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Psychiatry > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

What characterises schizophrenia?

A
  • Psychosis
  • Hallucinations
  • Delusions
  • Disorganised speech and behaviour
  • Flattened affect
  • Cognitive deficits
  • Occupational and social dysfunction
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2
Q

What is psychosis?

A

Loss of contact with reality

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3
Q

What are hallucinations?

A

False perceptions: may be auditory, visual, olfactory, gustatory or tactile. Auditory most common.

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4
Q

What are delusions

A

False beliefs maintained despite clear contradictory evidence
(e.g. persecutory: pt believes being tormented, followed, tricked, spied on)

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5
Q

What is flattened affect

A

Restricted range of emotions

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6
Q

What are cognitive deficits of schizophrenia?

A

Impaired reasoning and problem solving

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7
Q

Symptom onset schizophrenia?

A

Adolescence - early adulthood
Women: early - mid 20s
Men: slightly earlier, 40% by 20y

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8
Q

Duration required for diagnosis schizophrenia?

A

One or more episodes of symptoms must last >6mo before dx made

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9
Q

Brain alterations observed in schizophrenia?

A
  • Enlarged cerebral ventricles
  • Thinning of cortex
  • Decreased size of ant hippocampus and other regions
  • Altered neurotransmitters (esp dopamine and glutamate)
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10
Q

Posited cause of schizophrenia?

A

Neurodevelopmental vulnerabilities (interact with environmental stressors to give relapse-remitting)

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11
Q

What may cause neurodevelopmental vulnerability?

A
  • Genetic predisposition
  • Intrauterine/birth/postnatal complications
  • Viral CNS infection
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12
Q

Which factors increase risk of schizophrenia?

A
  • Maternal exposure to famine and influenza during 2nd/3

- Birth weight

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13
Q

Risk of schizophrenia in general population vs 1st degree relative v monozygotic twin affected?

A

1% general,10% with 1st degree, 50% monozyg twin

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14
Q

Endophenotypes of schizophrenia?

A
  • Aberrant smooth pursuit eye tracking
  • Impaired cognition and attention
  • Deficient sensory gating
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15
Q

Significance of schizophrenia endophenotypes?

A

Also occur in 1st degree relatives –> may represent inherited component of vulnerability

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16
Q

Stressors promoting emergence/recurrence schizophrenia?

A

-Biochem (e.g. marijuana)
-Social (losing job, leaving home, etc)
Not CAUSATIVE

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17
Q

Common outcomes schizophrenia?

A
  • Unemployment
  • Isolation
  • Deteriorated relationships
  • Diminished quality of life
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18
Q

Phases of schizophrenia?

A
  • Premorbid
  • Prodromal
  • Middle
  • Late
19
Q

What characterises premorbid phase?

A

-No Sx or
- impaired social competence
-mild cognitive disorganisation or perceptual distortion
-anhedonia
May be mild OR have impact on social / academic / work fxn

20
Q

What characterises prodromal phase?

A 
Subclinical symptoms:
-withdrawal / isolation
-irritability
-suspiciousness
-unusual thoughts
-perceptual distortions
-disorganisation
Onset of overt schiz (delusions and hallucinations) may be sudden (d->w) or slow (years)
21
Q

What characterises middle phase of schizophrenia?

A

Symptomatic periods may be episodic or continuous

Functional deficits worsen

22
Q

What characterises late illness?

A
  • Illness pattern established

- Disability may stabilise or diminish

23
Q

Categories of symptoms?

A
  • Pos: excess/distortion of N fxns
  • Neg: diminution / loss N fxns
  • Disorganised: thoughts d/o and bizarre behaviour
  • Cognitive: deficits in information processing and problem solving
24
Q

How may positive symptoms be classified?

A

Delusions or hallucinations

25
Q

What are delusions of reference?

A

Puts believe passages from books newspapers, song lyrics or other cues directed at them

26
Q

Delusions of thought insertion / withdrawal?

A

Pts believe others can:

  • read their mind
  • thoughts being transmitted to others
  • thoughts and impulses being imposed on them by outside forces
27
Q

What are disorganised symptoms?

