Schizophrenia Flashcards
What other names does schizophrenia go by?
paranoid illness, delusional disorder, psychotic state, psychosis.
What conditions are related to schizophrenia?
Drug-induced psychosis, schizoaffective disorder, psychotic depression.
What is a schizoaffective disorder?
A combination of bipolar and schizophrenia.
What is psychotic depression?
When one becomes so depressed that they lose touch with reality.
What is the lifetime prevalence of schizophrenia?
0.5 - 1%.
When does schizophrenia usually develop?
In late adolescence or early adult life.
Why are schizophrenia rates higher in ethnic minorities/immigrants?
Because the condition is exacerbated by the prejudice that these groups experience in their host country.
What is Knight’s Move Thinking?
Discourse consisting of a sequence of unrelated or only remotely linked thoughts/ideas.
What thought interferences are associated with schizophrenia?
Insertion, withdrawal, broadcasting, block.
What is thought broadcasting?
The belief that everyone can hear one’s thoughts.
What’s Knight’s Move Thinking?
Discourse consisting of a sequence of unrelated or only remotely linked thoughts/ideas.
What two categories are Schizophrenia symptoms separated into?
Positive and negative symptoms.
What are the positive symptoms of Schizophrenia?
Delusions, thought disorders, hallucinations, movement disorders. These are often the first symptoms to present.
What are the negative symptoms of Schizophrenia?
Social withdrawal, apathy.
Do Schizophrenic patients know they are acting bizarre?
No, they do not show insight of their condition.
What is insulin coma therapy?
This therapy uses large doses of insulin to induce hypoglycaemia and put the patient into a coma and cause them to seize. The patient would then be given glucose recovery.
What theory was insulin coma therapy based upon?
This was based on the now disproved theory that a person with epilepsy wouldn’t develop schizophrenia, hence inducing epilepsy/seizures to cure schizophrenia.
What is psycho-surgery (lobotomy)?
A drill or rod is used to permanently destroy brain cells.
What are the potential negative consequences of a lobotomy?
This treatment has many adverse events associated with it, such as cognitive and emotional effects.
What is electroconvulsive therapy?
It is uses to produce fits by electricity, based upon the same ideas about epilepsy and schizophrenia.
Does electroconvulsive therapy help in Schizophrenia? Does it help in any other conditions?
It hasn’t been found to help those suffering from schizophrenia however it has been proven to be of some help in depression.
What two categories are anti-psychotic medicines split into?
Typicals and atypicals.
What are some typical anti-psychotics?
Chlorpromazine, trifluoperazine.
What are some atypical anti-psychotics?
Risperidone, olanzapine, clozapine.
Which symptoms are anti-psychotic medication most useful against?
Anti-psychotic medication is generally more effective against the positive symptoms (with the exception of clozapine) and they work in three ways.
In what three ways do anti-psychotics affect the patient?
Calming affect, symptom control, relapse prevention.
How long can it take for anti-psychotics to have an effect on symptoms?
6-8 weeks.
Who usually provides support to Schizophrenic patients?
Community psychiatric nurses, support workers.
To whom do Schizophrenic patients pose the biggest risk?
Themselves.
When medication is stopped, how long does it take for relapse to occur?
2-6 months.
Why should some anti-psychotic drugs be used with caution in epileptic patients?
They can lower a person’s seizure threshold.
What side effects can one experience from anti-psychotic drugs?
Dry mouth, blurred vision, constipation, acute dystonia, Parkinsonian symptoms, akathisia, tardive dyskinesia.
What are Depot medications?
These are long acting injections which are given every 1-4 weeks and are effective for under 4 months.
What are the major advantages of atypical neuroleptics?
The major advantage of the atypical neuroleptics is that they give little or no movement disorder.
How much weight gain can one expect as a side effect of atypical neuroleptics?
5-10 kg.
What drug is indicated in the treatment of treatment resistant Schizophrenia?
Clozapine.
What neuroleptic is regarded as a dirty drug due to its activity at a lot of different receptors?
Clozapine has activity at many receptors hence it is considered a dirty drug.
