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Pat's psychiatry > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

ICD-10 definition of schizophrenia

A
  • Characterised by distortions of thinking and perception
  • manifest in hallucinations & delusions
  • presence of positive & negative symptoms
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2
Q

List the First-Rank Symptoms (FRS)

A
  1. Passivity
  2. Delusional perception
  3. Delusion of thought interference
  4. Auditory hallucinations
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3
Q

Types of Schneiderian auditory hallucinations

A
  1. Thought echo
  2. Running commentary
  3. Arguing
  4. 3rd person
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4
Q

Types of Schneiderian thought interference

A
  1. Broadcasting
  2. Insertion
  3. Withdrawal
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5
Q

Most common types of schizophrenia

A
  1. Persecutory
  2. Catatonic
  3. Disorganized
  4. Simple
  5. Residual
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6
Q

List of positive symptoms

A
  1. Hallucinations
  2. Delusions
    (same as first rank symptoms)
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7
Q

List of negative symptoms

A
  1. Blunted affect
  2. Poverty of thought
  3. Anergia
  4. Anhedonia
  5. Loss of motivation
  6. Inattention to cognitive input
  7. Loosening of association
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8
Q

What is catatonic schizophrenia and the abnormalities associated with it (Name at least 5)?

A 
Definition: schizohprenia which presents with psychomotor disturbance
Abnormalities include: 
1. Waxy flexibility
2. Stupor
3. Rigidity
4. Excitement
5. Posturing
6. Automatic obedience
7. Perseveration
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9
Q

What is “Perseveration”?

A 
A symptom of catatonic schizophrenia, characterised by inappropriate repetition of words or movements
Example:
You: Where were you born?
Patient: Orange Juice
You: What is your father's name?
Patient: Orange Juice
You: How old are you?
Patient: Orange Juice
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10
Q

What is simple schizophrenia?

A

Negative features only, with no positive symptoms ever

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11
Q

What is residual schizophrenia?

A

Presence of only negative symptoms after delusions and hallucinations subside

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12
Q

How long do the first rank symptoms have to be present for in order to make a diagnosis of schizophrenia?

A

1 month

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13
Q

What are the differential diagnosis for schizophrenia?

A
  1. Organic - substance misuse, dementia, delirium, epilepsy, side effect of medications and other (brain tumour, HIV, stroke, Wilson’s disease, neurosyphilis)
  2. Mood disorders
  3. Acute stress reaction
  4. Persistent delusional disorder
  5. Schizotypal disorder - Personality disorder
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14
Q

After performing a psychiatric hx, a MSE and a full physical exam, what other investigations would you like to do if you suspect someone of schizophrenia? (Think both physical and social and what other information you would like to gather)

A
  1. Bloods - FBC, U&E, TFT, LFT, lipids
  2. HIV screen
  3. MSU
  4. Tox screen (urine)
  5. STD screen - specifically for syphilis
  6. EEG - if epilepsy is indicated
  7. OT to assess function at home
  8. Social worker to assessment social needs like housing, financial, etc.
  9. Collateral hx from other people
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15
Q

Types and general MoA of anti-psychotics

A 
Typicals and atypicals
MoA: dopamine receptor antagonist (post-synaptic D2 specifically)
Typicals include:
1. Haloperidol
2. Chlorpromazine
3. Zulperide
Atypicals include:
1. Olanzipine
2. Respiradone
3. Quetrapine
4. Aripiprazole
5. Clozapine
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16
Q

What are the extrapyramidal side effects of

A
  1. Dystonia - abnormal painful contraction of body muscles
  2. Akathisia - inner feeling of restlessness
  3. Parkinsonism - triad
  4. Tardive dyskinesia - rhythmic involuntary movements of mouth, face, limbs and trunk which can be distressing
17
Q

What are the four dopamine pathways in the brain and how do they cause the symptoms (or side effects)?

A
  1. Nigrostriatal pathway - parkinsonism

2.

18
Q

What is the Parkinsonism triad?

A
  1. Bradykinesia
  2. Rigidity
  3. Resting Tremor
19
Q

What is the life-threatening side effect of anti-psychotics and its presentation?
What would you see in their bloods? What are they at high risk of?

A 
Neuroleptic malignant syndrome (NMS)
Presents with:
1. Tachycardia
2. Labile BP
3. Muscle stiffness & rigidity
4. Altered consciousness
Blood results: raised CK and WBC
High risk of Kidney failure due to rhabdomyolysis
20
Q

What are the general non-life threatening side effects of anti-psychotics?

A
  1. Extrapyramidal side effects
  2. Arrhythmia
  3. Metabolic syndrome
  4. Seizures - lowers seizure threshold
  5. Increases risk of diabetes and obesity
  6. Hyperprolactinaemia
  7. Anti-cholinergic symptoms (blurry vision, drooling, dry eyes and mouth, tachycardia, urinary retention and constipation)
21
Q

What would the ideal first-line anti-psychotic to give to a young female patient who is concerned by weight gain?

A

Aripiprazole - smaller risk of weight gain and obesity

22
Q

What are the major side effects specific to clozapine?

A

Agranulocytosis

Constipation

23
Q

What must you do every time before you start clozapine?

A

Do a clozapine assessment = Take bloods and check WBC

24
Q

What are the indications for starting clozapine?

A

Clozapine is reserved for treatment-resistance schizophrenia, meaning they must be on two different anti-psychotics, at least one of which is atypical, for at least six weeks.

25
Q

What are the three approaches to management?

A
  1. Biological
  2. Psychological
  3. Social
26
Q

What are the different types of psychological therapies for schizophrenia?

A
  1. CBT
  2. Family therapy
  3. Concordance therapy
27
Q

What are the social issues that would need addressing for patients with schizophrenia? Who would like to contact for help?

A
  1. Housing
  2. Financial
  3. Employment

Contact a care coordinator so they can arrange these things for the patient

Pat's psychiatry (2 decks)

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