Schizophrenia Flashcards
What are some positive symptoms of psychoses? (5)
- Hallucinations
- Delusions
- Disorganised speech/ thinking
- Grossly disorganised behaviour
- Catatonic behaviour (decrease reaction to surround environment)
What are some negative symptoms of psychoses? (3)
- Affective flattening (decrease emotional expression)
- Alogia (decrease speech)
- Avolition
Causes of schizophrenia?
Genetic (DISC-1, COMT, D3 may play a part)
Environment (Obstetric complications, early use of drugs)
Management of schizophrenia?
Pharmacological
Patient psychoeducation, family education
Problem solving, self help group
Job training, social skills training- Therapy
Assistance with daily living skills
What is schizotypal personality disorder?
Show symptoms such as: Ideas of reference Odd beliefs 'magical' thinking Unusual perceptual experiences Suspiciousness or paranoid ideation Odd behaviour
BUT NO HALLUCINATIONS
What is schizophreniform disorder?
A preliminary diagnosis for schizophrenia
If symptoms dont decrease within 6 months,, schiz is diagnosed
What is a brief psychotic disorder?
An extremely stressful event or trauma
Psychotic symptoms last for more than one day but less then one month
What is delusional disorder?
Non bizarre delusions: being deceived, poisoned, infected
Subtyped into categories: grandiose, jealous, persecutory
What is schizoaffective disorder?
Combination of schizophrenia and a mood disorder
What treatment is available for a schizoaffective disorder?
Medication: treat both psychotic and affective symptoms
Atypicals are better than typicals
Therapy to increase interpersonal skills/insight
Assistance with occupational issues
The dopamine hypothesis in schiz?
Positive symptoms shown by hyperactive mesolimbic projections (hyperstimulation of D2 receptors)
Negative symptoms shown by hypoactive mesocrtical projections to prefrontal cortex (hypostimulation of D1 receptors)
Which antipsychotics are better at treating positive symptoms?
typical antipsychotics
What are EPS?
Motor disturbances resulting form the basal ganglia and their connections, caused by decrease dopaminergic activity in nigrostriatal pathway
Acute: dystonia, akathiasia, parkinsonism
Chronic: tardive dyskinesia
Higher D2 antagonism, higher chance of EPS
Why do atypical not cause as many EPS as typical antipsychotics?
- Greater 5-HT2a: D2 antagonism ratio
- ‘Fast dissociation’ hypothesis
- Preferential action on limbic D2/D3 receptors
Common side effects of antipsychotics? (9)
- EPS
- Sedation
- Postural hypotension
- Blood dyscrasias
- Weight gain
- Glucose dysregulation dyslipidaemia
- Anticholinergic
- Hyperprolactinamia
- Sexual dysfunction
How to manage EPS?
- Reduce dose
- Switch to another antipsychotic- Aripiprazole, olanzepine, quetiapine, risperidone, clozapine
- Add anticholinergic
How to manage akathisia?
- Reduce dose
- Less responsive to anticholinergic
- Alternatives: propanolol or BZD
- Change med: aripiprazole, olanzepine, quetiapine, clonzapine
How to manage tardive dyskinesia?
- If detected early- antipsychotic can be ceased or reduced
- If detected late- may be unresponsive to treatment
- Mild symptoms- BZD (clonazepam)
- Botox may be helpful in some cases
- Change med to clonzapine, aripiprazole, quetiapine, olanzepine
What is neuroleptic malignant syndrome?
Can be associated with any antipsychotic
Shows S/S of fever, rigidity, confusion, altered conscious state, leucocytosis
Treat by stopping all antipsychotics, monitor BP/pulse, rehydrate, respiratory support, cool body if >39
Bromocriptin/dantrolene may be effective for agitation
What are major barriers to compliance?
- Regimen complexity
- Poor communication
- Unresolved concerns
Advantages and disadvantages of using a depot?
Advantages:
Overcomes difficulty of adherence problems
More consistent absorption
Delivers a constant dose throughout dosage period
Infrequent dosing
Disadvantages:
Injection
Long period of elimination if adverse effects occur
Specialist knowledge is required
