Schizophrenia Flashcards
Positive symptoms of Schizophrenia
Hallucinations
Delusion
Impaired insight
Disorganised thinking and speech eg tangential, LOA
Negative symptoms of schizophrenia
Lack of motivation Poor self care Blunted affect Reduced speech output Social withdrawal Also known as the 6 A - Attention impairment - Affect blunted - Alogia - poverty of speech - Anhedonia - inability to experience pleasure - Asocality - Lack of desire to form relationships - Avolition - lack of motivation
Cognitive symptoms of schizophrenia
Impaired planning Reduced mental flexibility Impaired memory - verbal memory Impaired social cognition Frontal deficits/executive functioning Reduce attention Impaired verbal fluency Problems with serial learning
Excitment symptoms of schizophrenia
Disorganised behaviour
Aggression
Hostility
Mood symptoms of schizophrenia
Depression
Anxiety
Term used for : Wandering from the topic (thought form)
Tangential
Term used for : Rapid, fragmented, unrelated ideas (thought form)
Flight of ideas
Term used for thoughts that drift from loosely related to completely off track.
Knights - move thinking or Derailment
Disorders of affect
Restricted/constricted = slightly less Blunted = ++ reduced Flat = almost absent Inappropriate = does not fit with speech content
Disorders of mood
Emotional lability = abnormal change ability
Depression and mania
Negative symptoms of Schizophrenia
Affect blunted - decreased facial expression of emotion
Alogia - poverty of speech
Anhedonia- inability to experience pleasure
Asociality- Lack of desire to form relationships
Avolition- and lack of motivation
Attention - impairments
-Ve symptoms have bigger impact on QOL, functional disability and burden to other then +Ve symptoms.
What make negative symptoms worse
Comorbid depression or anxiety Extra pyramidal side effects Environmental deprivation Secondary to positive symptoms Cognitive deficits
Extrapyramidal side effects of antipsychotic medication
1st - mins to hrs Acute dystopia - Involuntary sustained muscular contractions or spasm. Mx: Benztropine
2rd - hrs to days Akathisia- Subjective feeling of inner restlessness and muscular discomfort. Mx stop and swap
3rd - days- wk - M Parkinson like symptoms - muscular rigidity, bradykinesia and resting tremor. Mx Propanolol, Benztropine
4th - Months - Yr Tardive dyskinesia - rhythmic, involuntary movements of head, limbs, and trunk, especially chewing, grimacing of mouth and protruding darting movements of tongue. Mx switch to Clozapine
Phases of schizophrenia
Prodrome - deterioration of function Active psychotic (1month) - Delusion, Hallucinations, Disorganised speech, Grossly disorganised behaviour, Negative symptoms. Residual - functional impairment, abnormalities of affect, cognition and communication.
Post injection syndrome caused by Olanzapine depo
Profound sedation with dizziness, weakness, altered speech, HTN, and seizure, coma or delirium.
0.07%
Monitoring every 30 mins for the first 3 hours.
Risk factors of relapse in psychosis
Poor insight into purpose of medication
Psychosocial stressors, substance use and premature lowering of the dose
Or discontinuation of antipsychotic tx.
General side effect of antipsychotic drugs both first and second generation
Anticholinergic effect: Dry mouth, Blurred vision, Increase intraocular pressure, Constipation, Urinary hesitancy, Overdose - Delirium, enlarge pupil, hot, dry, flushed, skin and increase HR.
Alpha adrenergic anlog: orthrostatic hypotension, Impotence and failure to ejeculate
D2 antagonist: EPSE, increase prolactin: Hyperprolactinaemia: Gynaecomastia, Galactorrhea, Menstrual cycle disturbance, Anovulation, Impaired spermatogenesis, Decrease Libido, Decreased sexual arousal
- Impotence and anorgasmia
H antagonist: sedative
Haematological: agranulocytosis
Endocrine: Dyslipidaemia, Metabolic syndrome:
Other: LFT dysfunction, NMS, Rash, Temp.
