Schizophrenia Flashcards
Definition of schizophrenia?
IS A COMMON CHRONIC RELAPSING CONDITION OFTEN PRESENTING IN EARLY ADULTHOOD WITH PSYCHOTIC SYMPTOMS, DISORGANISATION SYMPTOMS, NEGATIVE SYMPTOMS AND SOMETIMES COGNITIVE IMPAIRMENT.
What are group 1 symptoms and signs of schizophrenia?
- Thought insertion, thought echo, thought withdrawal or thought broadcasting
- Delusions of control or passivity, delusions of perceptions
- Hallucinations (commentary, voices discussing the patient or voices coming from some part of the body)
What are group 2 signs and symptoms of schizophrenia?
- Persistent hallucinations for at least a month accompanied by delusions with no clear affective content
- Neologism or thought disorder
- Catatonic behaviour (excitement, posturing, waxing flexibility, negativism, mutism and stupor)
- Negative symptoms (apathy, poverty of speech, blunt or incongruous affect)
What are the types of schizophrenia ?
paranoid, hebephrenic, catatonic, residual, simple
What is paranoid schizophrenia?
Stable, often paranoid delusions, often accompanied by hallucinations. Disturbances of affect, volition, speech and catatonia are rare.
This is the commonest subtype and predominated by hallucinations and delusions
What is hebephrenic schizophrenia?
affective changes are prominent e.g. shallow inappropriate or facile delusions and hallucinations are fragmented and fleeting, behaviour is irresponsible and unpredictable. Mannerisms are common. Usually diagnosed in young people.(age of onset usually 15-25 y/o)
Has a poor prognosis
There is a prominent fluctuating affect and fleeting, fragmented hallucinations and/or delusions
What is catatonic schizophrenia?
Prominent psychomotor disturbances e.g. hyperkinesis, stupor, automatic obedience, negativism, posturing, waxy flexibility
What is residual schizophrenia?
Chronic stage of schizophrenia often with negative symptoms, underactivity, blunt affect apathy, poverty of speech, lack of facial expression and eye contact, poor self-care and social performance.
predominated by negative symptoms
What is simple schizophrenia?
insidious but progressive development of odd behaviour and inability to meet demands of society and decline in performance
predominated by negative symptoms
What is the lifetime risk of schizophrenia?
1%
What is the female:male ratio of incidence
1:1 (but men are more likely to have more negative symptoms and more severe forms of schizophrenia)
When is the peak onset?
20s-30s ( but second peak seen in late middle age - late onset schizophrenia)
What is the lifetime expectancy?
Patients tend to die 25 years younger than the general population
What is there increased risk and mortality from with schizophrenia?
Increased risk of suicide and increased risk of mortality from CVD, respiratory disease and infection
What is the genetic risk?
parent has it, 1 in 10 chance, if identical twin has it 1 in 2 chance (this shows that there are also environmental factors involved)
How much does the use of cannabis increase the risk?
doubles (x2) - but in heavy users can increase the risk to 6 times
What is often found in a patient withs schizophrenia’s personal history?
Childhood history of stress/dysfunction
What are the risk factors of schizophrenia?
- Family History
- Intrauterine and perinatal complications
- Intrauterine infections
- Abnormal early cognitive/neuromuscular development
- Social isolation/migrants
- Abnormal family interactions
What are first rank symptoms of schizophrenia?
- AUDITORY HALLUCINATIONS – third person, commentary, thoughts spoken aloud (most common)
- THOUGHT ALIENATION – Thought insertion, Thought broadcast, Thought withdrawal
- DELUSIONAL PERCEPTION
- PASSITIVITY PHENOMENA
These symptoms are mainly POSITIVE SYMPTOMS
What are secondary symptoms of schizophrenia?
- PERSISTENT HALLUCINATIONS IN ANY MODALITY – somatic, visual, tactile, which occur everyday for weeks on end
- Delusions
- Second person auditory hallucinations
- Thought disorder – thought interruption, thought block
- Catatonic behaviour (Strange, purposeless behaviour)
- Negative symptoms apathy, incongruent affect, paucity of speech, blunting or flat affect, self-neglect, Low motivation, underactivity, poor non-verbal communication, clear deterioration in functioning
- Lack of insight
What are positive symptoms?
hallucinations, passitivity phenomena, thought alienation, lack of insight, disturbace of mood and delusions
What sort of symptoms do people usually present with acutely?
Positive symptoms
as the disease becomes more chronic which symptoms are more likely to be seen?
Negative symptoms
What are negative symptoms?
apathy, incongruent affect, paucity of speech, blunting or flat affect, self-neglect, Low motivation, underactivity, poor non-verbal communication, clear deterioration in functioning
What are prodromal symptoms?
These are symptoms that precede most first episodes of psychoses by up to 18 months
What are prodromal symptoms characterised by?
Characterised by a gradual deterioration in functioning. Includes: transient psychotic symptoms, odd behaviour, beliefs and thoughts, concentration problems, altered affect, social withdrawal and reduced interest in daily activities.
How is schizophrenia diagnosed?
- Main criteria is to have at least one very clear FIRST RANK SYMPTOM (usually two or more if less clear-cut)
- Diagnosis is held off unless the symptoms last >6 months and symptoms are present most of the time for at least a month, AND there is marked impairment in work or home functioning.
