Schizophrenia Flashcards
Symptoms of schizophrenia are said to be _________. This means that each symptom is
pathognomonic.
present in some patients but no symptom is present in all
Schizophrenia damages multiple brain systems and produces
diverse signs and symptoms but is clearly recognisable as a syndrome.
SZ is characterised by
fundamental and characteristic distortions of thinking and perception, and affects that are inappropriate or blunted. Clear consciousness and intellectual capacity are usually maintained but certain cognitive deficits may evolve over the course of time. The most important psychopathological phenomena include: thought echo, thought withdrawal + insertion, thought broadcasting, hallucinatory voices commenting or discussing the patient in the third person and negative symptoms.
What are the 6 main symptoms of SZ?
- Auditory hallucinations
- Thought insertion/withdrawal
- Thought broadcast
- Feelings, impulses or acts are carried out under external control
- Passive/ reluctant target of bodily sensations imposed by some external agency
- Delusion perception
What are hallucinations?
Hallucinations are perception like experiences without an external stimulus. They are vivid and clear, with full force and impact of normal perceptions, and not under voluntary control. They may occur in any sensory modaility, (i.e visual, auditory, gustatory, olfactory and tactile)
What are delusions? What are the different kinds?
Fixed beliefs that are not changed in light of conflicting evidence.
- Persecutory delusions
- Referential delusions
- Grandiose delusions
- Erotomanic delusions
- Nihilistic delusions
- Somatic delusions
Negative symptoms account for a substantial portion of…
morbidity associated with SZ but less prominent in other psychiatric disorders
What are the two types of prominent negative symptoms of SZ?
Diminished emotional expression
Avolition
What are the two types of prominent negative symptoms of SZ? What are some other -ve symptoms?
- Diminished emotional expression
- Avolition (lack of drive to perform)
- Alogia
- Anhedonia (decreased ability to experience pleasure from +ve stimuli)
- Asociality (lack of interest in social interactions)
What is the Diagnostic Criteria: A?
- Hallucinations
- Delusions
- Disordered speech
- Grossly disorganised behaviour
- Negative symptoms
Two or more of the above present for a month - at least one should be 1, 2 or 3
What is the Diagnostic Criteria: B?
For a significant period of time since onset, level of function in one or more major areas is much lower the level prior to onset:
- work
- interpersonal relations
- self care
When onset is in childhood or adolescence. there is failure to achieve expected level of academic, interpersonal or occupational functioning
What is the Diagnostic Criteria: c?
Continuous signs of disturbance for at least 6 months. The 6 month period must include at least one month symptoms from CA, and may include periods of prodromal or residual symptoms. These periods of prodromal or residual symptoms, signs of disturbance may be only negative symptoms or 2 or more systems from CA in attenuated form.
What is the Diagnostic Criteria: E?
The disturbance cannot be due to the physiological effects of a substance (amphetamine), medication (L-Dopa) or another medical condition (astroglioma)
Causes of SZ? (clinically first, and then putative)
Clinically, SZ is heterogenous, so aetiology is likely to be heterogenous.
Putatively, genetic disorders (mono-zygotic twins), psychosocial stressors (onset coincides with stressful life events), chemical imbalance (drug misuse), neurodevelopment problems (age of onset).
The most common form of presentation for SZ is the initial acute episode with
florid positive symptoms followed by the emergence + persistence of negative symptoms
The course of the illness is highly _____ and depends on the ________ ______ of the individual
variable
psychosocial environment
SZ can follow a ________ and remitting course or it can be chronic and __________. The chronic and progressive course occurs in individuals who have a ______ onset of the disease.
relapsing
progressive
later
age and sex for SZ?
Male - 15 to 25
Female - 25 to 35
cumulative risk for development is equal for both sexes
What are the different types of SZ?
Paranoid Hebephrenic Catatonic Simple Undifferentiated Residual
Paranoid SZ is?
Paranoid delusions, auditory hallucinations, perceptual disturbances
Hebephrenic/ Disorganised SZ is?
Disorganised speech and behaviour.
Impairement in thought processes, speech, behavior, and emotional expression and response
Residual SZ is?
Hardest to treat. Long standing -ve symptoms
Catatonic SZ is?
Fluctuating psychomotor disturbances. Extremes of behaviour.
At one end of the extreme the patient cannot speak, move or respond - there is a dramatic reduction in activity where virtually all movement stops, as in a catatonic stupor.
At the other end of the extreme they are overexcited or hyperactive, sometimes mimicking sounds (echolalia) or movements (echopraxia) around them - often referred to as catatonic excitement.
