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Year 4 - Psychiatry > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

What is Schizophrenia?

A

Chronic relapsing condition, form of psychosis with distortion to thinking and perception and inappropriate or blunted affect

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2
Q

When does schizophrenia present?

A

15-30

Earlier in men than women

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3
Q

How long must symptoms be present for schizophrenia to be diagnosed?

A

1 month

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4
Q

What is Schizoaffective disorder?

A

Symptoms of schizophrenia with bipolar disorder

Patients have psychosis and symptoms of depression and mania

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5
Q

What is Schizophreniform disorder?

A

Same features as schizophrenia but less than 6 months

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6
Q

How would you explain schizophrenia to a patient?

A

Condition that affects how the brain processes information

Brain struggles to understand the world and makes mistakes deciding what information is important and organises thoughts in a confused way

This causes strong beliefs that do not fit with reality called delusions and experience voices that are not there called hallucinations

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7
Q

What is the psychosis?

A

Individual is experiencing a reality different to everyone else
Lack of insight

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8
Q

How long does it take for a psychotic episode to happen?

A

Can begin suddenly or gradually

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9
Q

How long do psychotic episodes last?

A

Days, weeks or months

Longer the psychosis, more damaging effects

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10
Q

What is a hallucination?

A

Perception in the absence of an external stimulus

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11
Q

Are voices in the head psychosis?

A

No, pseudohallucination

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12
Q

What is formal thought disorder?

A

Problem of speech, which means each sentence does not follow on from the next

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13
Q

What can a psychotic episode cause?

A

Personality change

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14
Q

What can cause psychosis?

A

Psychotic depression
Stroke
Hyperthyroidism
Cushing’s syndrome
Huntington’s
Steroid induced’
Brain tumours
Drugs
Mania

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15
Q

What causes schizophrenia?

A

Genetic and environmental factors

Family member affected is a large risk factor

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16
Q

What is the chance of schizophrenia in identical twins if one twin is affected?

A

50%

Environmental factors also contribute to risk of development

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17
Q

How does schizophrenia first present?

A

Prodrome phase
Precedes full symptoms of psychosis

Patient experiences subtle symptoms

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18
Q

What are the central features of schizophrenia?

A

Delusions
Hallucinations
Thought disorder (disorganised thoughts causing abnormal speech and behaviour)

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19
Q

What is lack of insight?

A

Important feature of psychosis

Lack awareness that delusions and hallucinations are not based in reality

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20
Q

What are the key positive symptoms typical in schizophrenia?

A
  • Auditory hallucinations
  • Persecutory delusions (someone is going to harm them)
  • Somatic passivity (external entity is controlling their sensations and actions)
  • Thought insertion or withdrawal
  • Thought broadcasting
  • Ideas of reference (events or details relate to them)
  • Delusional perceptions
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21
Q

What are the key negative symptoms of schizophrenia?

A

5 As

Affective flattening (minimal emotional reaction to emotive subjects or events)
Alogia (reduced speech)
Anhedonia
Avolition (lack of motivation towards goals)
Asociality (no desire for social interaction)

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22
Q

What is a delusional perception?

A

Delusion formed in response to external stimulus without any logical sense

e.g. watching TV and believing you were chosen to meet the president

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23
Q

What does a reduced level of functioning involve in schizophrenia?

A

Social engagement
Productivity and achievement at work or school
Self-care

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24
Q

What are the patterns of schizophrenia?

A

Continuous
Episodic
Single episode only

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25
Q

What is diagnosis of schizophrenia based on?

A

ICD-11 criteria only

Below is what DSM5 uses

Symptoms present for at least 6 months

Symptoms of active phase must be present for at least 1 month

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26
Q

How is schizophrenia managed?

A

Early intervention in psychosis
For first episodes of psychosis

Crisis resolution and home treatment teams
Urgent support for patients in a crisis

Acute hospital admission

Community mental health team
Ongoing monitoring and management

27
Q

What are Schneider’s first rank symptoms of schizophrenia?

A

ABCD

Auditory hallucination, about the person in the 3rd person, a voice or voices giving running commentary on the patient’s actions or thoughts in 3rd person

Broadcasting of thought

Controlled phenomenon - feelings, actions or impulses controlled by something or someone else

Delusional perception

28
Q

How is schizophrenia treated?

A

Antipsychotics
CBT

29
Q

What are antipsychotics also called?

A

Neuroleptics

30
Q

How do antipsychotic medications work?

A

Inhibiting dopamine receptors

D2 receptors

31
Q

What pathways are targeted?

A

Mesocortical
Mesolimbic

32
Q

Where do unwanted side effects of antipsychotic use come from?

A

Nigrostriatal
Tuberoinfundibular

33
Q

What are some examples of oral antipsychotics?

A

Chlorpromazine
Haloperidol
Quetiapine
Olanzapine
Risperidone

34
Q

What are depot antipsychotics and when are they used?

