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PAN- Psychiatry > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

What are some of the positive symptoms of schizophrenia?

A

Delusions
Thought Disorder
Altered Behavior- Catatonic or Grossly Disorganised
Hallucinations

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2
Q

What delusions are typically seen in schizophrenia?

A

Typically delusions of perception- there is normal perception but an abnormal interpretation

Delusions of persecution are common/paranoid delusions

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3
Q

What hallucinations are typically seen in schizophrenia?

A

Auditory hallucinations/voices

Third Person Voices- Providing a running commentary on what the patient is doing.

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4
Q

What are the negative symptoms of schizophrenia?

A

Absence of normal response/behaviours. This includes: flat effect, loss of interest in things, apathy (lack of interest or enthusiasm), reduced expression of emotion and avoilition (decreased motivation)

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5
Q

How long should symptoms have been present for for a diagnosis of schizophrenia to be appropriate?

A

Symptoms present much of the time for at least 1 month

Continuous problems, with social or occupational functioning, over the last 6 months

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6
Q

What symptoms predominate in patients with paranoid schizophrenic?

A

Prominent hallucinations/delusions relating to persecution and groups intending to harm them

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7
Q

What symptoms predominate in patients with hebephrenic schizophrenia?

A

Disorganised thoughts and behaviour- without purpose

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8
Q

What symptoms predominate in patients with catatonic schizophrenia?

A

Fluctuate between stupor and agitation
Patients have little awareness and little mobility at times
Unusual movements and behaviour

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9
Q

What is residual schizophrenia?

A

History of psychosis but negative symptoms only present now

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10
Q

What is undifferentiated schizophrenia?

A

Symptoms do not conform to any of the other subtypes, may have features of several

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11
Q

What are the prodromal symptoms of psychosis?

A

Symptoms precede the first episode of psychosis by up to 18 months. Generally a gradual deterioration in functioning including:
Social withdrawal
Altered affect
Reduced interest in daily activities
Poor concentration
Out of character thoughts, beliefs and actions
Transient or reduced psychotic symptoms

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12
Q

What is the main difference between typical and atypical anti-psychotics?

A

Typic APs are first generation and they are more likely to cause extra-pyramidal side effects

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13
Q

What are some examples of first generation APs?

A

Thioxanthenes- Flupentixol, Zuclopenthixol
Phenothiazines- Chlroprmazine, Trifluoperazine
Butyrophenones- Haloperidol

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14
Q

What are some advantages of typical antipsychotics?

A

Cheap
Long duration of use so effects are known
Available as injections- use in aggressive patients and for when compliance with oral meds is poor

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15
Q

What are some disadvantages of typical anti-psychotics?

A 
Side effect profile:
Increase in prolactin
Extra Pyramidal Side Effects
Anti-cholinergic S/Es
Histamine S/Es
Alpha S/Es
Weight gain--> Metabolic Syndrome
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16
Q

What are the extra-pyramidal side effects?

A

Tardive Dyskinesia
Akanthisia
Psuedo-Parkinsonism
Acute dystonia

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17
Q

How do APs cause galactorrhea?

A

Increase in prolactin secretion as dopamine usually reduces prolactin release but APs act to reduce the activity of dopamine

18
Q

What are the features of tardive dyskinesia?

A

Lip smacking
Tongue protrusion and rolling
Chewing motion
Involuntary movements of the body and extremities

(Irreversible side effect)

19
Q

What are the features of akanthisia?

A 
Restless legs
Trouble standing still
Pacing around
Feetin in constant motion
(Side effect most associated with suicide)
20
Q

What are the features of pseudo-parkinsonism?

A

Bradykinesia
Pill rolling tremor
Shuffling gait
Cog-wheel rigidity

21
Q

What are the features of acute dystonia?

A

Facial grimacing
Muscle spasm of tongue, face, neck and back
Laryngeal spasm- risk of airway compromise

22
Q

What is the management of extra-pyramidal side effects?

A

Stop AP (Exercise caution)
Reduce dose
Different AP
Akanthisia and Parkinsonism:
- Anti-muscarinic (procyclidine) or anti-cholinergic (Benzatropine)
Akanthisia:
- Beta blockers (e.g. propanolol) and benzodiazepa

If Tardive dyskinesia stop cholinergics as it can make things worse

23
Q

What anti-cholinergic S/Es may be seen with APs?

A

Constipation
Blurred vision
Dry mouth
Confusion

24
Q

What histamine mediated side effect may be seen with APs?

A

Sedation

25
Q

What alpha 1 mediated side effects may be seen with APs?

A

Postural hypotension

Impotence

26
Q

Why are patients on anti-psychotic medication prone to weight gain?

A

AP medication is associated with an increased appetite and so weight gain. At risk of metabolic syndrome. Require monitoring of glucose, cholesterol, triglycerides, blood pressure and BMI.

27
Q

What is neuroleptic malignant syndrome?

A

Autonomic instability- fluctuating HR, temperature, blood pressure
Confusion
Muscle rigidity and increased tone- leads to release of CK and myoglobin (risk of renal injury)

28
Q

What is the treatment for neuroleptic malignant syndrome?

A

Supportive-
Stop AP
IV Fluids, Temperature Support (e.g. cooling blankets)
Circulatory and ventilatory support
Muscle relaxants- Dantrolene
Dopamine agonists to reduce the blockade- Bromocriptine
Benzodiazepine to control agitation

29
Q

What are some causes of psychosis?

A

Organic causes
Schizophrenia
Psychotic depression
First episode psychosis

30
Q

What are some positive symptoms?

A

Delusions
Hallucinations
Disorganized speech
Abnormal motor behavoir

31
Q

What are delusions?

A

Abnormal beliefs that are strongly held and are out of touch with the patients normal cultural background

32
Q

What kind of hallucinations are common in schizophrenia?

A

Auditory hallucinations that are often third person and persecutory

33
Q

What is word salad?

A

Speech that disorganised and makes little sense

34
Q

What abnormal motor behavior is seen in schizophrenic patients?

A

Catatonic behavior
Agitation
Pacing

35
Q

What are the negative symptoms of schizophrenia?

A 
Flattened affect
Reduced eye contact
Reduced movement
Reduced facial expression
Reduced interest in activities and interaction
Anhedonia
36
Q

What features help to differentiate schizophrenia from other psychotic symptoms?

A

Presence of negative symptoms

37
Q

What prodromal symptoms may be seen in schizophrenic patients?

A

Deterioration in functioning
Withdrawn patient
Out of character thoughts, beliefs and behavior
Anhedonia

Can proceed first episode psychosis by upto 18 months

38
Q

What might be some other causes of schizophrenia like symptoms?

A 
Schizotypal personality disorder
Delusional disorder
First episode psychosis
Psychotic depression
Organic causes of psychosis
Schizoaffective disorder
Substance induced psychotic disorder
39
Q

What is schizoaffective disorder?

A

There is a combination of features of schizophrenia with mood disorder (depression or bipolar) but does not warrant a diagnosis of either alone

40
Q

What should the management for schizophrenia be?

A

A holistic approach is required- for first episode psychosis refer to EIS

Pharmacological- Antipsychotics, Antidepressants, Anxiolytics
Social support- Financial, Living arrangements, Job seeking
Physiological- Therapy, CBT, Family therapy

PAN- Psychiatry (7 decks)

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