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PSYCHIATRY > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

Positive symptoms:

Hallucinations:

  • 3rd or 2nd person
  • Types - 3

Delusions - types - 4

Thought disorder - types - 5

A

3rd
Thought echo (thoughts repeated back to them)
Running commentary
Overhead conversations

Persecutory
Reference
Interference
Passivity

Derailment 
Poverty of thought 
Circumstantiality 
Perseveration 
Blocking
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2
Q

Negative symptoms?

A 
Apathy/loss of energy 
Self-neglect 
Social withdrawal 
Emotional blunting 
Anhedonia - Inability to feel pleasure in normally pleasurable activities.
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3
Q

Prodrome symptoms

A

Social withdrawal
Reduced function i.e. work or studies
Poor self-care
Low mood or blunted affect

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4
Q

ICD-10:

How long must symptoms last for?

According to the criteria, they must have any 1 of these 4 symptoms. What are they?

According to the criteria, they must have any 2 of….

A

> 4 wks

(1) Thought echo/insertion/withdrawal/ broadcasting
(2) Delusions of thought control/ influence/ passivity; delusional perception
(3) Hallucinatory voices (running commentary or discussing patient between themselves), or other types of hallucinatory voices coming from some part of the body
(4) Persistent delusions of other kinds that are culturally inappropriate and completely impossible

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5
Q

ICD-10:

According to the criteria, they must have 2 or more of these 4 symptoms. What are they?

A

Persistent hallucinations (any modality), accompanied by delusions

Neologisms, breaks/ interpolations in the train of thought incoherence or irrelevant speech

Catatonic behaviour (e.g. excitement, posturing, waxy flexibility, negativism, mutism and stupor)

“Negative” symptoms (it must be clear that these are not due to depression or to neuroleptic medication)

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6
Q

How many different subtypes of schizophrenia are there?

Subtypes - Catatonic schizophrenia:

Define:

Waxy flexibility
Negativism
Mutism
Stupor

A 
5 subtypes 
///////////////
A decreased response to stimuli and a tendency to remain in an immobile posture.

Negativism - lacks verbal responses

Mutism - little to no verbal communication

Stupor - lack of response to stimuli

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7
Q

Subtypes - Disorganized/hebephrenic schizophrenia:

How is mood and behaviour affected?

What is the prognosis?

A
  • Inappropriate mood and behaviour including silliness, shallowness, and irresponsible actions.
  • Fragmented delusions and/or hallucinations

Poor

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8
Q

Subtypes - Paranoid schizophrenia:

Why is this important?

Subtypes - Simple schizophrenia:

What type of symptoms dominate, negative or positive?

A

The commonest type of schizophrenia

Negative symptoms

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9
Q

Risk Factors:

Perinatal - 3

Economic - 2

Race - 2

A

FH

Pre-term
In-utero viral infection
Hypoxic birth injury

Urban living
Low socio-economic class

Immigrants
Non-white

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10
Q

Schizophrenia illness pattern:

Group 1

Group 2

Group 3

Group 4

A

Only one episode - no impairment

Several episodes with no or minimal impairment

Impairment after the first episode with subsequent exacerbation and no return to normality.

Impairment increasing with each of several episodes and no return to normality.

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11
Q

Investigations:

What should be done to assess the patient:

  • 2 histories
  • 1 verbal examination
  • 1 physical examination

For differentials, if indicated:

  • Endocrine - 2
  • Infectious - 2
  • What can be found in a urine drug screen, weeks or even months after cessation?
  • Neurological - 4
A

Full history and MSE
Neurological examionation
Collateral

TFT, cortisol

Syphilis
HIV

Cannabis - weed

CT
MRI
LP
EEG

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12
Q

Management:

Where should patients with their first episode of schizo or at risk of psychosis be referred to?

A

EIP - early intervention in psychosis

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13
Q

Management - Biological - Antipsychotics:

1st line:

  • Route - 2
  • What type of APs should be used?

2nd line:

  • Typical AP starting with C?
  • Why is this one used?
  • When is it started?
A

Oral or depot

1st or 2nd - 2nd should be one of the two

Clozapine
More effective than others but does have other SE’s
2 different
2 different APs have been ineffective

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14
Q

Management - Biological - Antipsychotics:

What type of administration can be used for patients with poor adherence?

How should APs be started and how long do you wait to look for effectiveness?

When is the only time you cross-taper meds?

A

Depot drugs (e.g. risperidone, haloperidol, olanzopine)

Start low and titrate up

4-6 wks

If you are switching them onto other drugs

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15
Q

Management - Biological - Antipsychotics:

Basic tests at baseline and annual checkup:

  • Bloods - 3
  • What 2 things need to be monitored?
A

FBC, U&E, LFTs

Metabolic monitoring - fasting glucose, HbA1c
CV monitoring - Lipids, weight, waist circumference, BP,, ECG

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16
Q

Management - Psychological:

What should psychological therapies be offered in conjunction with?

What type of CBT is done?

How many sessions?

Aim of CBT?

What other people should be thought about?

What other therapies are available?

A

APs + CBT

Individual CBT

16 sessions

Focusing on re-evaluating abnormal thoughts and perceptions and reducing the distress resulting from symptoms.

Family intervention

Art therapy - helps self-expression and is delivered in groups, thus alleviating social isolation.

17
Q

Management - Psychological - Prevention:

What signs are there of someone at risk?

What can be offered to prevent the need of APs in full-blown schizo?

A

Distress and impaired social functioning
Plus transient/mild psychosis
1st degree relative with psychosis

CBT +/- family intervention

18
Q

Management - Social:

Lifestyle changes - 3

Assistance for….?

Type of support - 1

What may be good for those who feel socially isolated?

