Schizophrenia Flashcards
What is schizophrenia
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).
DSM-V criteria for SCZ diagnosis
Diagnosis (DSM-V): continuous disturbance for at least 6 months, within this 6 month period at least 1 month has to include at least 2 active phase symptoms (of these active phase symptoms, at least one must be delusions, hallucinations or disorganised speech):
* Delusions * Hallucinations * Disorganised speech * Grossly disorganised/catatonic behaviour * Negative symptoms * This 6 month period must cause a marked reduction in functioning in one area of the person's life e.g. work, finances, relationships * Schizoaffective, BPAD and MDD with psychosis must be ruled out and organic psychosis must be ruled out too. * If ASD or communication disorder Hx, prominent delusions/hallucinations form part of the necessary symtpoms displayed within the requisite timeframe
ICD-11 criteria for SCZ diagnosis
ICD-11 Criteria: Symptoms present for at least 1 month, causing significant impairment.
SCZ subtypes
- Paranoid Schizophrenia: Characterized by delusions and hallucinations, often with a persecutory theme.
- Catatonic Schizophrenia: Features motor disturbances and waxy flexibility.
- Hebephrenic Schizophrenia: Marked by disorganized thinking, emotions, and behavior.
- Residual Schizophrenia: Residual symptoms persist after a major episode.
- Simple Schizophrenia: Characterized by a gradual decline in functioning without prominent positive symptoms.
Risk of developing SCZ in general population
1%
Typical onset of SCZ
Generally 15-45
SCZ risk factors
- Genetics = biggest RF
- Childhood trauma
- Urban living
- Heavy cannabis use in childhood
Positive symptoms of SCZ
ABCD:
- Auditory hallucinations
- Broadcasting of thoughts
- Control/ passivity phenomena
- Delusions
Negative symptoms of SCZ
- Affect blunted
- Alogia (poverty of speech)
- Anhedonia
- Avolition
- Asociality
Schneider’s first rank symptoms of SCZ
- Delusions
- Thought disorder
- Passivity phenomena
- Auditory hallucinations
(ABCD)
The clinical picture of schizophrenia can be divided into 3 stages:
- At risk mental state
- Acute phase
- Chronic phase
What is ARMS
Prodrome - when you start to have mild psychosis, changing in behaviours, insight maintained.
- Mx: psychosocial treatment with CBT and family intervention advised
Acute phase of SCZ
Florid psychosis - ABCD symtpoms likely
Chronic phase of SCZ
Negative symptoms/5As more common here.
May have residual positive symptoms
What is acute and transient psychotic disorder
Sudden onset of psychosis - peaks within 2 weeks but won’t last longer than 3 months. Must be the first episode of psychosis.
What is schizoaffective disorder
Schizophrenia picture with mood disorder also present e.g. depression or mania. Different to primary mood disorder with psychosis, as psychosis only develops at their extremes.
What is delusional disorder
Isolated delusions lasting 3+ months, no mood changes or other symptoms of SCZ
SCZ investigations
- Full physical exam + obs
- Routine bloods - exclude metabolic cause e.g. hyperT
- HIV test & syphilis serology
- UDS
- Neuroimaging not routine unless indicated e.g. elderly person with head injury.
First line pharmacological intervention in SCZ
- Atypical antipsychotic
- Sedatives e.g. lorazepam or haloperidol can be used for acute management of risk taking behaviour
What is treatment resistant SCZ and how is it managed
- When psychosis persists despite trialling 2 or more antipsychotics (with at least one being atypical) for at least 6 weeks each.
- If this is the case, we give clozapine.
SCZ psychological intervention
- CBT offered to all patients with SCZ or ARMS
- Family intervention - can improve communication between pt and family to help them understand each other
- Art therapy
SCZ social approaches
- Psychoeducation
- Practical needs: benefits, housing, education
- Social skills training
- Rehabilitation: assimilating into education, jobs, supported housing, social activities.
Poor prognostic markers of SCZ
- Male
- Early, insidious onset
- Longer DUP (duration of untreated psychosis - refer to EIS is ∴ crucial)
- Low premorbid IQ
- Poor social support
- Cannabis/substance use
- FHx
