Schizophrenia Flashcards
What is the definition of schizophrenia?
A long-term mental disorder that can cause significant disruptions in a person’s thoughts, perceptions, emotions, and social interactions
What is the aetiology of schizophrenia?
Genetic factors
- 78% heritability
- Polygenetic
Environmental factors
- 2nd trimester viral illness
- Obstetric problems (pre-eclampsia, fetal hypoxia, emergency c-section)
- Childhood viral CNS infection
- Substance misuse, especially cannabis
What is the pathophysiology of schizophrenia?
Mesolimbic pathway implicated
High dopamine levels and overactive dopamine receptors
Serotonin receptors also thought to be implicated
What are the first rank symptoms of schizophrenia?
Auditory hallucinations (third person and/or voices commenting on person’s behaviour)
Thought abnormalities (blocking, withdrawal, insertion, broadcasting)
Delusional perception (persecutory, ideas of reference)
Passivity
What is the pathology of schizophrenia?
Enlarged ventricles
Reduced fronto-temporal volume
Reduced activation of prefrontal areas on specific tasks eg Stroop test
What are the positive cluster of schizophrenia symptoms?
Acute onset
Prominent delusions and hallucinations
Normal brain structure
Biochemical disorder involving dopaminergic transmission
Good response to neuroleptics
Better outcome
What are the negative cluster of schizophrenia symptoms?
Slow, insidious onset
Relative absence of acute symptoms
Presence of apathy
Social withdrawal
Lack of motivation
Underlying brain structure abnormalities
Poor antipsychotic response
What is hebephrenic schizophrenia?
Also known as ‘disorganised schizophrenia’
Affective changes prominent
Delusions and hallucinations
Behaviour irresponsible and unpredictable
Mood is shallow and inappropriate
Disorganised thoughts
Speech incoherent
Tendency to social isolate and negative symptoms
What is catatonic schizophrenia?
Movement disorder predominates, alternating between stupor and hyperkinesis
Automatic obedience, posturing and waxy flexibility may be seen
What is the medical treatment for an acute episode of schizophrenia?
1) 2nd generation antipsychotic (eg risperidone or olanzapine) titrated up over 6-8 weeks
2) 1st generation antipsychotic (eg haloperidol) titrated up over 6-8 weeks
3) Check diagnosis/compliance then consider combining two antipsychotics or clozapine
What method of treatment can be given for poor medication compliance in schizophrenia?
Depo injections
What factors are associated with better prognosis in schizophrenia?
Higher IQ/education level
Sudden onset
Presence of a precipitating factor
Strong support network
Predominance of positive symptoms
What is the prognosis for schizophrenia?
Rule of quarters:
25% never have another episode
25% improve substantially with treatment
25% some improvement
25% treatment resistant
