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4th year psych > Schizophrenia > Flashcards

Schizophrenia Flashcards

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1
Q

Schizophrenia is:

Changes in ____

Changes in _____

_________ affect

Decrease in ______ ______

______ usually intact in early stages

A

Thinking

Perception

Blunted/inappropriate

Social Functioning

Cognition

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2
Q

Define schneider’s first rank sx?

A

In the absence of organic cerebral pathology, these are indicative (but not pathognomic) of schizophrenia

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3
Q

What are the categories of schneider’s 1st rank sx

A

Auditory hallucinations

Thought alienation

Removal of free will/passivity

Delusional perception

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4
Q

What are the things in auditory hallucinations? (schneider’s 1st rank sx)

A

Repeating thoughts

3rd person talking about the patient

Running commentary

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5
Q

What is in thought alienation? (schneider’s 1st rank sx)

A

Insertion, withdrawal, broadcasting

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6
Q

What is in passivity? schneider’s 1st rank sx

A

Made feelings

Made impulses

Made actions

Somatic passivity

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7
Q

What is somatic passivity

A

Passive recipient of bodily sensations from an external agency

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8
Q

What is delusional perception?

A

A normal perception is interpreted as something significant for them

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9
Q

What are other features of schizophrenia?

A

Other persistent delusions or hallucinations

Overvalued ideas

Insertions into train of thought so that speech is incoherent or irrelevant

Neologisms

Catatonia, can be posturing or waxy flexibility

Negative symptoms in chronic

Change in personal behaviour

Circadian rhythm disturbance

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10
Q

What are some negative sx schizophrenia?

A

apathy

slowness

blunted affect

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11
Q

What should you exclude if there are negative sx schizophrenia?

A

Depression and antipsychotic SEs

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12
Q

What are the five subtypes of schizophrenia

A

Paranoid

Hebephrenic

Catatonic

Simple

Residual/chronic

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13
Q

What sort of auditory hallucinations might someone with paranoid schizophrenia get?

A

Command

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14
Q

What is the most common type of schizophrenia?

A

Paranoid

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15
Q

What is hebephrenic schizophrenia?

A

Irresponsible and unpredictable.

Pranks

Incoherent and rambling speech

Affect change- giggling when saying something awful

Poorly organised delusions

Frequent, fragmentary hallucinations

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16
Q

What is the prognosis in hebephrenic schiz?

A

Poor

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17
Q

What is simple schizophrenia?

A

Insidious onset of functional decline.

Negative sx develop without prior positive sx

Often only diagnosed confidently in retrospect

18
Q

In residual/chronic what symptoms predominate?

A

Negative

19
Q

What is residual/chronic schizophrenia often preceded by?

A

Another type

20
Q

Risk factors for schiz?

A

Bio:

Genetic

Born late winter/early spring

Maternal viral infection pre-natally

Obstetric complications

Relatives with schizotypal PD

Cannabis adolescence

Temporal lobe epilepsy

Social:

Psychosocial stress

High expressed emotion in family

21
Q

In chronic schizophrenia, social understimulation can lead to what?

A

Negative sx

22
Q

In chronic schizophrenia, social overstimulation can lead to what?

A

Relapse

23
Q

Imaging findings in schiz?

A

Increased ventricular size and decreased grey matter

24
Q

What is the schiz dopamine hypothesis?

A

Dopamine excess or overactivity in the mesolimbic dopaminergic pathway

25
Q

What are the four dopamine pathways relevant to schiz?

A
  1. Mesolimbic
  2. Mesocortical
  3. Nigrostriatal
  4. Tuberohypophyseal
26
Q

How is the mesolimbic pathway related to schiz sx?

A

Increase in dopamine activity causes positive sx

27
Q

How is the mesocortical pathway related to schiz sx?

A

dopamine hypoactivity- negative, cognitive and affective sx

28
Q

How is the nigrostriatal pathway related to schiz sx?

A

Drugs- extra pyramidal and tardive dyskinesia drug SEs

29
Q

How is the tuberohypophyseal pathway related to schiz sx?

A

Drugs- hyperprolactinaemia SEs

30
Q

Dopamine normally ____ prolactin release

A

Inhibits

31
Q

Investigations in psychosis?

A

Bloods: U&E, FBC, LFT, TFT, B12 and folate, syphilis

Drug screen

EEG

?CT/MRI

Hearing and vision tests in elderly

32
Q

Why do you to EEG in psychosis?

A

Could be complex partial seizures of temporal lobe

33
Q

Differentials for psychosis

A

Organic

Psychoactive substance use

Mood disorders- negative sx depression; mania + schneider’s 1st rank symptoms; personality changes and personality disorder

34
Q

Management of schizophrenia

A

Admit initially then regular f/u

ANTIPSYCHOTICS generally atypicals first. Clozapine if fail to respond. IM if refusing. Maintenance APs in chronic

ECT only really if catatonic stupor

Psychosocial- social skills training, group work if exposed to high expressed emotion or move out so don’t live w family, behaviour therapy.

35
Q

Do positive or negative symptoms respond better to APs?

A

Positive

36
Q

What can you give for parkinsonian SEs APs? In what case should you not give it??

A

Procyclidine

Tardive dyskinesia

37
Q

Schizophrenia prognosis

A

1/3 full recovery

1/3 relapsing and remitting

1/3 chronic

38
Q

What improves prognosis in schiz?

A

Female

Older age of onset

Sudden onset and rapid resolution

Good response to Rx

No cog impairment

No ventricular enlargement on CT/MRI

39
Q

What is schizoaffective disorder?

A

Episodic

Have features of a mood disorder AND schizophrenia in the same episode

40
Q

What are the two types of schizoaffective disorder?

A

Manic and depressive types

schiz + manic sx = manic type etc

41
Q

Which type of schizoaffective disorder has the worst prognosis?

A

Depressive type- increased chance they will develop negative sx schiz

42
Q

Management schizoaffective disorder?

A

Similar to schizophrenia

APs in manic type

ADs in depressive type (essentially Rx of depression)

4th year psych (15 decks)

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