Schizophrenia Flashcards
ICD-10 definition of schizophrenia
- Characterised by distortions of thinking and perception
- manifest in hallucinations & delusions
- presence of positive & negative symptoms
List the First-Rank Symptoms (FRS)
- Passivity
- Delusional perception
- Delusion of thought interference
- Auditory hallucinations
Types of Schneiderian auditory hallucinations
- Thought echo
- Running commentary
- Arguing
- 3rd person
Types of Schneiderian thought interference
- Broadcasting
- Insertion
- Withdrawal
Most common types of schizophrenia
- Persecutory
- Catatonic
- Disorganized
- Simple
- Residual
List of positive symptoms
- Hallucinations
- Delusions
(same as first rank symptoms)
List of negative symptoms
- Blunted affect
- Poverty of thought
- Anergia
- Anhedonia
- Loss of motivation
- Inattention to cognitive input
- Loosening of association
What is catatonic schizophrenia and the abnormalities associated with it (Name at least 5)?
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
What is “Perseveration”?
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
What is simple schizophrenia?
Negative features only, with no positive symptoms ever
What is residual schizophrenia?
Presence of only negative symptoms after delusions and hallucinations subside
How long do the first rank symptoms have to be present for in order to make a diagnosis of schizophrenia?
1 month
What are the differential diagnosis for schizophrenia?
- Organic - substance misuse, dementia, delirium, epilepsy, side effect of medications and other (brain tumour, HIV, stroke, Wilson’s disease, neurosyphilis)
- Mood disorders
- Acute stress reaction
- Persistent delusional disorder
- Schizotypal disorder - Personality disorder
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)
- Bloods - FBC, U&E, TFT, LFT, lipids
- HIV screen
- MSU
- Tox screen (urine)
- STD screen - specifically for syphilis
- EEG - if epilepsy is indicated
- OT to assess function at home
- Social worker to assessment social needs like housing, financial, etc.
- Collateral hx from other people
Types and general MoA of anti-psychotics
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
What are the extrapyramidal side effects of
- Dystonia - abnormal painful contraction of body muscles
- Akathisia - inner feeling of restlessness
- Parkinsonism - triad
- Tardive dyskinesia - rhythmic involuntary movements of mouth, face, limbs and trunk which can be distressing
What are the four dopamine pathways in the brain and how do they cause the symptoms (or side effects)?
- Nigrostriatal pathway - parkinsonism
2.
What is the Parkinsonism triad?
- Bradykinesia
- Rigidity
- Resting Tremor
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?
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
What are the general non-life threatening side effects of anti-psychotics?
- Extrapyramidal side effects
- Arrhythmia
- Metabolic syndrome
- Seizures - lowers seizure threshold
- Increases risk of diabetes and obesity
- Hyperprolactinaemia
- Anti-cholinergic symptoms (blurry vision, drooling, dry eyes and mouth, tachycardia, urinary retention and constipation)
What would the ideal first-line anti-psychotic to give to a young female patient who is concerned by weight gain?
Aripiprazole - smaller risk of weight gain and obesity
What are the major side effects specific to clozapine?
Agranulocytosis
Constipation
What must you do every time before you start clozapine?
Do a clozapine assessment = Take bloods and check WBC
What are the indications for starting clozapine?
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.
