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Psychiatry Year 3 Dundee > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

What are the primary symptoms of schizophrenia?

A

Thought Disorders
Delusions of control influence and passivity
Hallucinatory voices - running commentary or voices from distinct body parts
Persistent culturally inappropriate or impossible delusions.

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2
Q

What are the secondary symptoms of schizophrenia?

A

Persistent hallucinations in any modality for >1 month
Neologism incoherent or irrelevant speech
Catotonic behaviour waxy posturing and flexibility
Stupor
Negative symptoms

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3
Q

What are the negative symptoms of schizophrenia?

A

Blunted affect

Incongruity of emotional response

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4
Q

What are positive symptoms of schizophrenia?

A

Hallucinations
Delusions
Disorder of thought
Passivity phenomena

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5
Q

80% of schizophrenic patients are….

A

Paranoid

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6
Q

Hepephrenic schizophrenia

A 
Shallow innapropiate mood
Unpredictable fragmentary hallucinations and delusion
Incoherent speech
Social isolation
Negative symptoms
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7
Q

Paranoid schizophrenic

A

1st rank symptoms

positive schizophrenia symptoms

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8
Q

20% of schizophrenic patients are…

A

Hepephrenic

Catotonic

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9
Q

Catotonic schizophrenia

A

Movement disorder - swing between hyperkinesis and stupor

Automatic obedience in Waxy posturing and flexibility

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10
Q

What is pathophysiology behind schizophrenia?

A

Excessive and abhorrent firing of dopaminergic neurones.

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11
Q

List the dopamine pathways found in the brain.

A 
Mesolimbic
Mesocortical
Nigrostriatal
Tuberoinfundibular 
Hypothalamospinal
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12
Q

What drugs are initially prescribed with a first episode of psychosis?

A

Haloperidol
Raclopride
Aripiprazole

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13
Q

If extra-pyramidal side effects are of a great concern or the psychosis is resistant to treatment what 2nd generation anti-psychotic is used?

A

Clozapine

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14
Q

Which medication when used in psychosis is linked to an increase in cognition and concentration?

A

Lurasidone
Dopamine Adrenoreceptor antagonist
Seretonin partial agonist

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15
Q

What medication is used in the treatment of Schizophrenia?

A

Anti-psychotics - usually antidopaminergic

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16
Q

What are the main symptoms of the antipsychotic drugs used in schizophrenia?

A

Extra pyramidal
Neuroleptic Malignant Syndrome
Hyperprolactinaemia
Akanthesia

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17
Q

Why do patients of antipsychotics develop extra pyramidal side effects?

A

Blocking of the nigrostriatal pathway

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18
Q

What are the main symptoms of the extra-pyramidal side effects?

A

Acute dystonia
Parkinsonism
Tardive dyskinesia

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19
Q

What is Acute dystonia?

A

Gradual increase in muscle tone

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20
Q

What is the time scale of acute dystonia ?

A

minutes to hours

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21
Q

What are the main symptoms acute dystonia?

A

Jaw locking
Eyes roll back
Tongue protrudes
Body twists to the side of the stronger muscles

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22
Q

What percentage of patients on antipsychotics reports extrapyramidal side effects?

A

50%

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23
Q

What are the main symptoms of Parkinsonism?

A 
bradykinesia 
Cogwheeling rigidity
Resting tremor
Shuffling gait
Dead pan face
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24
Q

What is tardive dyskinesia?

A

Involuntary repetitive orofacial movements, can involve trunk or limbs

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25
Q

Give some examples of common movements in tardive dyskinesia.

A

Blinking
grimacing
Pouting
Lip smacking

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26
Q

What is the time scale for tardive dyskinesia?

A

Long term side effect years of use

Often is permanent even with withdrawal

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27
Q

Why do patients of antipsychotics develop extra pyramidal side effects?

A

An imbalance between acetylcholine and dopamine within the brain.

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28
Q

How are the extrapyramidal side effects of antipsychotics treated?

A

Withdrawal of medication and replaced with clozapine.

Reducing levels of acetylcholine to balance levels, both low.

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29
Q

Why is clozapine the replacement if extra pyramidal side effects are a worry?

A

It is least likely to cause extra pyramidal side effects

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30
Q

What medication is used to reduce the levels of acetylcholine and restore the balance with dopamine?

A

Procyclidine Oral

Orphenadrine IM

31
Q

Once the symptom of Tardive dyskinesia are present does it respond to removal of medication or anticholinergics?

A

No it is very unresponsive

32
Q

Why do patients on antipsychotics sometimes develop Neuroepileptic Malignant Syndrome?

A

Hippocampal dopamine receptors are blocked

33
Q

How many patients on Antipsychotics develop NMS?

A

Rare but 20 -30% of patients who develop it die

34
Q

What is NMS?

A

Gradual increase in muscular tone
Pyrexia
Autonomic dysfunction

35
Q

How does NMS kill you?

