Schizophrenia Flashcards
What is psychosis?
A mental health problem that causes the patient to be out of touch with reality. The patient experiences a different reality to others, and is unaware of this.
What are the main symptoms of psychosis?
- Hallucinations
- Delusions
- Confusion
- Lack of insight
What are hallucinations?
Perceptions in the absence of an external stimulus
Which type of hallucination is commonest in psychosis?
Auditory
What is are the common causes of visual hallucinations?
- Delirium
- Organic pathology
What do olfactory hallucinations tend to indicate?
Frontal lobe pathology
Define delusions
- A fixed firmly held belief in light of insufficient evidence
- Cannot be reasoned with
- Outside of sociocultural norms
List four types of delusions
- Grandiose
- Persecutory
- Reference
- Guilt
- Erotomanic
What are mood congruent delusions?
Delusions that align with a patients mood
In depression these include persecutor, guilt, poverty, hypochondriac and nihilism.
Mania commonly features grandiose, erotomanic.
How must insight be assessed?
- Is the patient able to recognize they have a problem?
- What does the patient think is the cause?
- Does the patient want help with their problem?
Define schizophrenia
A disorder characterised by the presence of positive symptoms and negative symptoms.
What are positive symptoms of schizophrenia?
- Hallucinations
- Delusions
Name four negative symptoms of schizophrenia?
- Marked apathy
- Passivity of speech
- Blunting of emotion
- Lack of awareness of socially appropriate behavior
- Difficulty in abstract thinking
Name two subtypes of schizophrenia
- Paranoid
- Hebephrenic: disorganised thoughts and behaviours
- Catatonic
What are Schneider’s symptoms of first rank?
- Auditory hallucinations
- Repeating subjects thoughts ‘echo de la pensee’
- Third person
- Running commentary
- Thought insertion, withdrawal, or broadcasting
- Passivity of affect, impulse, or volition - under external control
- Somatic passivity - somatic sensations by external agency
- Persistent delusions
What is the ICD-10 diagnostic criteria for schizophrenia?
Symptom(s) appear on most days for one month in duration:
- Any one of Schneider’s symptoms of first rank; or
- eg. Running commentary, thought insertion, passivity of affect.
- Any two of:
- Persistent hallucinations of any modality
- Breaks in train of thought - incoherent/irrelevant speech
- Catatonic behaviour: stupor or posturing etc.
- Negative symptoms
- Must not be an organic cause, or alcohol or drug related.
List four features of catatonic behavior consist?
- Excitement: bizarre, non-goal directed hyperactivity and impulsiveness
- Posturing; waxy flexibility
- Negativism: opposition or no response to instruction
- Aversion
- Mutism; stupor
- Agitation; grimacing
- Echolalia; echopraxia
When does the first episode of schizophrenia typically occur?
20’s
Name three differential diagnoses of schizophrenia
- Subtance-induced psychosis
- Organic disease
- Mood disorders with psychosis
- Dementia; delirium
- PTSD
- Anxiety; paranoid personality disorder
- OCD
Name two predisposing factors for schizophrenia
- Bio: Genetics, head trauma
- Psycho: Conflict
- Social: Environment/role
Outline two precipitating factors of schizophrenia
- Bio: Substance use, head trauma
- Psycho: Expressed emotion, life events, coping style
- Social: Poverty, isolation
Outline two perpetuating factors of schizophrenia
- Bio: Substance use, poor compliance
- Psycho: Expressed emotion, hopelessness
- Social: Social network, work, family
How does the initial presentation of schizophrenia differ between males and females?
Males tend to have earlier onset (23 vs 26), and develop more severe illness.
There is equal likelihood of developing schizophrenia in both genders.
What is expressed emotion?
A measure of family environment of a psychiatric patient.
High EE family members are more hostile, critical and intolerant of the patient.
Outline the illness course of schizophrenia
Prodromal phase
Active phase
Residual phase
What is the prodromal phase of schizophrenia?
Non-specific symptoms with marked mood symptoms; may last weeks-months:
- Loss of interest
- Social withdrawal
- Poor concentration
- Apathy
- Anger
- Odd behaviour.
What is the active phase of schizophrenia?
- Delusions
- Hallucinations
- Marked change in cognition
- Marked behavioural changes
Often triggered by stress and other environmental factors
What is the residual phase of schizophrenia?
Similar symptoms to the prodromal phase
eg. Loss of interest, withdrawal, poor concentration
Not all patients experience this phase.
Patients can enter remission or relapse.
How is the prognosis of schizophrenia?
- 1/3 - one psychotic episode
- 1/3 - recurrent psychotic episodes
- 1/3 - residual personality changes
Name three investigations would you do in suspected schizophrenia?
- Routine bloods: U+Es, LFT, calcium, FBC, glucose
- If Hx indicates: TFTs, PTH, cortisol, tumour markers
- CT head in suggested neurological or cognitive abnormality
- Drug screen
When is it appropriate to investigate schizophrenia with EEG?
- History of seizures
- Query temporal lobe epilepsy
Name two significant medical co-morbities of schizophrenia?
- Communicable diseases (HIV, HepC, TB)
- Epilepsy
- Diabetes
- Coronary artery disease
Outline the management of an acute episode of schizophrenia
- SGA at effective dose; or
- Use long-acting BDZ to control non-acute anxiety/behavioural disturbances.
- Low potency FGA titrated according to clinical effect.
According to the NICE guidelines, what should be offered to all first episodes of psychosis?
- Oral antipsychotic medication
- Psychological intervention (CBT + family intervention)
- CBT: reduces persistent symptoms and improves insight
- Family intervention: support and education for patient and family
What is the indication for Clozapine in regards to schizophrenia?
Clozapine is offered in cases of treatment-resistant schizophrenia.
- Failure to respond to at least 2 different antipsychotics
- One of which is a non-clozapine SGA eg. Olanzapine; Risperidone
Give two important instances of safety information when prescribing clozapine
- Immediately report symptoms of infection, esp flu-like illness
- Risk of neutropenia and fatal agranulocytosis (1%)
- Usually occurs at 6-18 weeks after initiating treatment
- Seek immediate medical advise if constipation develops
- Fatal risk of intestinal obstruction; faecal impaction; paralytic ileus
What factor favours the use of 2nd gen antipsychotics over 1st gen antipsychotics?
2nd gen antipsychotics have a lower risk of extra pyramidal side effects.
What is the benefit of using family intervention alongside CBT in schizophrenia management?
- Family intervention
- Significantly improves outcomes
- Reduces risk of relapse by 40%
- CBT
- Fewer hospital admissions
- Lower duration of admission
- Fewer crisis episodes
Describe Family intervention for people with schizophrenia
It is a type of psychosocial intervention designed to reduce the levels of expressed emotions.
Aims:
- Construct an alliance with relatives and carers
- Reduce the adverse family environment
- Enhance relatives problem solving
- Maintain reasonable expectations for patient performance
What social interventions can be undertaken for schizophrenic patients?
- Housing
- Activities
What are the intervention options during prodromal phase of schizophrenia?
No strong evidence supports any early interventions.
Guidance recommends watchful waiting and monitoring of symptoms.
What is early intervention for psychosis?
A multidisciplinary community mental health service that provides treatment and support to people experiencing psychosis.
Biopsychosocial interventions, education, and regular monitoring of physical and mental health and risk.
What is the reasoning behind employing early interventions for psychosis?
- Duration of untreated psychosis is correlated with worsening prognosis
- Education and employment are associated with reduced risk of relapse