Difference between First generation antipsychotic and second generation
More hyperprolactinaemia More EPSE More Hyperglycaemia Same anticholingeric effects Same dyslipidaeima Same orthostatic hypotension Same sedation Same wt gain
Adverse affects of Olanzapine
worse for WT gain sedation and metabolic syndrome
Better for prolactin and EPSE
Post injection syndrome
Don’t give with bento
What are the CVS AE of antipyschotic
Dyslipidaemia
Hyperglycaemia
HTN
Adverse affects of Risperidone
Compared to olanzapine More hyperprolactin More orthostatic hypotension EPSE less anticholingeric Less hyperglycaemia Less dyslipidaeia Less sedation Less wt gain
Adverse affects of Quetiapine
Compared to Olanzapine More hyperglycaemia More orthostatic hypotension EPSE Less Anticholingeric effects Less dyslipidaemia Less wt gain
Adverse affect of Paliperidone
Compared to Olanzapine Needs dose adjustment in kidney impairment much More prolactin Much more orthostatic hypotension More EPSE Less anticholinergic effects Less dyslipidaemia Less hyperglycaemia Less sedation Less wt gain
Adverse affects of Aripiprazole
Compared to Olanzapine Activating so take in mane less CVS AE EPSE less anticholingeric No hyperglycaemia No dyslipidaemia No hyperprolactin No sedation
Adverse affects of Amisulpride
Compared Olanzapine Precaution in kidney. Need to adjust dose Good for prominent negative symptoms Less CVS AE more prolactin
Adverse affects of Sertindole
Compare to olanzapine High risk of cardiac arrhythmia Only used if pt unable to tolerate at least one other antipsychotic Much more QT prolongation. Need ECG monitoring no anticholingeric No dyslipidaemia No EPSE No Hyperglycaemia No sedation Decrease Wt gain.
Adverse affects of Clozapine
Good for negative symptoms Reserved for tx resistance - 6-12 week of at least 2 antipsychotics Increase Risk of agranulocytosis Neutropenia Myocarditis Cardiomyopathy More anticholingeric affect More sedation more Orthostatic hypotension Myoclonus seizure No EPSE
IX for clozapine
WCC and neutrophil 18 wk
Cardiac - BMI, temp, HR, BP, RR, troponin, CRP, 4wks
ECG and Echo baseline
Metabolic - Wt, BMI. waist circumference BGL, Lipids
Clozapine level measured on morning trough
Ix prior to starting Antipsychotic
FBC U&E LFT BGL- fasting Lipid TFT Prolactin Urine toxicology CT
Duration of antipsychotic medication after first episode
Min 2yr after first psychosis then tapered over 3 months.
when to add benxodiasepine to a pt psychotic treatment
If using a less sedation antipsychotic to tx anxiety, agitation, insomnia, or activation syndrome (agitation/pacing, irritability, insomnia, N&V)
Short term - Diazepam.
Management of schizophrenia
Pharmacological tx
Broadly based tx program
- Psychotherapeutic - active listing, empathic responsiveness, explanation and reassurance
- MDT - GP
- Access to Case Mx, assertive community tx, CBT, Cognitive remediation for cognitive deficits, social skills programs, support employment programs, accommodation, disability support options, education, training assistance, social interventions to combat isolation.
Manage comorbidity
- Monitor substance use - risk of relapse
- assess for and tx comorbid depression, suicidality and anxiety disorder.
Maintain physical health
- Tx of CVS risk factors - Physical fitness, healthy eating, smoking cessation
- prevention - screening for pap smear
- Monitoring - BP, Wt, BMI, Waist circumference, serum lipids and BGL.
Work with family/carers - psychoeducation - early symptoms & signs of relapse, Med and AE, Physical health needs
Management of neg symptoms - psychosocial interventions, augmentation with antidepressant e.g. fluoxetine, lamotrigine.
Omega 3
First rank symptoms
- auditory hallucinations:
- thought withdrawal, insertion and interruption.
- thought broadcasting.
- somatic hallucinations.
- delusional perception.
- Passivity experience: feelings or actions experienced as made or influenced by external agents.
Initating Clozapine
First day requires hourly obs
First 2 wks requires daily ECG, and bloods
Then weekly ECG and bloods.
Differentiating between Seratonin syndrome and NMS
SERTONIN
Restless, twitching,
Flushed and sweating
GIT sym
NMS
Global rigidity
Pale
No GI.
