Schizophrenia

Question 1

What is Psychosis?

Answer 1

– An Umbrella term
– being out of touch with reality
– describes the experience of hallucinations, delusions and/or thought disorder

Question 2

Describe the epidemiology of schizophrenia

Answer 2

– Males
– symptoms for six months (one month of active symptoms)
– peak onset mid 20s for males and late 20s for females
– affects up to 1% of the population

Question 3

Describe the neurochemical theory of schizophrenia

Answer 3

There is increased dopamine in the mesolimbic pathway
This causes positive symptoms
——
There is decreased dopamine in the Misocortical pathway this causes negative symptoms
—-
It is thought that serotonin receptors (5HT) are also involved

Question 4

Name some risk factors for schizophrenia

Answer 4

– Genetics (50% MZ concordance)
- Multiple genes are thought to contribute
– environmental factors such as winter births, viral infections, and catholyte us, CNS pathologies
– life event: social exclusion, childhood trauma, migration, urban environment
– substance misuse: cannabis, amphetamines
-Perinatal trauma: hyperoxia, maternal

Question 5

Name the three most common positive symptoms which occur in schizophrenia

Answer 5

– Hallucinations (especially auditory)
– delusions
– thought disorder

Question 6

Name the five A negative symptoms of schizophrenia

Answer 6

– Avolition: lack of motivation
- Anhedonia: unable to experience pleasure
- Alogia:Poverty of speech
–Asociality: A lack of desire for relationships
– affect blunt: lack of response to stimulus

Question 7

Name’s Schneider’s First rank symptoms for schizophrenia

Answer 7

– Auditory hallucinations
– delusions
– thought disorder: thought broadcast, thoughts and session, thought withdrawal, thought echo

Question 8

How would you describe paranoid schizophrenia?

Answer 8

The patient would be relatively stable, have paranoid delusions and hallucinations

Question 9

How would you describe Hebephrenic Schizophrenia?

Answer 9

The behaviour of the patient would be irresponsible and in predictable
The mood would be shallow and inappropriate
Their speech would be incoherent
They would be socially isolated
There would be fleeting hallucinations and delusions

Question 10

When would you not Diagnose schizophrenia despite the symptoms being present

Answer 10

– If the patient has epilepsy
– if the patient has taken alcohol or is experiencing alcohol withdrawal
-If the patient had an affective mental disorder prior to the onset of schizophrenic symptoms

Question 11

In a patient with schizophrenia, what would you see on the SPECT scan?

Answer 11

The scan would show that there is a greater occupancy of DA receptors

Question 12

What is the short-term treatment for schizophrenia?

Answer 12

– Antipsychotics

– psycho education (CBT/family interventions)

Question 13

What is the long-term management for schizophrenia?

Answer 13

– Antipsychotics
-Antidepressants
-Lithium
– –
-CBT
– Supported employment
– family interventions
– reduce expressed emotion
– relapse signature
– art therapy

Question 14

Before prescribing antipsychotics to a patient with suspected schizophrenia, what checks would you need to do beforehand?

Answer 14

– Wait
– waist circumference
– pulse and blood pressure
– fasting blood glucose, HB a1C, blood lipid profile, prolactin levels
– ECG if risk factors present such as high blood pressure, history of cardiovascular disease, smoking

Question 15

Name some side-effects of first-generation drugs used to treat schizophrenia

Also name Some first-generation drugs

Answer 15

An example is haloperidol
– Tardive dyskinesia
-Extra pyramidal symptoms

Question 16

Name some side-effects of the second generation antipsychotics

Also name a few

Answer 16

Examples include risperidone, olzanzapine, clozapine

Side-effects include weight gain, dyslipidaemia, and hyperglycaemia

Question 17

Give a brief overview of Medical management in schizophrenia (biologically)

Answer 17

– You would prescribe an antipsychotic at a lower dose
– you would prescribe a second generation antipsychotic
You would trial each antipsychotic for at least 6 to 8 weeks
-If patient fails to respond to 2 Antipsychotics, one of which must be a second generation antipsychotic, prescribed clozapine.
-If patient shows improvement on And antipsychotic continue for at least six months and preferably for 12 to 14 months
-Depart preparations can be used to improve long-term compliance

Question 18

Why do you need to be weary of clozapine and what would you do to monitor this

Answer 18

You would be weary of agranulocytosis Occurring – this is low white blood cells in the blood, leucopenia
You would monitor this by doing a full blood count weekly

Question 19

Other than a granulocytosis, name some side-effects of using clozapine

Answer 19

Myocarditis, weight gain, excess salivation, seizures and sedation

Question 20

What receptor the first generation antipsychotics work on

Answer 20

D2

Question 21

What receptor do second generation antipsychotics work on

Answer 21

D2 and 5HTA

Metabolic effects