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PSYCHIATRY > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

How is schizophrenia distinguished from other psychosis?

A

-Presence of specific types of delusions, hallucination and thought disorder
-The primary disorder is not one of effctive or organic aetiology
-The clinical course

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2
Q

When does schizophrenia usually present?

A

In young adults - especially when they transition into independent living

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3
Q

What does the course of schizophrenia look like?

A

-Prodromal period, preceding a first episode of psychosis
-Followed by an acute episode of marked by hallucinations, delusions and behavioural disturbance accompanied by agitation and distress
-Pharmacological intervention usually happens at this stage but negative symptoms can remain which lasts for years

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4
Q

What is the prodromal period charcterised by?

A

-Deterioration of personal function
-Short lasting and mild psychotic symptoms
-Memory and concentration problems
-Unusual behaviour and ideas
-Issues with communication
-Social withdrawal, apathy and reduced interest in daily activities

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5
Q

What symptoms follow the prodromal period of schizophrenia?

A

-An acute episode marked by hallucinations, delusiona nd behavioural disturbances accompanied by agitation and distress

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6
Q

What are first rank symptoms?

A

-Thought insertion, echo, withdrawal or broadcasting
-Third person auditory hallucinations
-Running commentary
-Passivity of thought, feelings or action
-Delusional perception

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7
Q

What are the characteristic symptoms of acute schizophrenia?

A

-First rank symptoms
-Bizarre delusions
-Odd behaviour
-Thought disorder
-Lack of insight
-Prodromal period of decline in perfromance and social withrdrawal

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8
Q

What is duration criteria for acute schizophrenia?

A

Symptoms must persist for at least one month

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9
Q

What is the exclusion criteria for schizophrenia?

A

-Not secondary to a mood disorder
-No organic cause (ampethamines, temporal lobe dementia)

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10
Q

What are the subtypes of schizophrenia?

A

-Paranoid - persecutory, systematized delusions, hallucinations (usually audiory)
-Disorganised (though disorder, odd behaviour, bizarre delusions)
-Catatonic (motor signs) - this is now more rare

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11
Q

What is the most common type of schizophrenia?

A

-Paranoid
Note: in this type personailty is normally resevred

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12
Q

Examples of auditory hallucinations?

A

-Third person discussion
-Though echo
-Voice commenting on patients behaviour

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13
Q

Examples of thought disorder?

A

-Thought insertion
-Thought withdrawal
-Thought broadcasting

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14
Q

Examples of passivity phenomena?

A

-Bodily sensations being controlled by external influence
-Action/impulses/feelings experiences which are imposed on the individual or influenced by others

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15
Q

How do delusional perceptions occur?

A

a two stage process) where first a normal object is perceived then secondly there is a sudden intense delusional insight into the objects meaning for the patient e.g. ‘The traffic light is green therefore I am the King’.

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16
Q

What are some other features of schizophrenia?

A

-Impaired insight
-Negative symptoms
-Neologism
-catatonia

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17
Q

What kind of symptoms are more prominent in chornic schizophrenia?

A

-Negative symptoms

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18
Q

What is it called when the negative symptoms are prominent?

A

A deficit syndorme

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19
Q

What are the “three clusters” of chornic schizophrenia?

A

-Relaity disortion (delusions and hallucinations)
-Disorganisation (thought disorder)
-Psychomotor poverty similar to negative symptoms

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20
Q

What are the negative symptoms seen in schizophrenia?

A

-Flattened (blunted) mood
-Apathy and loos of drive
-Social isolation
-Poverty of speech
-Poor self care

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21
Q

How is management of acute schizophrenia consdiered?

A

-According to stage of illness (acute vs chronic)
-According to intervention (physical, psychological , social)

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22
Q

Why is gradual onset associated with worse prognosis?

A

-Psychosis is toxic, the longer a patient is psychotic the more it will affect their cognitive abilities
gradual onset delays diagnosis and treatment so worse prognosis

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23
Q

Prevention/early intervention of psychosis?

A

-Early intervention in psychosis (EIP) service

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24
Q

What is the aim of EIP service?

