Schizophrenia Flashcards
What is schizophrenia?
Refers to a chronic or relapsing and remitting form of psychosis characterized by positive symptoms (such as hallucinations, delusions, thought disorders) and negative symptoms (including alogia, anhedonia, and avolition)
Causes of schizophrenia?
Genetic factors:
- FHx of schizophrenia
Environmental factors:
- childhood trauma
- heavy cannabis use in childhood
- maternal health issues (malnutrition, infections like rubella and cytomegalovirus)
- birth trauma (hypoxia and blood loss)
- urban living and immigration to more developed countries
How does schizophrenia present?
Positive symptoms:
- auditory hallucination
- broadcasting of thoughts
- control issues
- delusional perception
Negative symptoms:
- Alogia (speaking less)
- Anhedonia (lack of interest/pleasure)
- Affective incongruity or blunting
- Avolition (lack of motivation)
Risk indicators:
- hallucination
- hx of deliberate self-harm or suicidal ideation
Diagnosis of schizophrenia?
Clinical diagnosis
Exclude organic causes of psychosis:
- CT/MRI (rule out structural abnormalities)
- blood tests (exclude HIV, syphilis, TFTs)
- drug screening to identify substance misuse
How is schizophrenia managed in primary care?
Risk assessment
High risk with psychosis →refer to psychosis service (if not, then to crisis resolution/home tx team).
High risk with prodromal phase of psychosis →refer to psychosis service or specialist mental health service.
Don’t start antipsychotic drug tx unless advised by a consultant psychiatrist or if ongoing care then they can continue prescribing medication.
If psychosis solely treated in primary care, refer to secondary care if:
- poor or partial response to tx or poor adherence
- person’s functioning declines significantly
- develop intolerable or medically important adverse effects from medication
- Comorbid alcohol or drug misuse is suspected.
- potential risk to the person or others
- woman with a psychotic disorder is pregnant or planning a pregnancy
How is schizophrenia managed in secondary care?
Tx for co-existing anxiety disorders, depression, personality disorders, or substance misuse.
Oral second-generation antipsychotic (atypical; e.g. risperidone) AND:
- family intervention
- individual CBT
- art therapies (helps negative symptoms)
Monitor health and effects of medication for at least the first 12 months until stable.
Care plan
- crisis plan
- advance statement
- key clinical contacts
What medications can be used to treat acute episodes of schizophrenia, especially if you want to manage dangerous behaviour?
Sedatives may be used like:
- lorazepam
- promethazine
- haloperidol
Oral atypical antipsychotics such as:
- risperidone
- olanzepine
- quetiapine
(sometimes IM/depot injections may be necessary).
When is clozapine considered?
When schizophrenia is resistant to other antipsychotics (in those who have not responded to 2 other trials of antipsychotics).
Due to its potential lethal side effects, it requires intensive monitoring.
What is the prognosis like for schizophrenia?
Varies significantly between individuals with schizophrenia.
Factors associated with a better prognosis include:
- higher IQ/education level
- sudden onset
- presence of a precipitating factor
- a strong support network,
- predominance of positive symptoms
