Schizophrenia

Question 1

What are the different types of schizophrenia?

Answer 1

Paranoid- persecutory, systematised delusions, hallucinations, auditory. Commonest.

Disorganised- hebephrenic- bizarre delusions

Question 2

What are the CFs of chronic schizophrenia?

Answer 2

Burn out disease. - negative sx.
Acute- +ve sx. Can be both anytime.
Negative sx: flattened (low)mood
Apathy, loss of drive, - avolotion
Social isolation
Poverty of speech
Poor self care

+ve sx persist or recur at time of stress

Mild cognitive impairment is common

Question 3

Some +ve sx?

Sx that are usually not there

Answer 3

Reality distortion - delusions (fixed unshakable belief), hallucinations

Disorganization (thought disorder)

Psychomotor poverty- like retardation- similar to negative sx.

Question 4

Prognosis

Answer 4

The more years the higher the chances of suicide. 1 in 10

Question 5

Tx?

Answer 5

Acute vs chronic.
Physical, psychological, social

Admission- under mental health act if necessary and dangerous
Antipsychotics- sx tx for 2-3W
Benzodiazepines- for sedation if distressed or difficult
Establish context disorder
Asses needs and risk
Educate family,

Following a svhizophrenic episode, post-schizophrenic depression is common.

Question 6

Management of chronic schizo?

Answer 6

Prevent relapse
Oprimise functioning

Antipsychotic meds- reduce relapse for 2Y after episode from 70-50%
Adherence?
MDT
Care program approach- medical and social needs met
Readmit during relapse- stabilise
Cognitive therapy- reduce sx
Social skills training- to improve social functioning

Question 7

What are the main typical of antipsychotics?

Answer 7

typical and atypical
Also used to treat aggitated behaviour or violence.

All are dopamine D2 receptor antagonists - alliviate +ve sx of schizo.
Early dx imp, the longer the untreated psychosis, the worse the outocme.

Typical:
Haloperidol
Chloropromazine
Fluphenazine

Question 8

SE of typical antipsychotics?

Answer 8

Rspestlensness, constipation, tardive dyskinesia, sedation, hypotension.

Question 9

When are the atypical antipsychotics used? Give some examples

Answer 9

Better at treating schizo and less likely to cause extra pyramidal motor side effects like rigidity and tremors.

Clozapine (GOLD STANDARD) but can obly be presceibed when 2 other antipsychotics have failed

Risepiridone
Quetiapine

Question 10

Why is clozapine used after 2 antipsychotics have failed?

Answer 10

Can cause serious agranulocytosis and requires blood monitoring

Question 11

What are some SE of atypical antipsychotics?

Answer 11

Wt gain
Nausea
Impaired glucose tolerance

Question 12

Whats the schizoaffective disorder?

Answer 12

Both features of schizo and mood disorder, can be either bipolar or major depressive disorder, but not meeting criteria for both.

Onset usually young adulthood.

Question 13

What is it? Whatbare the clinical features?

Answer 13

Closer to madness- psychotic.
If paranoid- then dangerous.

Characteristic sx:
1st rank sx:
Thought insertion, echo, (hear ur thoughts like u hear me?) withdrawal, broadcasting.
3rd person auditory hallucinations- talking about u
Passivity of thoughts- thoughts controlled by somone else??
Delusional perception (association)
Thought disorder
Lack of insight (reality distortion- here and now)
Soacial withdrawal

Duration: at least 1 M

Exclusion: Not secondary to elevation or depression

No organic causes- amfetamines, temporal lobe epilepsy.

The more sx there are the more likely it is.