Schizophrenia Flashcards
positive symptoms
delusions- persecutory, passivity, thought interference; auditory hallucinations; formal thought disorder
negative symptoms
poverty of speech and thought, flattened mood, anhedonia, loss motivation, blunted affect, social withdrawal
what are the first rank symptoms
3rd person auditory hallucinations, thought echo, delusional perception, thought insertion/withdrawal, passivity
how long must you be experiencing symptoms for for diagnosis
1 month ICD10, 6 DSM
types of schizophrenia
paranoid, catatonic, hebephrenic, residual(chronic), undifferentiated (simple)
what is paranoid schizophrenia
most common. delusions and auditory hallucinations
what is catatonic schizophrenia
uncommon. psychomotor disturbance, rigidity, posturing, echolalia, echopraxia
differentials
substance induced psychosis, psychosis due to general medical condition, mood disorders with psychotic features, sleep related disorder, dementia and delirium, PTSD, OCD, schizoaffective disorder
aetiology
neurochemical, genetic, neurodevelopmental, social
what happens to the chemicals in the brain
increased dopamine, increased serotonin, decreased glutamate
neurodevelopmental causes
obstetric complications, neurodevelopmental delay, cannabis, temporal lobe epilepsy
genetic causes
50% those with monozygotic twins have it
social causes
socio economic deprivation, excess of life events, living in a family with high expressed emotion- more likely to relapse
what is high expressed emotion
family is overinvolved, critical comments, making it hostile
what is schizoaffective disorder
mixture of schizophrenic and affective symptos- equal weighting
what is delusional disorder
fixed delusion or delusional system with other areas of thinking preserved
what is brief psychotic episodes
lasting less time than required for schizophrenia diagnosis
what can be used to treat acute psychotic episode
lorazepam and haloperidol (oral first line, IM second line)
what are the main side effects of typical (conventional) antipsychotics
EPSEs- dystonia, akithisia, tardive dyskinesia, parkinsonism
what is the benefit of atypical antipsychotics
less EPSEs as they target D2 less than D1
how do antipsychotics work
block D1 and D2 receptors so less dopamine
examples of typical antipsychcotics
chlorpromazine, haloperidol, trifluoperazine
examples of atypicals
olanzapine, clozapine, quetiapine, amisulpiride, risperidone
what are the side effects of risperidone and amisulpiride
hyperprolactinaemia
side effect olanzapine
weight gain, increased risk diabetes
side effect clozapine
agranulocytosis
what is the neuroleptic malignancy syndrome
muscle rigidity, fever, autonomic, delirium. increased CK levels and WCC
what can you give to treat neuroleptic malignant syndrome
bromocriptine
what is a neurological emergency from antipsychotics
neuroleptic malignant syndrome
what is used for treatment resistant
clozapine
definition of treatment resistant
failure to respond to more than 2 drugs for 6 weeks or more
how does clozapine work
blocks D1 and D4, lower affinity for D2 so lack of EPSEs
what are the contraindications of clozapine
neutropenia, myocarditis, pericarditis, cardiomyopathy, cardiac or renal disorders, hepatic
what is the usual dose clozapine
200-450mg
what do you measure before initiating clozapine
leukocyte count
why do you need to do weekly FBCs in clozapine use
checking for agranulocytosis
anticholinergic side effects antipsychotics
dry mouth, blurred vision, urinary retention, constipatiorn
anti adrenergic side effects
postural hypotension, tachycardia, sexual dysfunction
anti histaminic side effects
sedation, weight gain
what is schizotypal disorder
cluster A personality disorder, no delusions or hallucinations. ideas of reference, odd beliefs, odd behaviour or appearance odd speech
tests for cognition
stroop test- words and colours, trail making executive planning.
acute v chronic schizophrenia
acute- psychotic, delusions. chronic- negative symptoms
psychological and social management
psych- CBT, education, family therapy. social- housing and benefits, substance misuse, occupation, lifestyle
depot antipsychotics benefits
less frequent than tablets, known compliance, predictable bioavailability, contact and monitoring
depot antipsychotics risks
inflexible administration, longer washout if side effects, getting to steady state, patient acceptability
suicide risk is higher in
young men, first few years of illness, persistent hallucinations or delusions, hx illicit drug use, prev suicide attempts