A 
Thought disorders and bizarre behaviours
-thinking disorganised
-rambling, non directed speech; shifts from one topic to another
Behaviour: 
-childlike silliness,
- agitation and 
-inappropriate appearance / hygiene / conduct.
-Catatonia (extreme)
28
Q

How may schizophrenia be classified?

A

Deficit (prominent negative symptoms) and non-deficit (+ve symptoms but relatively fee of neg symptoms)

29
Q

Major cause of premature death in schizophrenics?

A

Suicide: 5-6% commit, 20% attempt

30
Q

Most at risk of suicide?

A

Young men with schizophrenia and substance abuse

31
Q

Relationship between violence and schizophrenia?

A

Modest risk factor for violence:

  • threats / minor outbursts not seriously dangerous behaviour
  • substance abuse, persecutory delusions or command hallucinations, non Rx comp
  • attack . murder someone they perceive as source of difficulties (very depressed / isolated / paranoid puts)
32
Q

How is schizophrenia diagnosed?

A

Hx, symptoms and signs. DSM-5:
1. >2 characteristic Sx (delusions, hallucinations, disorganised speech, disorganised behaviour, negative symptoms) for sig portion 1mo period
2. Prodromal or attenuated signs of illness with social, occupational or self care impairments for 6mo period including 1mo active symptoms
Must r/o other causes (e.g. psychosis due to medical d/o or substance abuse)

33
Q

Factors associated with good prognosis?

A
  • Good premorbid function
  • Late / sudden onset
  • FHx mood d/o (other than schiz)
  • Min cognitive impairment
  • Few negative symptoms
  • Shorter duration untreated psychosis
34
Q

Factors ass/w poor prognosis?

A
  • Young age at onset
  • Poor premorbid function
  • FHx of schizophrenia
  • Many -ve symptoms
  • Longer duration untreated psychosis
35
Q

How does substance abuse interact with schizophrenia?

A
  • Significant predictor of poor outcome
  • May lead to:
  • drug non adherence
  • repeated relapse
  • frequent rehospitalisation
  • declining function
  • loss of social support (inc homelessness)
36
Q

Treatment of schizophrenia?

A
  • Antipsychotics
  • Rehab (inc comm support services)
  • Psychotherapy
37
Q

Goals of schizophrenia Rx?

A
  • Reduce symptoms severity
  • Prevent recurrences and deterioration of function
  • Help function at highest level possible
  • Teach illness self management
38
Q

Conventional v second gen antipsychotics?

A

-SGAs modestly greater efficacy (-alleviate +ve Sx, lessen -ve Sx)
-Reduced likelihood of movement disorder (less extrapyramidal AEx, less tardive dyskinesia)
-Increase prolactin slightly or not at all (except risperidone)
-Less cognitive blunting
BUT
-increased risk metabolic syndome

39
Q

DDx for poor motivation in previously psychotic individual?

A
  • -ve Sx schizophrenia
  • AEx Rx e.g. sedation
  • Major depression
  • Schizoaffective d/0: depressive ep
  • BPAD, depressive ep
  • Substance use
  • Underlying organic d/o (e.g. hypothyroidism, anaemia)
  • grief
  • normal adolescence
40
Q

Long term Mx of schizophrenia?

A

-Case management with eventual transition to GP care
>regular MSE for +ve Sx
-revise dx
-drug Mx
-metabolic syndrome
-beware suicidal ideation
-D+A: motivational interviewing
-Continuous psychoeducation: (CBT for EWS, psychotherapy, family/group therapy)
-Continuous grief process
-Psychosocial rehabilitation ($, transport, occupation, housing, social)

41
Q

what are the 4 principles for motivational interview?

A
  1. Engage
  2. Point out differences
  3. Roll with resistance
  4. Empower
42
Q

What is schizoaffective d/o?

A

Pt with both mood d/o and psychotic features without clear relationship between them.

43
Q

What is schizophreniform disorder?

A

Features parallel schizophrenia but duration must not exceed 6/12 i.e. pts with abrupt onset who respond well to treatment and are free or residual symptoms.

Psychiatry (16 decks)

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