A

IM injections every 2 weeks-3 months

Useful when adherence is an issue

Aripiprazole
Risperidone
Paliperidone

35
Q

What can happen with chlopromazine use?

A

Oculogyric crisis

Dystonic reaction, causes extrapyramidal effects

36
Q

What do you give for extrapyramidal side effects? e.g. oculogyric crisis

A

Procyclidine

37
Q

When is clozapine used?

A

When other treatments do not control symptoms

Only available orally

Very effective but significant adverse effects

38
Q

What are the adverse effects of clozapine?

A

Agranulocytosis
Myocarditis
Constipation
Seizures
Excessive salivation

39
Q

What are the common side effects of clozapine use?

A

Constipation
Excess salivation
Weight gain
Sedation
Metabolic disturbances

40
Q

Before starting antipsychotics and during what is monitored?

A
  • Weight and waist circumference
  • BP and HR
  • Bloods
  • ECG
41
Q

What are the side effects of antipsychotics?

A
  • Weight gain
  • Diabetes
  • Prolonged QT interval
  • Raised prolactin
  • Extrapyramidal symptoms
42
Q

What are the extrapyramidal side effects?

A

Akathisia (inability to stay still)
Dystonia
Pseudo-parkinsonism
Tardive dyskinesia (abnormal movements, particularly affecting face)

43
Q

What can be given for tardive dyskinesia?

A

Tetrabenazine

T=Tardive

44
Q

What is the difference in side effects between typical and atypical antipsychotics?

A

Typical
More likely to cause extra-pyramidal side effects
Dizziness
Sexual dysfunction
Binds to more muscarinic and histaminic receptors

Atypical
More serotonergic activity
Weight gain
Dyslipidaemia and diabetes

45
Q

What are some examples of Typical antipsychotics?

A

Haloperidol
Chlopromazine
Flupenthixol
Zuclopenthixol
Sulpiride

46
Q

What are some examples of Atypical antipsychotics?

A

Clozapine
Olanzapine
Quetiapine- used in BPAD, can increase risk of lithium toxicity
Risperidone
Amisulpiride
Aripipzaole

47
Q

How does clozapine work?

A

D2 antagonist
5HT-2 antagonist

48
Q

When is clozapine used?

A

In schizophrenia after two other antipsychotics have not been effective

49
Q

How is clozapine monitored?

A

Agranulocytosis risk
Weekly FBC for first 18 weeks
Biweekly for up to a year
Then monthly

50
Q

What is the highest cause of fatality in clozapine use?

A

Significant hypo-mobility of the bowels
Constipation causing fatal bowel obstruction

51
Q

How is agranulocytosis treated?

A

Stop clozapine
Stop any other bone marrow suppressors e.g. sodium valproate
If antipsychotic needed give aripiprazole
Prophylactic ABx
Lithium to increase WCC and neutrophil count

Consider G-CSF

52
Q

What is neuroleptic malignant syndrome?

A

Life threatening complication of antipsychotics

Typical Triad
Muscle rigidity
Hyperthermia
Altered consciousness
Autonomic dysfunction

53
Q

What causes death in neuroleptic malignant syndrome?

A

Rhabdomyolysis
Renal failure
Seizures

54
Q

What are the risk factors for neuroleptic malignant syndrome?

A

High potency dopamine antagonists (typical antipsychotics)
High doses
Young men

55
Q

What are the key blood findings in neuroleptic malignant syndrome?

A

Raised creatine kinase
Raised white cell count

56
Q

How is neuroleptic malignant syndrome managed?

A

Stop causative medications
Supportive care- cooling blankets, fluids etc

Bromocriptine (dopamine agonist) in severe cases with dantrolene (muscle relaxant)

57
Q

How is rhabdomyolysis treated in neuroleptic malignant syndrome?

A

Fluids and sodium bicarbonate
Alkalises the urine

58
Q

What is part of the mesocortical pathway and what does it do?

A

Ventral tegmental area
Prefrontal cortex

Executive functions

59
Q

What is part of the nigrostriatal pathway and what does it do?

A

Substantia nigra
Caudate nucleus
Putamen

Motor function
Reward-related cognition
Associative learning

60
Q

What is part of the tuberoinfundibular pathway and what does it do?

A

Hypothalamus
Pituitary gland

Prolactic secretion

61
Q

Why can gynaecomastia develop in antipsychotic use?

A

D2 receptor inhibition in the tuberoinfundibular pathway

This causes a rise in prolactin as there is reduced regulation from reduced dopamine

Increase prolactin leads to gynaecomastia, galactorrhoea, reduced libido

62
Q

What antipsychotic has the lowest risk of hyperprolactinaemia?

A

Aripiprazole

63
Q

Why does olanzapine not work as well in patients who smoke?

A

Smoking can induce CYP450 enzymes in the liver

This causes increased breakdown up to 50% of olanzapine, so patients will need an increased dose

Year 4 - Psychiatry (23 decks)

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