Schizophrenia Flashcards
Describe the historical background to Schizophrenia
Up until the 20th century it was considered ‘madness’
Bleuler gave the name Schizophrenia in 1911
Psychosis is the principal symptom
Describe the aetiology and pathology of schizophrenia?
Onset – adolescence/early adulthood
Lifetime risk is ~1%
Presentation of symptoms and outcome – highly varied
No single, definable cause
Higher incidence in lower socioeconomic groups
Attributed to downward drift of sufferers due to impaired function
Describe the neuropathology of schizophrenia?
1978 – modern imaging techniques (PET, fMRI, EEG, ECoG)
Enlarged ventricles
Post mortem – reduced temporal lobe volume
Cerebral blood flow – reduced frontal function
Not progressive
Aetiology: what genetic/environmental factors could contribute to the development of schizophrenia?
Inherited genetic factors
Increased risk in families if one family member affected
In twins: Dizygotic(fraternal) 17%; Monozygotic (identical) 48%
Identification of susceptibility genes e.g. Neuregulin 1
Environmental factors
Birth complications, viral infection, inner cities, immigration, drug misuse
Neurodevelopmental model:
Early environmental insult and/or genetic factors lead to changes in brain development with later environmental factors contributing to risk
Name some ILLICIT drugs which pose a risk in schizophrenia (in incidence and complication)?
Amphetamines Cocaine MDMA PCP Magic mushrooms Alcohol Mescaline, psylocybin, LSD Khat Solvents
Name some PRESCRIPTION drugs which pose a risk in schizophrenia (in incidence and complication)?
α-adrenoceptor blockers Antibiotics Anticholinergics Antiepileptics Antihistamines Antimalarials (mefloquine) Digoxin Dopaminergics H2 receptor antagonists Retinoids SSRIs (e.g. Prozac)
Symptoms of schizophrenia can be divided into positive and negative. what does this mean?
Positive: disinhibited behaviours/thoughts
Negative: inhibited/withdrawn behaviours/thoughts.
What are some of the symptoms?
Thought disorder (+/-) Abnormal beliefs/delusions (+) Abnormal experiences (+) Mood disorder (+/-) Motor alterations (+/-) Changes in social function (-)
What are Prognostic signs for isolated episodes?
No family history Stable premorbid personality Acute onset Emotional responses preserved Early diagnosis and treatment
What are the Prognostic signs for persistent (chronic) schizophrenia ?
Family history
Disturbed premorbid personality
Difficulty forming relationships early in life
Poor social adjustment/disrupted domestic life
Insidious onset
Loss of initiative and drive
Delayed diagnosis and treatment
What are the aims of treatment? (4)
Control acute attacks (prevent harm to self and others)
Resolve contributory social and domestic factors
Rehabilitate the patient
attacks of psychosis have consequential effects on mood, emotion etc.
Begin long-term maintenance therapy if necessary.
What is the dopamine hypothesis of schizophrenia?
Result of an overactive dopamine system in the corticolimbic regions of the brain - decision making and reward
Explain the treatment rationale for schizophrenia
- Drugs that block dopamine function
All antipsychoticsare dopamine antagonists.
Amphetamine which increases the levels of dopamine may produce a psychosis like state.
What are the treatment options?
Antipsychotic (neuroleptic) drugs
e. g. haloperidol, chlorpromazine (1st Generation)
e. g. risperidone, olanzapine, amisulpride (2nd Generation)
Generally only treat POSITIVE symptoms
Which drug affects some negative symptoms AND can be used in treatment- resistant patients?
Clozapine
