Schizophrenia

Question 1

What is schizophrenia the most common cause of?

Answer 1

Psychosis

Question 2

What is the typical age of onset of schizophrenia?

Answer 2

15-35yo

Question 3

What is the strongest risk factor for schizophrenia?

Answer 3

FH

Question 4

What are the first rank symptoms of schizophrenia?

Answer 4

ABCD
Auditory hallucinations
Broadcasting of thoughts
Controlled thought 
Delusions

Question 5

What are the common auditory hallucinations?

Answer 5

Running commentary
Discussing patient
Coming from another part of body

Question 6

What are some types of controlled thoughts?

Answer 6

Insertion, withdrawal

Question 7

What are common delusions in schizophrenia?

Answer 7

Often of control, influence or passivity

Question 8

What are the second rank symptoms of schizophrenia?

Answer 8

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

Question 9

What are some catatonic behaviours seen in schizophrenia?

Answer 9

Posturing or waxy flexibility

Negativism, mutism, stupor

Question 10

How is schizophrenia diagnosed?

Answer 10

At least 1 first rank symptom or 2 second rank symptoms

Question 11

What is the first line management of schizophrenia?

Answer 11

Oral antipsychotic wth psychosocial intervention

-continue antipsychotic for t least 6 months following remission

Question 12

What are some of the first line antipsychotics for schizophrenia?

Answer 12

Risiperidone
Olanzapine
Quetiapine
Aripriprazole

Question 13

What are some of the psychosocial interventions used in schizophrenia?

Answer 13

CBT
Cognitive remedition
Family intervention

Question 14

What is the 2nd step in schizophrenia management?

What is the management of treatment resistant schizophrenia?

Answer 14

2. Change antipsychotic if poor response at 4 weeks

Resistant= Clozapine

Question 15

What is the management of acute psychosis in schizophrenia?

Answer 15

1. Oral/IM antipsychotic

2. IM lorazepam

Question 16

What are some poor prognostic factors for schizophrenia?

Answer 16

Strong FH
Slow insidious onset
Low IQ
Lack of obvious precipitant

Question 17

What are the side effects of risiperidone?

Answer 17

Dose dependent weight gain and sedation

Question 18

What are the side effects of olanzapine?

Answer 18

Dramatic weight gain
Prominent hypertriglyceridaemia, hypercholesterolaemia and hyperglycaemia
Sedation

Question 19

What are the side effects of quetiapine?

Answer 19

Sedation
Orthostatic hypotension
Abnormal LFTs
Less prominent than olanzapine- weight gain, hypertriglycaeidaemia, hypercholesterolaemia and hyperglycaemia

Question 20

When is clozapine used?

Answer 20

Treatment resistant patients due to side effects

Question 21

What are the side effects of clozapine?

Answer 21

Agranulocytosis- fever, rigors and sore throat, rapidly progressive and life threatening
Dramatic weight gain
Hypertriglyceridaemia, hypercholesterolaemia and hyperglycaemia

Question 22

What are some adverse effects of all antipsychotics?

Answer 22

Tardive dyskinesia
Extrapyramidal side effects
Neuroleptic malignant syndrome

Question 23

What extrapyramidal side effects can be seen with antipsychotics?

Answer 23

Acute dystonia
Parkinsonism
Akathisia (restlessness)

Question 24

What is neuroleptic malignant syndrome?

Answer 24

Life threatening reaction to neuroleptic/antipsychotic medication, most often haloperidol
Onset 4-14 days after starting

Question 25

What is the presentation of neuroleptic malignant syndrome?

Answer 25

High fever, Sweating
Confusion, altered LOC
Muscle rigidity
Unstable BP
Tachycardia