Schizophrenia Flashcards
what is required for a diagnosis of schizophrenia
at least 1 out of 4 of the main symptoms
or
at least 2 out of 4 of the additional symptoms
symptoms must be present for at least 6 months and significantly impair work/functioning
list the 4 main symptoms of schizophrenia
thought disorder - echo, broadcasting, insertion or withdrawal
delusion of control, influence and passivity
hallucinations
persistent delusions that are culturally inappropriate
list the 4 additional symptoms of schizophrenia
persistent hallucinations in any modality
neologisms
catatonic behaviour
negative symptoms
describe catatonic behaviours
sudden strange purposeless movements such as excitement, posturing, waxy flexibility
describe negative symptoms of schizophrenia
reduced amount of speech reduced drive reduced social interaction apathy blunting of affect
describe positive symptoms of schizophrenia
hallucinations
delusions
passivity phenomena
disorder of form and thought
list the different types of schizophrenia
paranoid
hebephrenic
catatonic
what is the most common type of schizophrenia
paranoid - typically presents with positive symptoms
describe the behaviours seen in hebephrenic schizophrenia
delusions and hallucinations
behaviour is unpredictable and disruptive
mood is shallow and inappropriate
social isolation and -ve symptoms
describe the behaviours seen in catatonic schizophrenia
mainly movement disorders
stupor and hyperkinesis
posturing and waxy flexibility may be seen
what are paranoid psychoses
cluster of disorders such as persistent delusions, schizotypal and schizoaffective disorder
fixed delusions are the main feature
what is the first line treatment for schizophrenia and give an example
second generation antipsychotic such as risperidone, quetiapine, olanzapine
what is the second line treatment for schizophrenia and give an example
an alternative second generation antipsychotic or first generation such as haloperidol, chlorpromazine or zuclopenthixol
what is the third line treatment for schizophrenia
clozapine
why is clozapine third line in treating schizophrenia
severe side effects such as agranulocytosis, myocarditis, constipation, sialorrhoea, weight gain and sedation
what are the main side effects of antipsychotics
extra-pyramidal side effects
neuroepileptic malignant syndrome
hyperprolactinaemia
which generation of antipsychotics typically cause extra-pyramidal side effects
first generation - hence why second generation are tried first
list the types of symptoms experienced with extra-pyramidal side effects
Parkinsonism
acute dystonic reaction
tardive dyskinesia
what is acute dystonia
increasing muscle tone, onset within minutes
muscles appear flexed, oculogyric crisis and tongue protrusion
how are extra-pyramidal side effects managed
treat with anticholinergics such as procyclidine, trihexiphenidyl
what is neuroepileptic malignant syndrome
potentially fatal condition where increasing muscle tone, pyrexia, fluctuating BP/HR can result in rhabdomyolysis and renal failure
describe the clinical features of hyperprolactinaemia
women - galactorrhoea, reduced libido and anorgasmia, amenorrhoea
men - gynaecomastia, erectile dysfunction
both - reduced bone density
why is hyperprolactinaemia a side effect of antipsychotics
prolactin release is inhibited by dopamine, when dopamine gets blocked then increased prolactin release occurs
list some additional side effects - more commonly seen in second generation antipsychotics
anticholinergic s/e - blurred vision, dry mouth, constipation, urinary retention weight gain postural hypotension prolonged QT interval photosensitivity
