Schizophrenia Flashcards
Define schizophrenia
A disorder characterised by psychotic episodes (hallucinations and delusions) and a personality change due to negative symptoms – something is missing from their personality with symptoms lasting longer than 1 month.
What’s the difference between schizoaffective disorder, schizotypal personality disorder and schizophreniform disorder
Schizoaffective – combination of psychosis and affective mood disorders i.e. both mania/depression and psychosis/schizophrenia at the same time in the same episode. Differentiated from an affective disorder with psychosis by whether the affective symptoms or the psychotic symptoms came first.
Schizotypal personality disorder – partial expression of schizophrenia not treated with medication i.e. odd eccentric behaviour without hallucinations or delusions.
Schizophreniform – disorders that fail to meet the threshold of schizophrenia usually due to duration but have symptoms and deterioration in function.
What are the risk factors for developing schizophrenia?
1% prevalence and 15/100’000 incidence
Higher in afro-Caribbean groups and UK migrants
Usually has an age of onset around 20s
Early cannabis use, influence of genetics and amphetamines and cocaine
What causes schizophrenia?
Unknown
Role of family and upbringing
Illicit drug use
Genetics
What are schneider’s first rank symptoms of schizophrenia?
First rank symptoms
- Thought insertion, broadcast, and thought withdrawal
- Passivity phenomena - delusions that thoughts, feelings, impulses, or actions are influenced/controlled by external forces – disorder of the self, individual can no longer distinguish between themselves and the world
- 3rd person auditory hallucinations including running commentary of life, thought echo or voices discussing the patient in the third person
- Persistent delusions that are culturally inappropriate
- Persistent Hallucinations in any other modality – somatic, visual, or tactile)
What symptoms of schizophrenia are there other than schneider’s first rank symptoms?
Other symptoms
6. Breaks in speech or train of thoughts giving irrelevant speech that flies from one topic to another (formal though disorder) with odd logic and neologisms (made up words)
7. Catatonic behaviour – strange purposeless behaviour such as sudden excitement, posturing, waxy flexibility, mutism, negativism, and imitations of movement
8. Negative symptoms
• Autism (meaning in their own little world)
• Flat affect (affect = the emotional reaction you have to the world around you)
• Withdrawal and self-neglect
• Ambivalence – attitudes that are both positive and negative
• Loosening of associations – formal thought disorder
• Amotivation and Apathy
What are the diagnostic criteria for schizophrenia?
Diagnosis based on 1 very clear symptom from 1-4 or 2 from 5-8. Symptoms must last for more than 6 months and last for the majority of the time in a month. Must have ruled out drug induced psychosis, alcoholism, CNS disorders, head injury and bipolar disorder.
What are the different types of schizophrenia?
Paranoid – persecutory delusions or grandiose delusions (lack of thought disorder, disorganised behaviour, and flatting affect).
Disorganised (hebephrenic) – thought disorder and flat affect present together
Catatonic – immobile, agitated purposeless movement, lack of speech
Undifferentiated type – none of the above
Residual – all positive symptoms have gone but negative symptoms remain
Is there any warning before schizophrenia symptoms start?
Schizophrenia is often preceded by around 18 months by a prodromal set of symptoms where the patient is not themselves with deterioration in function, low intensity psychotic symptoms, odd thoughts, behaviour and beliefs, altered affect, social withdrawal and reduced interest in daily life.
What is the definition of psychosis?
Psychosis – an individual experiencing a reality different to everyone else around them. Can occur gradually or suddenly and the person will lack insight. They do not know they are psychotic – they have no insight.
What is the definition of a hallucination?
Hallucinations – felt in any of the 5 sense modalities giving the perception of a sense in the absence of an external stimulus. Auditory 2nd person – spoken directly to them, 3rd person spoken about them. Visual hallucinations are generally more associated with delirium. Olfactory indicates frontal lobe pathology. Pseudohallucinations – ‘hearing voices in my head.’
What is the definition of a delusion?
Delusions – a fixed firmly held belief that is false and cannot be reasoned away. This belief is held despite evidence to the contrary and is out of keeping with a person’s sociocultural norms. Can be delusions of persecution, grandiose or reference (the milk ran out so I must be God).
What investigation and history should be considered in a patient suspected of having schizophrenia?
Blood tests – U&E, TFT, LFT and FBC
Drug tests
CT head
Collateral history Mental state examination Financial investigation Carers Housing
What organic differentials should be ruled out before diagnosing schizophrenia?
Got to rule out organic problems – delirium, dementia, infection, endocrine, neoplasm, epilepsy specifically temporal lobe epilepsy etc.
What is the general management of schizophrenia?
Location of treatment depends on risk and insight (will they take meds in the community)
Antipsychotics are the mainstay treatment. If concordance is an issue can use depots (except with clozapine).
Mood stabilisers if necessary, e.g. Schizoaffective disorder
Supportive counselling, family therapy and individual CBT
Involvement of a community psychiatric team and CPN
Sort out social problems – debts, benefits and housing
After treating the initial psychosis start to work on insight and residual symptoms then plan how relapses will be prevented.
What monitoring must take place prior to starting an antipsychotic and whilst taking it?
Antipsychotic monitoring
At baseline – FBC, U&E, LFT, Lipids, weight, blood glucose and HbA1C, ECG and Blood pressure. Prolactin only required for typical antipsychotics
At dose changes – BP and ECG
At 3 months – Lipids, blood glucose, weight and HbA1C
At 6 months – Lipids, blood glucose, weight and HbA1C
Annually – FBC, U&E, LFT, Lipids, blood glucose, HbA1C, BP and ECG