A

Healthy eating
Physical activity
Smoking cessation

Mainstream education, work or training

Peer support - given by recovered and stable patients who have had schizophrenia or psychosis.

Day centres

19
Q

Management - Social:

Options available for smoking cessation?

What do support carers do?

A

Nicotine replacement
Bupriopion or varenicline

Offer a formal assessment of their needs by mental health services, and provide support as needed.

20
Q

Complications - 4

Bad prognostic factors

A

Drug use
Risk of criminal victimisation, including violence
Suicide
Early death from meds SE

Early or insidious onset
Continued exposure to precipitants
Family FH of schizophrenia or mood disorder or family member with high expressed emotion
Low IQ

21
Q

First Generation Antipsychotics:

Drugs - Oral examples:
C, H, T, S, P, P, L

Drugs - Depot examples:
H, F, F, Z

A 
Chloropromazine
Haloperidol ******
Trifluoperazine 
Sulpiride
Pimozide 
Prchlorperazine 
Levomepromazine 
///////////////////////////////////////
Haloperidol ******
Fluphenazine
Flupentixol 
Zuclopenthixol
22
Q

First Generation Antipsychotics:

MOA

Extrapyramidal side effects (EPSE):

  • The ain one
  • Signs of tardive dyskinesia? When does it tend to happen? How may it be treated?
  • Akathisia - what is it? why is it important?
  • Acute dystonia - what is it?
A

Parkinsonism

Lip-smacking 
Rocking
Rotating ankles 
Marching in place 
Repetitive sounds

Chronic use

Tetrabenazine - monoamine uptake inhibitors - used to treat hyperkinetic movements disorders.

An inner state of restlessness - increases suicide risk

Painful, sustained muscle spasm, especially of neck, jaw or eyes.

23
Q

FGA vs SGA:

Which one causes greater EPSE?

What is a severe side effect of antipsychotics?

A

FGA WAS thought to cause more side effects, but it was only consistently shown in haloperidol.

Now thought to be quite equal!!!!!
/////////////////
Neuroleptic malignant syndrome (NMS)

24
Q

First Generation Antipsychotics:

Other side effects:

  • What does dopamine inhibition increase the secretion of? - P
  • Anti-histaminergic effects - 2
  • Weight?
  • Metabolic - 1
  • CVD - 2
  • Anticholinergic effects
  • BP
  • Which drugs cause long QT syndrome?
  • Which drug causes sexual dysfunction?
A

Prolactin

Sedation and apathy

Weight gain

T2DM

Stroke and VTE

Dry mouth, retention etc.

Postural drop in BP

Haloperidol and pimozide

Haloperidol

25
Q

Second Generation Antipsychotics:

Drugs - oral examples:
- A, A, C, O, R, Q

Drugs - depot examples:
- O, R

A 
Amisulpiride
Aripiprazole 
Clozapine 
Olanzapine ******
Risperidone ******
Quetiapine

Olanzapine **
Risperidone **

26
Q

Second Generation Antipsychotics:

  • What does dopamine inhibition increase the secretion of? - P
  • Anti-histaminergic effects - 2
  • Weight?
  • Metabolic - 1
  • CVD - 2
  • Anticholinergic effects
  • BP
  • Which drug causes long QT syndrome?
  • Which drug cause sexual dysfunction?
A

Prolactin

Sedation and apathy

Weight gain

T2DM

Stroke and VTE

Dry mouth, retention etc.

Postural drop in BP

Quetiapine

Risperidone

27
Q

Second Generation Antipsychotics:

Clozapine:

Why is this drug controversial?

Common side effects - 4

What common GI effect do you get?

A

It is the most effective but the ‘dirtiest’ antipsychotic, with lots of side effects.

Sedation, metabolic syndrome, low BP, anticholinergic effects.

Constipation

28
Q

Neuroleptic malignant syndrome:

HARD mneumonic for tetrad - what is it?

What else may present with this leading to cocacola coloured urine and kidney dysfunction?

Cause:
- Main cause?

How soon after the first dose does it present?

Inv - What may be found on bloods?

Management:

  • Main Rx
  • What can be done for rigidity?
  • What can be done for psychomotor agitation?
A

Hyperthermia - Fever

Altered mental status - confusion, delirium

Riigidity (tremor, akinesia)

Dysautonomia - tachycardia, labile BP and sweating

Rhabdomyolysis

Antipsychotics

2 wks after

=====

Electrolyte imbalances
Raised CK

========
Discontinue antipsychotic

Give dantrolene - prevents release of calcium in striated muscle - less contractions

Benzos

29
Q

HISTORY:

Q’s to ask about auditory hallucinations?

A

Do you ever hear noises or voices when there is nobody else there?

Are the voices like you hear mine right now?

Can you hear them in your ears, or are they in your mind?

How many voices are there?

Do you recognise the voices?

What do they say?

Do they tell you to do things? (Do you obey?)

Do they tend to comment on what you are doing/thinking?

Are they present all the time?

Does anything make them better or worse?

Do you ever find yourself having a conversation with them?

Do you smell or see anything at the same time that you hear these voices?

30
Q

HISTORY:

Q’s to ask about thought disorder? - 3

A

Do you feel able to think clearly?

Do you ever experience you thoughts suddenly stopping as though there were no thoughts left?

What is it like? How do you explain it?

31
Q

HISTORY:

Q’s to ask about thought withdrawal? - 1

Q’s to ask about thought insertion? - 2

Q’s to ask about thought broadcasting? - 2

A

Is there anyone or anything taking thoughts out of your head?
///////////
Are you thoughts your own?

Is there anyone/anything putting thoughts into your head that you know are not your own?
////////
Can anyone hear your thoughts? For example, can I head what you are thinking right now?

Do you ever hear your own thoughts echoed or repeated?

PSYCHIATRY (20 decks)

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