Schizophrenia Flashcards
What is schizophrenia?
A relapsing and remitting form of psychosis characterised by positive features and negative features
What is the epidemiology of schizophrenia?
Typically develops in early adulthood (20s and 30s)
Slightly more common in men
What is the strongest risk factor for schizophrenia?
Genetics
What is the risk of developing schizophrenia if a monozygotic twin or both parents have schizophrenia?
50%
What is the risk of developing schizophrenia if a parent or sibling has the condition?
10%
What are the environmental risk factors for developing schizophrenia?
Heavy cannabis use in childhood
Childhood trauma
Maternal health issues - rubella and CMV
Birth trauma
What are Schneider’s first rank symptoms of schizophrenia?
Auditory hallucinations
Thought disorders
Passivity phenomena
Delusional perceptions
What thought disorders are common in schizophrenia?
Thought withdrawal
Thought insertion
Thought broadcasting
What types of auditory hallucinations are seen in patients with schizophrenia?
Two or more voices discussing the patient in third person
Voices commenting on the patient’s behaviour
Thought echo
What is thought echo?
A hallucination where the patient hears their own thoughts as if they were being spoken aloud
What is passivity phenomena?
The feeling that a patient’s actions, thoughts, bodily sensations or feelings are being controlled by an external influence
What is a delusional perception?
A true perception, to which the patient attributes a false meaning
What are the negative features of schizophrenia?
Alogia - decrease in the amount of words a person says
Anhedonia
Blunted affect
Avolition - poor motivation
Social withdrawal
What is blunted affect?
Decreased expression of emotion through facial expressions, tone and movement
What are the differentials of schizophrenia?
Substance induced psychosis
Schizoaffective disorder
Dementia with psychosis
Depression with psychosis
Autoimmune encephalitis
Metabolic disorders
What investigations are helpful in the diagnosis of schizophrenia?
Mostly a clinical diagnosis
CT/MRI to rule out structural abnormalities
Infectious screen
TFTs
U&Es
Drug screening
What is the first line management of schizophrenia?
Atypical antipsychotics e.g risperidone
CBT
What is given first line for an acute episode of schizophrenia?
Oral benzodiazpine e.g lorazepam or haloperidol
What drug is considered if schizphrenia is resistant to other antipsychotics?
Clozapine
What is the major side effect of clozapine?
Agranulocytosis
What monitoring does clozapine require?
FBC before starting
FBC weekly for 18 weeks
then FBC fortnightly until 1 year
then FBC monthly
What factors are associated with poor prognosis for schizophrenia?
Strong family history
Gradual onset
Low IQ
Lack of obvious precipitant
What are the side effects of risperidone?
Weight gain
Poor glycaemic control
Dyslipidaemia
What are the side effects of haloperidol?
Dystonia (acute dystonic reaction)
Parkinsonism
Tardive dyskinesia
Akathisia
What are the side effects of all antipsychotics?
Sedation
Hyperprolactinaemia
Sexual dysfunction
Cardiac arrhythmias
Reduction of seizure threshold
What drug can be used to manage the extra pyramidal side effects of antipsychotics?
Procyclidine
What are the different types of schizophrenia?
Catatoic
Hebephrenic
Simple
Undifferentiated
Paranoid
What is tardive dyskinesia?
Involuntary movements most commonly in the face, eyes and mouth
What is acute dystonia?
Sustained muscle contraction (commonly affects the head, face and neck, including the eyes)
