Schizophrenia Flashcards
What is the strongest risk factor for developing schizophrenia?
Having a parent with the condition
Relative risk increase: 7.5
What are the risks associated with different family members having the condition and developing schizophrenia?
- Monozygotic twin: 50%
- Parent: 10-15%
- Sibling: 10%
- No relatives: 1%
What are the non-family related risk factors for schizophrenia development?
- Black caribbean ethnicity: RR 5.4
- Migration: RR 2.9
- Urban environment: RR 2.4
- Cannabis use (mostly heavy use in childhood): RR 1.4
- Childhood trauma: poor maternal bonding, poverty, exposure to natural disasters
- Maternal health issues: malnutrition, infections such as rubella and CMV
- Birth trauma: hypoxia and blood loss
What are Schneider’s first rank symptoms of schizophrenia?
- Auditory hallucinations
- Thought disorders
- Passivity phenomena
- Delusional perceptions
What are the auditory hallucinations associated with schizophrenia?
- Two or more voices discussing the patient in the third person
- Thought echo
- Voices commenting on the patient’s behaviour
What are the thought disorders associated with schizophrenia?
- Thought insertion
- Thought withdrawal
- Thought broadcasting
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 are delusional perceptions?
A two stage process where a normal object is perceived and there’s a sudden intense delusional insight into the objects meaning
Eg. The traffic light is green and therefore I am the king
What are the other symptoms of schizophrenia (not including Schneider’s first rank symptoms)?
- Impaired insight
- Negative symptoms
- Neologisms (made-up words)
- Catatonia
What are the negative symptoms of schizophrenia?
- Incongruity/ blunting of affect
- Anhedonia
- Alogia (poverty of speech)
- Avolution (poor motivation)
- Social withdrawal
Which factors are associated with a poor schizophrenia prognosis?
- Strong family history
- Gradual onset
- Low IQ
- Prodromal phase of social withdrawal
- Lack of obvious precipitant
What is the general management for schizophrenia?
- Oral atypical antipsychotics (first line)
- CBT to all patients
- Close cardiovascular risk-factor modification
Why are there higher rates of cardiovascular disease in schizophrenic patients?
Due to the antipsychotic medication and high smoking rates (generalisation)
What is the diagnostic criteria for schizophrenia?
ICD-10, symptoms must be present most of the time during a period of at least one month
What investigations should be done in a ?schizophrenia patient to exclude organic causes of psychosis?
- Brain imaging (CT/MRI) to rule out structural abnormalities
- Blood tests to exclude infection (HIV, syphilis etc) or metabolic causes (eg. TFTs)
- Drug screening
What is the management for an acute episode of schizophrenia?
Sedatives:
- Lorazepam
- Promethazine
- Haloperidol
When is clozapine considered in schizophrenia?
When a patient has treatment resistant schizophrenia: lack of clinical improvement following sequential use of at least two antipsychotics for 6-8 weeks, at least one of the antipsychotics must be atypical
Due to the potentially lethal side effects (neutropaenic sepsis), it requires intensive monitoring
What is the rule of quarters in the schizophrenia prognosis?
- 25% never have another episode
- 25% improve substantially with treatment
- 25% show some improvement
- 25% are resistant to treatment
What is catatonia?
The stopping of voluntary movement/ staying in an unusual position
Believed to occur due to abnormalities in the balance of dopamine and other neurotransmitter systems
How is catatonia managed?
- Benzodiazapines
- ECT in some centres
How do extrapyrimidal side effects (associated with some antipsychotics) present?
- Dystonia (continuous muscle spasm and contractions)
- Parkinsonism
- Tardive dyskinesia (facial tics like lip-smacking, tongue thrusting, rapid blinking)
What are the side effects of clozapine?
- Weight gain
- Excessive salivation
- Agranulocytosis
- Neutropenia
- Myocarditis
- Arrhythmias
What is the deprivation of liberty safeguards (DoLS)?
Used when necessary to deprive a patient or resident of their liberty as they lack capacity to consent to treatment or care to keep them safe from harm
Ammendment to restrict/ restraint a patient and deprive them of their liberty
