Schizophrenia Flashcards
What is schizophrenia
- A chronic relapsing condition
- Often presenting in early adulthood
- With psychotic, disorganisation, negative symptoms
Psychotic and disorganisation symptoms
- Psychotic = Hallucinations and Delusions
- Disorganisation = Incongruous mood, abnormal speech + thought
Negative symptoms (W.A.R.B.S.)
- Withdrawal
- Apathy
- Reduced motivation
- Blunted mood
- Self neglect
3 common symptoms of schizophrenia
- Psychosis
- Distorted thinking (delusions)
- Distorted perception (hallucinations)
4 types of psychosis
- Affective psychoses
- Transient psychotic disorders
- Psychosis due to medical disorder
- Schizophrenia-like non-affective disorders
2 examples of affective psychoses
- Depression
- Bi-polar disorder
Cause of transient psychotic disorders
Usually drug abuse
Cause of psychosis due to medical disorder
Brain tumour
8 things you should look for when diagnosing schizophrenia
1-Thought insertion, broadcasting, withdrawal
2-Delusions that external forces influence/control feelings/actions/impulses
3-Auditory hallucinations (voices)
4-Persistent delusions (culturally inappropriate or impossible)
5-Persistent hallucinations of any modality (somatic, visual, tactile)
6-Breaks in train of thought
7-Catatonic behaviour
8-Negative symptoms
What about the persistent hallucinations makes it diagnostic
They occur every day for weeks on end
What do breaks in train of thought cause
- Incoherence
- Irrelevant speech
- Tangents
- Neologisms
What is catatonic behaviour
- “Strange, purposeless, behaviour”
- Sudden excitement
- Negativism
- Mutism
- Waxy flexibility
- Echopraxia (involuntary imitation of another’s actions)
What are negative symptoms
- Apathy
- Paucity of speech
- Blunting or incongruity of affect (laughing at bad news)
Main diagnostic criteria for schizophrenia
- At least 1, clear cut, symptoms from 1-4 (2/> if less clear cut)
- 2 symptoms from 5-8
MUST BE FOR 6/> MONTHS
What should be done before diagnosing schizophrenia
Rule out other causes:
- Bi-polar
- Drugs/alcohol
- CNS tumour
- Head injury
3 sub-types of schizophrenia
- Paranoid
- Hebephrenic
- Catatonic
Describe paranoid schizophrenia
- Comments
- Hallucinations + delusions are prominent
Describe hebephrenic schizophrenia
- 15-25 yrs onset
- Poor prognosis
- Fluctuating affect prominent
- Fleeting, fragmented, delusions + hallucinations
Describe catatonic schizophrenia
- Stupor
- Posturing
- Waxy flexibility
- Negativism
Frequent symptoms of schizophrenia
- Lack of insight (97%)
- Auditory hallucinations (74%)
- Ideas of reference (70%)
- Paranoia
- Flat affect
- Persecutory delusions
Frequent behaviours in schizophrenia
- Social withdrawal
- Anhedonia
- Apathy
- Psychomotor retardation
If concordance with a medication is an issue what is a possible solution
IM depots (long lasting injection)
Broad Rx for schizophrenia
- Antipsychotics
- Psychological interventions (CBT)
Pharmacological Rx of schizophrenia
- Risperidone (Second generation antipsychotic) (1st line)
- Haloperidol (first generation antipsychotic)
- Aripiprazole (third generation antipsychotic)
Rx of treatment-resistant schizophrenia
Clozapine
What should be checked before commence antipsychotic medication
-Hx/FHx of diabetes, hypertension, CVS disease
-Check:
BP
FBC
Weight
Fasting blood glucose
Lipid profile
ECG (if on clozapine)
What should be done after 6 months of antipsychotic medication
- LFTs
- U&Es
- Weight
- Hba1c
- Prolactin
SEs of antipsychotic medication
- Hunger
- Thirst
- Sexual dysfunction
- DM
- Weight gain
- Seizure threshold reduced
What should be stopped when taking antipsychotic medication
- Smoking, induces metabolism thus requiring higher doses
- Breast-feeding
