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Mental health > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

What is psychosis?

A

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.

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2
Q

What are the main symptoms of psychosis?

A
  • Hallucinations
  • Delusions
  • Confusion
  • Lack of insight
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3
Q

What are hallucinations?

A

Perceptions in the absence of an external stimulus

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4
Q

Which type of hallucination is commonest in psychosis?

A

Auditory

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5
Q

What is are the common causes of visual hallucinations?

A
  • Delirium
  • Organic pathology
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6
Q

What do olfactory hallucinations tend to indicate?

A

Frontal lobe pathology

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7
Q

Define delusions

A
  • A fixed firmly held belief in light of insufficient evidence
  • Cannot be reasoned with
  • Outside of sociocultural norms
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8
Q

List four types of delusions

A
  • Grandiose
  • Persecutory
  • Reference
  • Guilt
  • Erotomanic
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9
Q

What are mood congruent delusions?

A

Delusions that align with a patients mood

In depression these include persecutor, guilt, poverty, hypochondriac and nihilism.

Mania commonly features grandiose, erotomanic.

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10
Q

How must insight be assessed?

A
  • 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?
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11
Q

Define schizophrenia

A

A disorder characterised by the presence of positive symptoms and negative symptoms.

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12
Q

What are positive symptoms of schizophrenia?

A
  • Hallucinations
  • Delusions
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13
Q

Name four negative symptoms of schizophrenia?

A
  • Marked apathy
  • Passivity of speech
  • Blunting of emotion
  • Lack of awareness of socially appropriate behavior
  • Difficulty in abstract thinking
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14
Q

Name two subtypes of schizophrenia

A
  • Paranoid
  • Hebephrenic: disorganised thoughts and behaviours
  • Catatonic
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15
Q

What are Schneider’s symptoms of first rank?

A
  • 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
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16
Q

What is the ICD-10 diagnostic criteria for schizophrenia?

A

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.
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17
Q

List four features of catatonic behavior consist?

A
  • 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
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18
Q

When does the first episode of schizophrenia typically occur?

A

20’s

19
Q

Name three differential diagnoses of schizophrenia

A
  • Subtance-induced psychosis
  • Organic disease
  • Mood disorders with psychosis
  • Dementia; delirium
  • PTSD
  • Anxiety; paranoid personality disorder
  • OCD
20
Q

Name two predisposing factors for schizophrenia

A
  • Bio: Genetics, head trauma
  • Psycho: Conflict
  • Social: Environment/role
21
Q

Outline two precipitating factors of schizophrenia

A
  • Bio: Substance use, head trauma
  • Psycho: Expressed emotion, life events, coping style
  • Social: Poverty, isolation
22
Q

Outline two perpetuating factors of schizophrenia

A
  • Bio: Substance use, poor compliance
  • Psycho: Expressed emotion, hopelessness
  • Social: Social network, work, family
23
Q

How does the initial presentation of schizophrenia differ between males and females?

A

Males tend to have earlier onset (23 vs 26), and develop more severe illness.

There is equal likelihood of developing schizophrenia in both genders.

24
Q

What is expressed emotion?

A

A measure of family environment of a psychiatric patient.

High EE family members are more hostile, critical and intolerant of the patient.

25
Q

Outline the illness course of schizophrenia

A

Prodromal phase

Active phase

Residual phase

26
Q

What is the prodromal phase of schizophrenia?

A

Non-specific symptoms with marked mood symptoms; may last weeks-months:

  • Loss of interest
  • Social withdrawal
  • Poor concentration
  • Apathy
  • Anger
  • Odd behaviour.
27
Q

What is the active phase of schizophrenia?

A
  • Delusions
  • Hallucinations
  • Marked change in cognition
  • Marked behavioural changes

Often triggered by stress and other environmental factors

28
Q

What is the residual phase of schizophrenia?

A

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.

29
Q

How is the prognosis of schizophrenia?

A
  • 1/3 - one psychotic episode
  • 1/3 - recurrent psychotic episodes
  • 1/3 - residual personality changes
30
Q

Name three investigations would you do in suspected schizophrenia?

A
  • 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
31
Q

When is it appropriate to investigate schizophrenia with EEG?

A
  • History of seizures
  • Query temporal lobe epilepsy
32
Q

Name two significant medical co-morbities of schizophrenia?

A
  • Communicable diseases (HIV, HepC, TB)
  • Epilepsy
  • Diabetes
  • Coronary artery disease
33
Q

Outline the management of an acute episode of schizophrenia

A
  • SGA at effective dose; or
    • Use long-acting BDZ to control non-acute anxiety/behavioural disturbances.
  • Low potency FGA titrated according to clinical effect.
34
Q

According to the NICE guidelines, what should be offered to all first episodes of psychosis?

A
  • Oral antipsychotic medication
  • Psychological intervention (CBT + family intervention)
    • CBT: reduces persistent symptoms and improves insight
    • Family intervention: support and education for patient and family
35
Q

What is the indication for Clozapine in regards to schizophrenia?

A

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
36
Q

Give two important instances of safety information when prescribing clozapine

A
  • 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
37
Q

What factor favours the use of 2nd gen antipsychotics over 1st gen antipsychotics?

A

2nd gen antipsychotics have a lower risk of extra pyramidal side effects.

38
Q

What is the benefit of using family intervention alongside CBT in schizophrenia management?

A
  • Family intervention
    • Significantly improves outcomes
    • Reduces risk of relapse by 40%
  • CBT
    • Fewer hospital admissions
    • Lower duration of admission
    • Fewer crisis episodes
39
Q

Describe Family intervention for people with schizophrenia

A

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
40
Q

What social interventions can be undertaken for schizophrenic patients?

A
  • Housing
  • Activities
41
Q

What are the intervention options during prodromal phase of schizophrenia?

A

No strong evidence supports any early interventions.

Guidance recommends watchful waiting and monitoring of symptoms.

42
Q

What is early intervention for psychosis?

A

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.

43
Q

What is the reasoning behind employing early interventions for psychosis?

A
  • Duration of untreated psychosis is correlated with worsening prognosis
  • Education and employment are associated with reduced risk of relapse

Mental health (27 decks)

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