- RULE OUT other causes of psychosis: Bipolar, CNS tumours, drugs/alcohol, head injury
Organic DDx of schizophrenia?
o Drug induced psychosis - Cannabis
o Temporal Lobe epilepsy (seizures)
o Dementia
o Encephalitis
o Alcohol hallucinosis
o Delirium – due to many causes (VITAMIN CDE)
o Cerebral syphilis
o Neurological Huntington’s disease, MS etc.
o Endocrine thyroid, adrenal (Cushings, phaeo)
Psychiatric DDx of schizophrenia?
o Mania o Psychotic depression o Some personality disorders o Panic disorders o Dissociative identity disorder
What is the dopamine hypothesis of schizophrenia?
Over activity of dopamine (D2) receptors – mesolimbic – hallucinations and delusions (THIS ONE HAS HIGH HEREDITABILITY, SO PSYCHOSIS CAN RUN IN FAMILIES)
Under activity of dopamine receptors (D1) – mesocortical – blunted emotion, anhedonia, apathy
What Ix would be taken out for potential schizophrenia diagnosis?
Bloods and urinalysis to rue out any organic/physical causes or drugs or alcohol
management of schizophrenia?
antipsychotics, psychological interventions
How can antipsychotics be subtyped?
first generation(typical) and second generation (atypical)
What are examples of first generation (typical) antipsychotics?
- Haloperidol
- Chlorpromazine
- Prochlorperazine
- Pipothiazine
- Zuclopenthixol
- Flupenthixol
- Sulpride
what is the mechanism of action for first gen (typical) antipsychotics?
These work by blocking D2 receptors in the brain but this can cause Extra-pyramidal side effects (EPSEs).
What are the extra-pyramidal side effects?
- Acute dystonic reaction – can occur within hours of treatment with antipsychotic meds. Is MUSCLE SPASM, ACUTE TORTICOLIS, OCCULAR GYRATE CRISIS
- Parkinsonism – can occur days after having treatment –cause tremor, bradykinesia
- Akathisia – can occur days – weeks after taking meds, causing ‘inner restlessness’, manifests as pacing and agitation, often very intolerable.
- Tardive Dyskinesia – can occur months – years after going on meds, causes grimacing, tongue protrusion, lip smacking, ‘gurning’
What is the acute dystonic reaction? and how quickly does this side effect become apparent?
MUSCLE SPASM, ACUTE TORTICOLIS, OCCULAR GYRATE CRISIS
Can occur within hours of taking the medication
What is Parkinsonism? and how quickly can this SE become apparent?
Causes tremor and bradykinesia
Can occur within days after administering treatment
What is akathisia? and how quickly can this SE become apparent?
Akathisia causes ‘inner restlessness’, manifests as pacing and agitation and is often intolerable.
this can occur weeks after administering treatment
What is Tardive dyskinesia? and how quickly does this SE become apparent
causes grimacing, tongue protrusion, lip smacking, ‘gurning’
This can occur months or years after going on medication
What are examples of second generation (atypical) antipsychotics?
and their side effects
- Olanzipine (SE: weight gain, sedation)
- Risperidone (SE: Hypotension, nausea)
- Clozapine (SE: AGRANULOCYTOSIS)
- Aripiprazole (SE: nausea, agitation)
- Amisulpride (SE: Increased prolactin, weight gain)
- Queliapine (SE: hypotension, nausea)
Do second generation antipsychotics cause EPSEs?
no due to a slightly different pharmacological mechanism so that they have serotonin (5HT2a) occupancy
When is clozapine used?
in drug resistant schizophrenia.
Only used after trying at least 2 antipsychotics to treat schizophrenia which have no effect
Why is it very important to monitor bloods on clozapine?
Agranulocytosis - the loss of WCC and neutrophils
how can agranulocytosis present?
Sore throat and white spots on tongue
what can be the impact of delaying antipsychotics?
Worsening of negative symptoms
What psychological interventions are available for schizophrenia?
- CBT – general or targeted on auditory hallucinations
- Working with the family (family therapy)
- Social support
When is the prognosis better with schizophrenia?
Prognosis is better when it is sudden onset, no negative symptoms, supported at home, of the female sex, later onset of illness, no CNS ventricular enlargement, and no family history.
Overall, what percentage of patients only experience one episode of schizophrenia?
10%
with treatment, how many patients with schizophrenia need intensive input/hospitisation for more than 2 years after the first admission?
<7%
What percentage of patients have recovered at 15 years?
40%
What is the incidence of suicide in the acute phase?
10%
What is the incidence of suicide in the chronic phase?
4%
How many patients recover?
1 in 5
How many patients recover but have relapses?
3 in 5
How many patients keep having symptoms and develop depression?
1 in 7
What is catatonic schizophrenia dominated by?
• Dominated by prominent psychomotor disturbances that may alternate between extremes such as hyperkinesia and stupor, or automatic obedience and negativism.
may also have some episodes of violent excitement in this condition
What is catatonia?
state of apparent unresponsiveness to external stimuli in a patient who appears to be awake
What is Catalepsy?
state characterised by patient keeping uncomfortable, rigid and fixed posture despite external stimulus or resistance.
What may the catatonic phenomena be combined with?
a dream-like state with vivid scenic hallucinations
Which form of schizophrenia has affective changes as a prominent feature with delusions and hallucinations fleeting and fragmentary, behaviour irresponsible and unpredictable and mannerisms common.
hebephrenic
