time
- low morbidity
- high mortality
give examples of unpredictable adverse effects
- ocular deposits
- photosensitivity
- hepatitis
- ECG changes
what is tardive dyskinesia caused by
- clozapine helps improve symptoms
- olanzapine- incidence 1% per year
- FGAs- incidence 10-20% first year, 4-5% per year
- other SGAs are all noted to have potential to cause TD
what is neuroleptic malignant syndrome
- rare and potentially fatal
- difficult to diagnose
- reports with SGAs including clozapine
what are the signs and symptoms of NMS
- increased temperature
- labile blood pressure
- muscle rigidity
- leucocytosis
- altered consciousness
- increased creatine kinase
what does EPSE stand for
extrapyramidal side effects
which antipsychotic produces the most EPSEs
haloperidol, risperidone
which antipsychotic is most likely to cause hyperprolactinaemia
haloperidol, risperidone, amisulpride
which antipsychotics are most likely to cause weight gain
clozapine, olanzapine (>6kg), risperidone, quetiapine
which antipsychotics are most likely to cause hyperglycaemia
clozapine, olanzapine, risperidone, quetiapine
describe the antipsychotic efficacy of clozapine, risperidone and olanzapine in refractory schizophrenia
- clozapine= compelling evidence
- risperidone- no evidence
- olanzapine- no evidence
what should be considered when choosing an antipsychotic
- balance between efficacy, patient tolerability and how the proposed treatment will impact patients lifestyle
outline the pharmacological treatment of schizophrenia
- SGAs considered to be 1st line in patients with newly diagnosed schizophrenia
- SGAs are the treatment of choice for managing an acute schizophrenic episode when discussion with the individual is impossible
- an SGA should be considered for any individual suffering unacceptable side effects from a conventional FGA
- SGA should be considered in an individual in relapse whose symptoms were previously inadequately controlled
- changing to an SGA is not necessary if a conventional FGA controls symptoms adequately and the individual doesn’t suffer unacceptable side effects
- clozapine should be introduced if schizophrenia inadequately controlled despite sequential use of 2 or more antipsychotics at optimal dose and with compliance assured for a period of 6-8 weeks each
describe the results of the 2GA vs 1GA study
- overall efficacy- 4 SGA were better than FGAs in ascending order
- risperidone
- olanzapine
- amisulpride
- clozapine
outline NICEs updated guidelines on using antipsychotics for treatment
- offer oral antipsychotic medication to people newly diagnosed
- provide info in a usable format on the benefits and side effects
- decide which antipsychotic to use in partnership with the service user
- consider potential to cause EPSEs or metabolic side effects - don’t start regular combined antipsychotic medication, except for short periods