A

Autonomic dysfunction results in a massively varying BP HR.
Rhabdomyolysis leads to acute renal failure
Coma
Death

36
Q

What investigation can aid in the diagnosis of NMS?

A

Creatine Kinase

37
Q

What is the treatment for hypothalamic NMS?

A 
STOP antipsychotic
Rapid cooling
Renal suport
Skeletal muscle relaxants
Dopamine agonists
38
Q

What dopamine agonist is used in the treatment of NMS?

A

Bromocriptine

39
Q

Why do patients of antipsychotics present with hyperprolactinaemia?

A

Dopamine inhibits prolactin release from the pituitary gland so reduced dopamine results in excess prolactin release.

40
Q

Women with hyperprolactinaemi present with….

A 
Galactorrhea
Reduced libido arousal 
Anorgasmic
Amenorrhea
Anovulation
41
Q

Men with hyperprolactinaemia present with…..

A

Gynaecomastia
Erectile dysfunction
Oligospermia
Reduced libido

42
Q

Prolactin affects….

A

Boobs
Balls
Bones

43
Q

Hyperprolactinaemia has what affect on the bones?

A

Reduced bone mineralisation density

Osteoporosis

44
Q

What percentage of patients on antipsychotics complain of akathisia?

A

20%

45
Q

What is the time scale of initiation of antipsychotic to side effect onset?

A

Days to weeks

46
Q

What is Akathisia?

A

Restlessness
Pacing
Poor sleep

47
Q

What is the particular risk associated to Akathisia?

A

Due to poor sleep there is an increased risk of suicide.

48
Q

What mediation is used in the treatment of Akathisia?

A

Beta blockers - Propanolol

BDZ - for severe acute episodes

49
Q

Due to there unknown effect on other receptors throughout the brain what other effects can Atipsychotic drugs have and why?

A

Anticholinergic - dry mouth constipation blurred vision
Anti-serotonergic - weight gain Type 2 diabetes
Anti adrenergic - postural hypertension

50
Q

What are some other common side effects of Anti-psychotics?

A

Hepatotoxicity
Prolonged QT
Photosensitivity

51
Q

What severe side effects are associated with clozapine?

A

Agranulocytosis
Myocarditis
Sever weight gain 10kg in 3 months
Severe constipation

52
Q

What is agranulocytosis?

A

Dangerously low white blood cell count - leading neutropenic sepsis as unable to fight infection

53
Q

What other side effects of clozapine are common?

A

Sedation

Sialorrhoea

54
Q

Why is constipation considered a severe side effect of clozapine?

A

Leads to gastroperesis obstruction and perforation of the bowel

55
Q

Apart from reduced risk of extra pyramidal side effects what are the benefits of clozapine?

A

Reduces risk of suicide

Good for negative symptoms of psychosis

56
Q

How long does someone need to be on the titrated adequate dose before they can be reviewed for alternative treatment?

A

6-8 weeks

57
Q

Alongside pharmacological treatments what else must be considered ?

A

optimising social supports

Psychological therapy

58
Q

If someone is unresponsive to both 1st and 2nd generation drugs what must be considered?

A

Check diagnosis correct

Check compliance

59
Q

If a patient has poor compliance what can be considered?

A

IM Depots in gluteal of deltoid muscle every 3 months

Haloperidol Risperidone

60
Q

Why do patients with psychosis have many illnesses factors?

A 
Poor diet
Lack of support
poor access to transport
Chronic health condition
poor concentration - missed appointments prescriptions etc
Higher rate of smoking
Co morbid drug use
61
Q

When is a very rare age period for a diagnosis of schizophrenia?

A

Old age and adolescence

62
Q

Is there any gliosis present in schizophrenia?

A

NO

63
Q

What is the biggest risk factor for developing schizophrenia?

A

Family History

64
Q

What are some other risk factors for developing schizophrenia?

A

2nd trimester viral illness
Obstetric problems - pre eclampsia foetal hypoxia
Childhood viral CNS infection
Substance misuse

65
Q

Why does substance misuse increase your risk of developing schizophrenia?

A

Its multi factorial so patient may be genetically predisposed and the substances trigger schizophrenia.

66
Q

What substances carry a particular risk of triggering schizophrenia?

A

Amphetamines
Cocaine
Cannabis
Synthetics - Spice Ivory wave

67
Q

What may be seen in the brain of a patient with schizophrenia?

A

Enlarged ventricles
reduced frontal lobe volume and grey matter
Reduced activation of pre frontal regions

68
Q

Subcortical dopamine hyperactivity leads to…

A

Psychosis

69
Q

Mesocortical dopamine hypoactivity leads to…

A

Negative and cognitive symptoms

70
Q

What genes are related to schizophrenia?

A

Neuregulin
Dysbindin
DISC-1

71
Q

Neureglin

A

Signalling protein mediating cell to cell interaction

72
Q

Dysbindin

A

Essential for adaptive neural plasticity

73
Q

DISC-1

A

Involved in neural growth

Cortical development

Psychiatry Year 3 Dundee (21 decks)

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