Schizophrenia Flashcards
What are the four first rank symptoms of schizophrenia?
- Auditory hallucinations (2nd/3rd person, thought echo)
- Thought disorder (insertion, withdrawal, broadcasting)
- Passivity phenomena (somatic passivity, made act/feeling/drive)
- Delusional perceptions
What are the other features of schizophrenia that aren’t first rank?
- persistent hallucinations in any modality
- neologisms, breaks in train of thought, incoherent/irrelevant speech
- Catatonia
- Negative sx
What are -ve sx?
incongruity/blunting of effect
anhedonia
alogia - poverty of speech
avolition - poor motivation
What is the diagnostic criteria of schizophrenia? How long is the time frame?
1 or more of the first rank sx for 1 month or more
OR
Any 2 of the other symptoms
decrease in function!
What are the four different causes of psychosis? give examples
- Affective disorders (schizophrenia, depression, bipolar)
- Transient psychosis (drugs/alcohol)
- Med conditions (dementia, delirium, tumour)
- Schizophrenia like non-affective disorders (brief psychotic disorder, delusional disorder, schizophreniform disorder)
what are the four subtypes of schizophrenia?
- Paranoid - mainly hallucinations +/- delusions
- Hebephrenic - fluctuating affect prominent w fleeting fragmented delusions and hallucinations
- Catatonic - stupor, posturing, waxy flexibility, negativism
- Simple and residual - mainly negative sx
What are prodromal sx to schizophrenia? how early do they precede the first episodes of psychosis?
Decline in functioning: transient/attenuated psychotic sx odd thoughts beliefs etc conc. problems altered affect (immediate emotional responses) social withdrawal reduced interest in activities
Give an MRI sign in schizophrenics and 2 social factors linked to causing it.
Small amygydalas, frontal lobes temporal lobes. Social: Brought up in a city, being a migrant
What is the main aetiological theory behind schizophrenia?
Unusual neurodevelopment via genetics/insult to brain in development.
What are the two strands of management?
Antipsychotics and psychosocial interventions
Describe three schizophrenia-like disorders.
Schizoaffective disorder: mania/depression with schizophrenia at the same time at the same intensity.
Schizotypal disorder: Personality disorder (see later).
Schizophreniform disorder: Failure to meet threshold for schizophrenia (usually due to time) but some symptoms and a decrease in function.
What psychological therapy has strong evidence? Give 2 other non-pharmacological methods.
CBT for psychosis. Also: family therapy, social support (!)(money, job house)
Give 5 Ix to monitor in antipsychotic use.
Glucose, lipids, prolactin, LFT, U+E, ECG, BP, weight
Which drug is first line?
Any antipsychotic. All have efficacy but different side effects. Normally antipsychotics begin working on psychosis in a couple of weeks
Define treatment resistant schizophrenia. What is used to treat it?
if 2 sets of 6 week trials of antipsychotics failed (incl. 1 non-clozapine SGA)
USE CLOZAPINE
What if there is a failure to respond to this?
Can combine. Can use lamotrigine to augment. ECT can be used.
When should antipsychotics be stopped?
A guide is 3 years, before this 80% relapse. But there is no completely safe time.
Give the treatment for: acute dystonia, akathisia, and tardive dyskinesia.
Dystonia: IM/PO procyclidine. Akathisia: Lower dose or change or stop medicine. Propranolol can be tried. Tardive dyskinesia: May be irreversible, tetrabenzine can be used.
What is the prognosis like for schizophrenia?
Generally not great. 10% have one episode, 40% are better in 15 years. On average, schizophrenics die 25 years earlier than a normal person
The cause of psychosis can be tricky to find. With auditory hallucinations what is it likely to be? What about non-auditory? When should a CT be done?
Auditory: likely to be a mental disorder – schizophrenia/depression etc. Non-auditory: 90% have substance abuse/withdrawal/physical illness. CT head needed in any olfactory, tactile, or gustatory hallucinations, or any suspicion of neurological disease