A
  • to enage patients with very early symptoms of psychosis from adulthood unitl 35
    -Patients offered antipsychotics and psycholoigcal interventions
    -Aim is to keep duration of untreated psychosis under 3 motnhs
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25
Q

What is the earliest age a ateitn can be referred to EIP?

A

-14
-CAMHS can manage psychosis in children up to 17

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26
Q

Patient in EIP but needs urgent intervention?

A

-Crisis resolution team
-Home treatment team

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27
Q

What is the mode of action of antipsychotics?

A

-Block dopamine (D2) receptors

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28
Q

Why does blockade of D2 receptors help with symptoms of psychosis?

A

It is thought that excessive dopamine in the mesolimbic system cause the symptoms of psychosis

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29
Q

How is an atypical antipsychotic descirbed?

A

An antipsychotic that does not produces extrapyramidal side effects (EPS)

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30
Q

Typical antipsychotics?

A

-Chlorpromazine
-Haloperidol
-Flupentixol decanoate

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31
Q

Atypical antipsychotics?

A

-Olanzapine
-Risperidone
-Quetiapine
-Aripiprazole
-Amisulpride
-Clozapine ? though this is a unique antipsychotic

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32
Q

What are the main typical antipsychotics that are used?

A

-Haloperidol
-Chlorpromazine

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33
Q

What are extrapyramidal side effects (EPS)?

A

Involuntary movements that patient is unable to control
-MOTOR ABNORMALITY

34
Q

Why do EPS occur with antipsychotic use?

A

-EPS are motor abnormalities that are related to dopaminergic receptor blockade in the basal ganglia

35
Q

WHat are the four types of EPS?

A

1.Acute dystonia
2.Tardive dyskinesia
3.Akathisa
4.Parkinsonism

36
Q

What is acute dystonia?

A

-Painful contraction of muscles in head, neck and jaw

37
Q

What group of people are particularly vulnerable to acute dystonia when given antipsychotics?

A

Young men that are uven high doses

38
Q

what is the onset of acute dystonia?

A

Happens within hours or days

39
Q

What is the tretament for acute dystonia?

A

IM and IV anticholinergic

40
Q

How does parkinsonism present?

A

-Decreased facial movements
-Shuffling gait
-Stiffness
-Tremor

41
Q

How are parkinsonism features managed?

A

-Reduce dose
-Anticholingeric

42
Q

what can parkinsonism features sometimes be confused with when giving antipsychotics?

A

-Depression
-Negative symptoms of schizophrenia

43
Q

What is akathisia?

A

-Feeling of restlessness and need to walk around
NOTE: can be confused with psychotic behaviour

44
Q

When do parkinsonism symptoms normally occur once given antipsychotics?

A

Early weeks of treatment

45
Q

Management for symptoms of akathisia?

A

-Lowering dose
-Propanolol

46
Q

What is tardive dyskinesia?

A

-Uncontrollable grimacing movements of face, tounge and upper body
-Very distressing and disabling

47
Q

How common is tardive dyskinesia?

A

-Occur in 5% of people who take long term antipsychotics every year
-No way of predicting who will develop it

48
Q

Treatment for tardive dyskinesia?

A

-No reliable treatment
-Sometimes irreversible

49
Q

What are the two more rare but life threatening conditions?

A

-Neuroleptic malignant syndrome (NMS)
-Prolongation fo QTc interval on ECG

50
Q

What are the clinical features of neuroleptic malignant syndrome?

A

-Fever (pyrexia)
-Stiffness
-Autonomic instability (tachycardia and fluctuating BP)

51
Q

What are charcterisitic lab features of neuroleptic malignant syndrome?

A

-Raised creatine kinase
-Leukocytosis (increaseWBC)
-Metabolic acidosis

52
Q

What is the incidence of neuroleptic malignant syndrome?

A

-1 in 500

53
Q

How serious is neuroleptic malignant syndrome?

A

-Life threatening
-Fatal in around 10%

54
Q

What antipsychotics does neuroleptic malignant syndrome occur with?

A

-Can occur with any
-Particularly with high dose such as haloperidol
-Can also occur following an increase of dose

55
Q

After an episode of NMS how do you restrat antispychotic?

A

-Restart gradually with atypical antipsychotic and close monitoring

56
Q

What does prolonged QTc on ECG predispose patient to and why does this occur?

