Schizophrenia Flashcards
what is the strongest risk factor for developing schizophrenia?
Family history
risk with monozygotic twin having schizophrenia
50%
risk with parent with schizophrenia
10-15%
risk with sibling with schizophrenia
10%
other risk factor for shizophrenia
black Caribbean ethnicity
schneider’s first rank symptoms
- auditory hallucinations
- thought disorders
- passivity phenomenal
- delusional perceptions
Auditory hallucinations
- two or more voices discussing the patient in the third person
- thought echo
- voices commenting on the patient’s behaviour
Thought disorder
- thought insertion
- thought withdrawal
- thought broadcasting
Passivity phenomena
- bodily sensations being controlled by external influence
2. actions/impulses/feelings - experiences which are imposed on the individual or influenced by others
Delusional perceptions
a two stage process) where first a normal object is perceived then secondly there is a sudden intense delusional insight into the objects meaning for the patient e.g. ‘The traffic light is green therefore I am the King’.
Features of schizophrenia (6)
- impaired insight
- incongruity/blunting of affect (inappropriate emotion for circumstances)
- decreased speech
- neologisms: made-up words
- catatonia
- negative symptoms: incongruity/blunting of affect, anhedonia (inability to derive pleasure), alogia (poverty of speech), avolition (poor motivation)
- insomnia + sleep disturbances as symptoms of schizo develop
Management of schizophrenia
- oral atypical antipsychotics are first-line
- cognitive behavioural therapy should be offered to all patients
- close attention should be paid to cardiovascular risk-factor modification due to the high rates of cardiovascular disease in schizophrenic patients (linked to antipsychotic medication and high smoking rates)
Factors associated with poor prognosis
- strong family history
- gradual onset
- low IQ
- premorbid history of social withdrawal
lack of obvious precipitant
mechanism of action of anti psychotics
Antipsychotics act as dopamine D2 receptor antagonists, blocking dopaminergic transmission in the mesolimbic pathways
typical anti psychotics - extrapyramidial side effects
- Parkinsonism
- acute dystonia (e.g. torticollis, oculogyric crisis)
- akathisia (severe restlessness)
- tardive dyskinesia (late onset of choreoathetoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible, most common is chewing and pouting of jaw)
definition of parkinsonism
clinical syndrome characterised by ; tremor, bradykinesia, rigidity postural instability.
definition of acute dsytonia
refers to sustained muscle contractions, frequently causing twisting, repetitive movements or abnormal postures.
definition of akathisia
is a movement disorder characterized by a feeling of inner restlessness and inability to stay still.
definition of tardive dyskinesia
(late onset of choreoathetoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible,
- most common is chewing and pouting of jaw
side effects with anti psychotics
- antimuscarinic: dry mouth, blurred vision, urinary retention, constipation
sedation, weight gain
2, raised prolactin: galactorrhoea, impaired glucose tolerance - neuroleptic malignant syndrome: pyrexia, muscle stiffness
- reduced seizure threshold (greater with atypicals)
- prolonged QT interval (particularly haloperidol)
anti psychotic monitoring
- FBC - weekly espec for clozapine
- LFTs + U+E ( at the start + anually)
- Lipid + weight ( start - 3 months - anually)
- Fasting blood glucose - start/6months/anually
- BP + ECG
- Cardiovascular risk assesment
atypical anti psychotics example
- clozapine
- olanzapine
- risperidone
Clozapine risk
- significant risk of agranulocytosis and full blood count monitoring is therefore essential during treatment.
- For this reason clozapine should only be used in patients resistant to other antipsychotic medication
- agranulocytosis (1%)
- neutropaenia (3%)
- reduced seizure threshold - can induce seizures in up to 3% of patients
atypical anti psychotic side effects
- weight gain
2. clozapine is associated with agranulocytosis
steroid induced psychosis
Sudden onset psychosis following course of corticosteroids – consider steroid-induced psychosis
Steroid-induced psychosis is a recognised side effect of corticosteroid use
