Schizophrenia Flashcards
What are the common causes of psychoses?
Substance abuse Organic causes Affective disorders Schizophrenia Dementia Delirium Temporal lobe epilepsy
What are the first rank symptoms of schizophrenia?
Auditory hallucinations Thought withdrawal/insertion/interruption/broadcast Delusions Passivity Lack of insight
What are the negative symptoms of schizophrenia?
Apathy Self neglect Blunted mood Social withdrawal Lack of motivation
What are the risk factors for developing schizophrenia?
Genetic predisposition
Family history
Intrauterine and perinatal complications
Abnormal early cognitive/neuromuscular development
Poor parental relationship e.g. Hostile, overly critical parents
Social factors e.g. Inner city, migrants
Cannabis - especially if using since an early age
What factors would suggest a better prognosis for schizophrenia?
Sudden onset Female Supportive family and friends No negative symptoms No family history Later onset
What type of delusions may schizophrenic patients get?
Persecutory
Paranoid
Grandiose
What would you look for on MSE of a schizophrenic patient?
A - withdrawn, suspicious, self neglect. may have stereotyped movements
S - interrupted (due to though interruption), loosening of associations
E - blunted mood, low
P - auditory hallucinations
T - delusions
I - lack of insights
C - assess concentration, orientations, memory and attention to rule out dementia or delirium
What issues are commonly associated with schizophrenia and should be screened for?
Depression
Drug and alcohol problems
Social issues
How would you manage schizophrenia?
Non-pharm: MDT- gp, social support, CPN. risk assessment and prevention
Pharm: antipsychotics
How are antipsychotics classed?
Typical
Atypical
Name some typical antipsychotics
Haloperidol
Chlorpromazine
Name some atypical antipsychotics
Clozapine Risperidone Olanzapine Quetiapine Aripiprazole
What is the main difference between typical and atypical antipsychotics?
Antipsychotics have less extrapyramidal side effects so are generally preferred
What are the general side effects of atypical antipsychotics?
Weight gain Diabetes Sexual dysfunction Drowsiness Olanzapine and risperidone may still cause EP side effects at high doses Hyperprolactinaemia
What are the serious side effects of clozapine?
Agranulocytosis
Cardiomyopathy and myocarditis
What investigations would you do for a patient presenting with psychosis for the first time?
LFTs and FBC for alcoholism
Urinalysis for drugs of abuse
CT head if focal signs present (SOL, cerebral atrophy)
Consider syphillis, EEG
What is the diagnostic criteria for schizophrenia?
At least one first rank symptom (auditory hallucinations, though disturbance, passivity, delusions)
Or at least 2 other symptoms (persistent hallucinations, incoherent or irrelevant speech, neologisms, catatonic phenomena, negative symptoms)
define hallucination
a false perception where there is no external stimulus
define delusion
a false, firmly held belief, held on inadequate grounds that is not inkeeping with the person’s cultural or religious background
What are the extra pyramidal side effects of antipsychotics?
Parkinsonism eg. tremor, rigidity, bradykinesia
Acute dystonic reactions
Akathisia
Tardive dyskinesia
What drugs are used to treat the extra pyramidal side effects of antipsychotics?
Anticholinergics e.g. procyclidine
