Schizophrenia Flashcards
Schizophrenia is:
Changes in ____
Changes in _____
_________ affect
Decrease in ______ ______
______ usually intact in early stages
Thinking
Perception
Blunted/inappropriate
Social Functioning
Cognition
Define schneider’s first rank sx?
In the absence of organic cerebral pathology, these are indicative (but not pathognomic) of schizophrenia
What are the categories of schneider’s 1st rank sx
Auditory hallucinations
Thought alienation
Removal of free will/passivity
Delusional perception
What are the things in auditory hallucinations? (schneider’s 1st rank sx)
Repeating thoughts
3rd person talking about the patient
Running commentary
What is in thought alienation? (schneider’s 1st rank sx)
Insertion, withdrawal, broadcasting
What is in passivity? schneider’s 1st rank sx
Made feelings
Made impulses
Made actions
Somatic passivity
What is somatic passivity
Passive recipient of bodily sensations from an external agency
What is delusional perception?
A normal perception is interpreted as something significant for them
What are other features of schizophrenia?
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
What are some negative sx schizophrenia?
apathy
slowness
blunted affect
What should you exclude if there are negative sx schizophrenia?
Depression and antipsychotic SEs
What are the five subtypes of schizophrenia
Paranoid
Hebephrenic
Catatonic
Simple
Residual/chronic
What sort of auditory hallucinations might someone with paranoid schizophrenia get?
Command
What is the most common type of schizophrenia?
Paranoid
What is hebephrenic schizophrenia?
Irresponsible and unpredictable.
Pranks
Incoherent and rambling speech
Affect change- giggling when saying something awful
Poorly organised delusions
Frequent, fragmentary hallucinations
What is the prognosis in hebephrenic schiz?
Poor
What is simple schizophrenia?
Insidious onset of functional decline.
Negative sx develop without prior positive sx
Often only diagnosed confidently in retrospect
In residual/chronic what symptoms predominate?
Negative
What is residual/chronic schizophrenia often preceded by?
Another type
Risk factors for schiz?
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
In chronic schizophrenia, social understimulation can lead to what?
Negative sx
In chronic schizophrenia, social overstimulation can lead to what?
Relapse
Imaging findings in schiz?
Increased ventricular size and decreased grey matter
What is the schiz dopamine hypothesis?
Dopamine excess or overactivity in the mesolimbic dopaminergic pathway
What are the four dopamine pathways relevant to schiz?
- Mesolimbic
- Mesocortical
- Nigrostriatal
- Tuberohypophyseal
How is the mesolimbic pathway related to schiz sx?
Increase in dopamine activity causes positive sx
How is the mesocortical pathway related to schiz sx?
dopamine hypoactivity- negative, cognitive and affective sx
How is the nigrostriatal pathway related to schiz sx?
Drugs- extra pyramidal and tardive dyskinesia drug SEs
How is the tuberohypophyseal pathway related to schiz sx?
Drugs- hyperprolactinaemia SEs
Dopamine normally ____ prolactin release
Inhibits
Investigations in psychosis?
Bloods: U&E, FBC, LFT, TFT, B12 and folate, syphilis
Drug screen
EEG
?CT/MRI
Hearing and vision tests in elderly
Why do you to EEG in psychosis?
Could be complex partial seizures of temporal lobe
Differentials for psychosis
Organic
Psychoactive substance use
Mood disorders- negative sx depression; mania + schneider’s 1st rank symptoms; personality changes and personality disorder
Management of schizophrenia
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.
Do positive or negative symptoms respond better to APs?
Positive
What can you give for parkinsonian SEs APs? In what case should you not give it??
Procyclidine
Tardive dyskinesia
Schizophrenia prognosis
1/3 full recovery
1/3 relapsing and remitting
1/3 chronic
What improves prognosis in schiz?
Female
Older age of onset
Sudden onset and rapid resolution
Good response to Rx
No cog impairment
No ventricular enlargement on CT/MRI
What is schizoaffective disorder?
Episodic
Have features of a mood disorder AND schizophrenia in the same episode
What are the two types of schizoaffective disorder?
Manic and depressive types
schiz + manic sx = manic type etc
Which type of schizoaffective disorder has the worst prognosis?
Depressive type- increased chance they will develop negative sx schiz
Management schizoaffective disorder?
Similar to schizophrenia
APs in manic type
ADs in depressive type (essentially Rx of depression)