A

-A serious arrhythmia - torsade de pointes
- IT is thought to be related to inhibition of specific cardiac potassium channels
-Thought to increase the low but increased incidence of sudden death in people using antipsychotics

57
Q

Why are atypicals used over typicals in tretament of schizophrenia?

A

-Due to side effect profiles
-There is no good evidence that atypicals are more effective than typicals

58
Q

What atypical antipsychotic has best long-term evidence for efficacy?

A

Risperidone
NOTE: availble as depot

59
Q

What is the antipsychotic that has second best evidence for long term efficacy ? (aside form clozapine)

A

Olanzapine

60
Q

What type of symptoms is amisulpride effective against?

A

Negative symptoms

61
Q

Where is quetiapine particularly useful?

A

-Treatemnt of depressive epidosde in bipolar disorder

62
Q

What particular side effct does quetipine have?

A

It is very sedating

63
Q

How is aripiprazole different?

A

-It is a dopamine PARTIAL AGONIST
- It stabilises dopamine antagonising it when levels are high and mimicking when levels are low

64
Q

What are the side effects associated with atypical antipsychotics ?

A

-Weight gain
-Hyperglycaemia and T2DM
-Metabolic syndrome (comprises duslipidaemia and hypertension
-Stroke

65
Q

What antipsychotics are more likely to cause weight gain, hyperglycemia and T2DM?

A

-Olanzapine
-Clozapine

66
Q

What are other side effects of antipsychotics?

A

Hyperprolactinaemia
-Galactorrhoea
-Amenorrhoea
-Gynaecomastia
-Hypogonadism

67
Q

What must you check before tretament with antipsychotic?

A

-History of hypertension, CVD, diabetes and obesity
-BP and pulse
-BMI
-Waist and hip circumference
-Glucose and lipid levels
-HbA1c
NOTE: GP will monitor and treat

68
Q

What should be taken every clinic appointment in someone taking antipsychotics?

A

-BMI
-Waist and hip circumference
-BP and pusle

69
Q

What should be monitored every three years for first year then annually?

A

-Glucose and lipid profile
NOTE: glucose does not need to be fasting

70
Q

What should be monitored annualy?

A

HbA1c

71
Q

How do you manage abnormalities of antipsychotic use?

A

-Advice and information on diet and lifestyle
-Can swtich to an antipsychotic less liekly to cause metabolic syndrome (if taking olanzapine or clozapine)
-Treat diabetes, hypertension and hyperlipidemia as usual

72
Q

What psychological management can be helpful in schizophrenia?

A

-CBT 16 weeks (useful positive symptoms
-Social skill training for negative symptoms
-Family therapy
-Concordance therapy where patient is encouraged to consider pros and cons of treatment

73
Q

What antipsychotic is used in patients with schizophrenia that has been resistant to other antipsychotics?

A

Clozapine

74
Q

What is treatment resistance defined as in schizophrenia?

A

-Failure to respond to 2 or more antipsychotics at least one of which is an atypical, given at a therapeutic dose for 6 weeks

75
Q

How effective is clozapine in individuals with treatment resistant schizophrenia?

A

30% of patients

76
Q

What is clozapine thought to reduce in schizophrenia?

A

Suicide risk
NOTE: no clearly greater efficacy against negative or cognitive symtpoms

77
Q

What is the biggest risk that clozapine carries?

A

It causes agranulocytosis in 1-2% patients

78
Q

Define agranulocytosis

A

-Absolute neutrophil count (ANC) is less than 100 neutrophils per microlitre of the blood

79
Q

What must be monitored weekly in patients taking clozapine?

A

-WCC
-Patients must be registered with clozapine monitoring service
-Test weekly to check for early signs of neutropenia

80
Q

Presentation of argunulocytosis?

A

Fever (normally >40) , chills, hypotension, swollen tender gums, increase RR, tachycardia,

81
Q

Aside from agranulocytosis what other side effcts can clozapine cause?

A

-Weight gain
-Hyperglycemia
-T2DM
-Metabolic syndrome
-Hypersalivation
-Weight gain
-Seizure can also occur at high doses

PSYCHIATRY (3 decks)

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