Schizophrenia Flashcards
Define schizophrenia
Schizophrenia, a form of psychosis, is characterised by distortion to thinking and perception and inappropriate or blunted affect.
Define Psychosis
Symptoms associated with significant alternations to a person’s perception, thoughts, mood, and behaviour. i.e Hallucinations and delusions
What are the positive symptoms of schizophrenia?
- Hallucinations: perceptions in the absence of stimuli.
- Delusions: A fixed, false belief not in keeping with cultural and educational background.
- Thought and speech disorder: Thought processes are altered and disordered.
What are the negative symptoms of schizophrenia?
- Affective flattening (lack of spontaneity or reactivity of mood)
- Avolition (lack of drive)
- Anhedonia (lack of pleasure)
- Attention deficit
- Poverty of speech
- Social isolation
What are schneiders first rank symptoms?
Positive symptoms:
•Thought echo (hearing your own thoughts out loud)
- Thought insertion or withdrawal
- Thought broadcasting
- 3rd person auditory hallucinations
- Delusional perception
- Delusions of control - Passivity and somatic passivity
What is the ICD-10 criteria for schizophrenia?
Schizophrenia may be diagnosed if one (or more) of the first rank symptoms is present for 1+ month
The episode should not be attributable to any other underlying illness
What is the DSM-V criteria for schizophrenia?
Patients suffering with a psychotic episode lasting for at least 1+ month with two (or more) of either positive or negative symptoms present.
should not be attributable to underlying illness.
What is paranoid schizophrenia?
Predominant symptom is that of what are stable, normally paranoid delusions. These are often accompanied by hallucinations (often auditory) but catatonic symptoms and those of abnormal affect, volition and speech are normally absent.
What is Hebephrenic schizophrenia?
Affective symptoms are prominent with abnormal behaviour. Negative symptoms are significant and social isolation may result.
What is catatonic schizophrenia?
Predominant symptoms are those of psychomotor disturbance, and may exhibit both hyperkinesis and stupor as well as automatic obedience and negativism. Other features may include episodes of violent excitement.
What is undifferentiated schizophrenia?
Those that meet the diagnostic threshold but do not fit into one of the above categories.
What investigations would you do, to rule out differentials?
- FBC
- Blood sugar
- LFT
- Thyroid function tests
- Syphilis serology
- Urine dipstick (+/- MSU)
- Rule out UTI causing delirium
- Rule out drug intoxication
• ECG (evaluate for long QT if considering antipsychotics)
• Autoimmune screen (e.g. ANA, anti-DS DNA for Lupus)
- autoimmune encephalitis (in particular anti–NMDA) presentation can mimic psychosis and schizophrenia
• CT, MRI head or EEG
How would you manage prevention/anticipation of schizophrenia?
People who do not have a clear diagnosis of a psychotic disorder should ideally be monitored in secondary care for up to 3 years to ensure early diagnosis if a psychotic disorder develops.
Also:
• Undertake risk assessment
• For people at high risk of harm to themselves or others, arrange specialist mental health assessment by early intervention
How do you manage psychosis?
Oral antipsychotic in conjunction with any or all of the following:
o Family intervention
o Individual CBT
o Arts therapies may be offered, particularly to help with negative symptoms.
Set up care plan o Assessing health and social needs o Creating a care plan o Appointing a key worker to be the first point of contact o Reviewing treatment
How should antipsychotic drug treatment be managed?
- Monitor the effects for min. 12 months
- Record:
- weight
- height
- waist circumference
- pulse
- blood pressure
• Assess any: -movement disorders -nutritional status diet -level of physical activity
•Monitor:
- fasting blood glucose
- hba1c
- blood lipid profile
- prolactin levels