What are the side effects of Clozapine?
Neutropenia/agranulocytosis, weight gain (10-20kg), diabetes, seizures, tachycardia, hypersalivation, constipation.
How can the hypersalivation associated with Clozapine use be treated OTC?
Hyoscine 300mcg.
Why should Clozapine patients be given regular blood tests?
Because neutropenia/agranulocytosis is a possible side effect and blood cell levels should be monitored to prevent this happening.
What advice should be given to Clozapine patients regarding weight gain?
Patients should be advised on reducing fatty foods, increasing fruit and veg intake, and undertake regular exercise. In extreme cases, a dietitian support may be needed.
On what receptors does Olanzapine have an effect?
- D (including D2).
- 5HT (including 5HTA).
- H1.
- Anti-cholinergic.
What are the side effects of Olanzapine?
Weight gain (10kg), diabetes, increased cholesterol.
What monitoring should be given to those patients on Olanzapine?
Regular blood tests and weight monitoring.
To what receptors does Risperidone have activity?
Risperidone has a high affinity for serotonergic 5-HT2 and dopaminergic D2 receptors.
What are the side effects of Risperidone?
Weight gain (3-5kg), hypotension, increased serum prolactin.
What are the consequences of increased serum prolactin?
- Galactorrhoea,
- Gynecomastia.
- Amenorrhea.
- Sexual side effects – impotence etc.
- Potential risk of osteoporosis.
- Possible link with breast cancer.
Describe the unique release mechanism of release in Risperidone consta.
This mechanism features microsphere biodegradable polymer beads which degrade releasing over a sustained period.
To what receptors does Quetiapine have action?
Quetiapine has affinities for serotonin receptors (5-HT2), dopamine receptors (D1 and D2), adrenergic receptors, and H1 receptors.
What are the side effects of Quetiapine?
As with other drugs, it can lead to weight gain and there have been case studies showing a diabetes risk.
To what receptors does Aripiprazole have action?
Aripiprazole shows partial agonism at D2 and 5-HT1a receptors and antagonism against 5-HT2a receptors.
What are the side effects of Aripiprazole?
Some weight gain, anxiety, insomnia, akathisia, nausea, and vomiting.
When in Schizophrenia is Aripiprazole used?
First episode use.
Why are schizophrenic thought abnormalities hard to detect?
They can be subtle.
When may male patients begin to show schizophrenic symptoms? What about this may cause problems diagnosing the symptoms as being caused by schizophrenia?
In their late teens or early 20s. These symptoms may be overlooked as normal adolescent behaviours.
What environmental factors are associated with the development of Schizophrenia?
Various factors, including prenatal and perinatal events, such as rubella, maternal influenza, smoking, and obstetric complications associated with hypoxia are associated with an increased risk of schizophrenia.
If one parent has schizophrenia, how likely is the child to develop schizophrenia?
14% chance.
If both parents have schizophrenia, how likely is the child to develop schizophrenia?
24% chance.
If a patient just commenced on clozapine, when are agranulocytosis and neutropenia most likely to occur?
Within the first 18 weeks.
The serum levels of which antipsychotic, in particular, are affected by smoking?
Clozapine. Smoking reduces clozapine levels by up to 50%. Patient on clozapine, who give up smoking, can experience dramatically increased drug levels with disastrous consequences.
How should tolerability be confirmed prior to the initiation of Risperidal Consta (risperidone)?
A trial of oral risperidone is used to confirm tolerability.
Which antipsychotics are associated with the highest risk of diabetes?
Clozapine and olanzapine.
What is the most significant biochemical change during Neuroleptic Malignant Syndrome (NMS)?
Dopamine blockade in the hypothalamus.
What is tardive dyskinesia?
A late onset involuntary movement disorder that is irreversible and difficult to treat; it is a form of brain damage.
What is aripiprazole’s key receptor activity?
D2 receptor activation and 5HT2A antagonism.
What is treatment-resistant schizophrenia?
It is defined as a lack of response to two antipsychotic drugs, one of which is an atypical, prescribed at the therapeutic dose for at least 6-8 weeks.
