Schizophrenia Flashcards
Schizophrenia risk factors
lower socioeconomic class
migrant populations and ethnic minorities
family history of schizophrenia
urban populations
obstetric complications (prenatal nutritional deprivation, prenatal brain injury, prenatal influenza)
neurological abnormalities
first year parental separation
substance misuse
Early signs of schizophrenia in young adulthood (prodrome)
anxiety
nervousness
restlessness
depression
trouble concentrating
unclear thinking
diminished self-confidence
low energy levels
severe decline in work or school performance
social withdrawal
Schizophrenia symptoms
positive symptoms - hallucinations, disorganised speech, delusions, disorganised behaviour
negative symptoms - diminished speech, diminished motivation, emotional blunting, diminished pleasure-seeking
Catatonic symptoms
stupor - marked decrease in reactivity or mutism
excitement - increase in purposeless activity, not influenced by external stimuli
waxy flexibility (catalepsy) - can be moulded like max into a position that is then maintained
stereotypy - repeated complex non-goal directed movement eg. rocking
mannerism - goal-directed movement performed repeatedly or at socially inappropriate times eg. waving, saluting
ambitendence - begins to make movement but before completing starts the opposite movement
autonomic obedience - obeys commands, even when told not to
Types of schizophrenia
paranoid
hebephrenic/disorganised
residual
catatonic
simple
post-schizophrenic depression
undifferentiated
Features of paranoid schizophrenia
presence of delusions + hallucinations
negative symptoms and catatonia uncommon
most common type, better prognosis
Features of hebephrenic/disorganised schizophrenia
affective changes
disturbed behaviour
mannerisms
social isolation
delusions + hallucinations fleeting + fragmented
age of onset 15-25y
rapid development of negative symptoms eg. flat affect + avolition
Features of residual schizophrenia
chronic stage
clear progression from positive symptoms to later stage with mainly negative symptoms
Features of catatonic schizophrenia
catatonic symptoms
rare
treatment - antipsychotics, benzodiazepines, ECT
catatonic symptoms can also occur in encephalitis, carbon monoxide poisoning, drug and alcohol and mood disorders
Features of simple schizophrenia
insidious, progressive development of oddities of conduct, inability to meet the demands of society and decline in total performance
negative features of schizophrenia develop without being preceded by other overt psychotic symptoms
Features of post-schizophrenic depression
depressive episode arising in the aftermath of a schizophrenic illness
some schizophrenic symptoms may be present, but do not dominate the clinical picture
increased risk of suicide
Features of undifferentiated schizophrenia
meets general diagnostic criteria but does not conform to any subtype, or features of >1 subtype without a clear predominance
Schizophrenia investigations
bloods - FBC, U+Es, LFTs, glucose, HbA1c, lipid levels, bone group - establish baseline before starting antipsychotics, exclude medical causes
urine drug screen
ECG
consider CT head
What should be considered when deciding where someone with psychosis/schizophrenia should be managed?
severity
risks
housing situation
support
compliance with medications
insight
if hospital - informal or under MHA
Biopsychosocial model for treatment of schizophrenia
biological:
- antipsychotics
- consider ECT if catatonic
- ?PRN medications for agitation or insomnia
- address substance misuse
psychological:
- CBT reduces psychotic symptoms
- family intervention reduce relapse rates
- art therapy helps negative symptoms
Social:
- financial benefits, accommodation
- supported employment programmes
- support groups
