Schizophrenia Flashcards
What is schizophrenia the most common cause of?
Psychosis
What is the typical age of onset of schizophrenia?
15-35yo
What is the strongest risk factor for schizophrenia?
FH
What are the first rank symptoms of schizophrenia?
ABCD Auditory hallucinations Broadcasting of thoughts Controlled thought Delusions
What are the common auditory hallucinations?
Running commentary
Discussing patient
Coming from another part of body
What are some types of controlled thoughts?
Insertion, withdrawal
What are common delusions in schizophrenia?
Often of control, influence or passivity
What are the second rank symptoms of schizophrenia?
Persistent hallucinations daily >1 month
Neologisms, breaks of interpolations in train of thought, leading to incoherent or irrelevant speech
Catatonic behaviour
Negative symptoms- marked apathy, paucity of speech, blunting/incongruity of emotional response
What are some catatonic behaviours seen in schizophrenia?
Posturing or waxy flexibility
Negativism, mutism, stupor
How is schizophrenia diagnosed?
At least 1 first rank symptom or 2 second rank symptoms
What is the first line management of schizophrenia?
Oral antipsychotic wth psychosocial intervention
-continue antipsychotic for t least 6 months following remission
What are some of the first line antipsychotics for schizophrenia?
Risiperidone
Olanzapine
Quetiapine
Aripriprazole
What are some of the psychosocial interventions used in schizophrenia?
CBT
Cognitive remedition
Family intervention
What is the 2nd step in schizophrenia management?
What is the management of treatment resistant schizophrenia?
- Change antipsychotic if poor response at 4 weeks
Resistant= Clozapine
What is the management of acute psychosis in schizophrenia?
- Oral/IM antipsychotic
2. IM lorazepam
What are some poor prognostic factors for schizophrenia?
Strong FH
Slow insidious onset
Low IQ
Lack of obvious precipitant
What are the side effects of risiperidone?
Dose dependent weight gain and sedation
What are the side effects of olanzapine?
Dramatic weight gain
Prominent hypertriglyceridaemia, hypercholesterolaemia and hyperglycaemia
Sedation
What are the side effects of quetiapine?
Sedation
Orthostatic hypotension
Abnormal LFTs
Less prominent than olanzapine- weight gain, hypertriglycaeidaemia, hypercholesterolaemia and hyperglycaemia
When is clozapine used?
Treatment resistant patients due to side effects
What are the side effects of clozapine?
Agranulocytosis- fever, rigors and sore throat, rapidly progressive and life threatening
Dramatic weight gain
Hypertriglyceridaemia, hypercholesterolaemia and hyperglycaemia
What are some adverse effects of all antipsychotics?
Tardive dyskinesia
Extrapyramidal side effects
Neuroleptic malignant syndrome
What extrapyramidal side effects can be seen with antipsychotics?
Acute dystonia
Parkinsonism
Akathisia (restlessness)
What is neuroleptic malignant syndrome?
Life threatening reaction to neuroleptic/antipsychotic medication, most often haloperidol
Onset 4-14 days after starting
What is the presentation of neuroleptic malignant syndrome?
High fever, Sweating Confusion, altered LOC Muscle rigidity Unstable BP Tachycardia