Simple SZ is?
Progressively strange behaviour, poor social functioning, deteriorating daily functioning and mostly negative symptoms. Overt psychotic symptoms often absent.
Undifferentiated SZ is?
The undifferentiated subtype is diagnosed when people have symptoms of schizophrenia that are not sufficiently formed or specific enough to permit classification of the illness into one of the other subtypes
SZ symptoms presenting in acute phase?
- lack of insight
- auditory hallucinations
- ideas of references
- suspiciousness
- flattening of affect
- voices speaking to the patient
- delusional mood
- delusions of persecution
- thought echo
Management for SZ needs to be ______ for optimal response and thus the following components should be addressed…
____________ management should be considered as a first line treatment intervention in all cases
holistic psychological emotional social pharmacological
Antipsychotic response is seen after ____ weeks. It is ___% effective against positive symptoms. Which type of antipsychotics are more efficient agains ____ symptoms.
Which antipsychotic licensed for treatment of resistant illness?
2-4weeks
60%
SGAs
Antipsychotic response is seen after ____ weeks. It is ___% effective against positive symptoms. Which type of antipsychotics are more efficient agains ____ symptoms.
Which antipsychotic licensed for treatment of resistant illness?
2-4weeks
60%
SGAs
clozapine
What is the increase dopaminergic theory SZ?
Increased dopaminergic transmission is a pathogenic factor of SZ
SZ is due to ______ dopaminergic transmission whereas PD is _______ transmission
increased
decreased
Dopamine (D2) blockade of the ________ pathway has an anti_______ effect
limbic
psychotic
What are the two pathways you can block the D2 receptors on? And on what area of the brain?
Striatum - meso limbic
Hypothalamus - Tubero infundibular
What are the side effects of blocking D2 receptors on striatum?
Extrapyramidal side effects: - Parkinsonism - Dystonia - Akathisia Risk factor for tardive dyskinesia
What are the side effects of blocking D2 receptors on hypothalamus?
HYPERPROLACTINAEMIA
- amenorrheoa
- gynaecomastia
- sexual dysfunction
- galactorrhoea
- increased risk of osteoporosis
Blockade of D2 receptors in the mesolimbic pathway leads to
antipsychotic action of first-generation agents
Antagonism of D2 receptors in the nigrostriatal pathway is associated with
increased risk of extrapyramidal symptoms.
Blockade of D2 receptors in hypothalamus/ tubero-infundibular pathway…
increases prolactin levels by promoting its release in the pituitary gland.
Examples of FGA?
Chlorpromazine Haloperidol Sulpiride Trifluoperazine The majority of depot injections
Typical/ FGAs are…
- non selective
- 76%-80% occupancy of mesolimbic D2 receptors required for effect
- This means that FGA can act on other pathways.. leading to hyperprolactinaemia (tuberoinfundibular) and EPSE (nigrostriatal)
Examples of SGA?
- CLOZAPINE!
- risperidone
- sertindole
SGAs are…
- selective D2 blockade (of meso limbic)
- Variable receptor occupancy oh 5HT-1A, 5HT-2A, 5HT-2C and ALPHA 1 subtypes
- Fewer or no EPSE
- Fewer or no hyperprolactinaemia (except risperidone and amisulpride)
Predicted adverse effects (Type A; augmented)
PCDDHL
- predicted from pharmacology of drug
- common
- dose dependent
- decreased severity with time
- high morbidity
- low morbidity
Examples of predicted side effects?
- Histamine blockade
- Anticholinergic
- Alpha blockage
Unpredicted adverse effects (Type B; bizzare)
- not predictable from pharmacology
- not common
- not dose dependent
- severity does not decrease with time
- low morbidity
- high mortality
Examples of predicted side effects?
- Histamine blockade
- Anticholinergic
- Alpha blockage
Examples of unpredicted side effects?
- ocular deposits
- photosensitivity
- hepatitis
- ECG changes
- convulsions
Which antipsychotic helps improve symptoms of tardive dyskinesia?
Clozapine
MAJOR SIDE EFFECT OF SGA?
Metabolic disturbances such as weight gain and hyperglycaemia
In order to choose and antipsychotic you need a balance between
efficacy, patient tolerability, and how the treatment will impact on the patient’s lifestyle
Which antipsychotic is first line in patients with newly diagnosed SZ?
SGA
when discussion with the individual is impossible what do you give?
SGA e.g clozapine
MAJOR SIDE EFFECT OF SGA?
Metabolic disturbances such as weight gain, hyperglycaemia, blood pressure and cholesterol
