Schizophrenia and Personality Disorders Flashcards

1
Q

Define schizophrenia

A

Characterised by mental disturbances in multiple mental modalities including:
* Thinking (e.g. delusions)
* Perception (e.g. hallucination)
* Cognition (e.g. impaired attention)
* Behaviour (e.g. bizarre and unpredictable)

Must experience symptoms for at least 1 month.

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2
Q

Define the following:

  • Hallucination
  • Delusion
A
  • Hallucination - Perceiving something that is not present in the environment (can include 5 senses)
  • Delusion - A belief that is strongly held despite evidence to the contrary
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3
Q

Define the following suptypes of schizophrenia:

  1. Paranoid schizophrenia
  2. Catatonic schizophrenia
  3. Hebephrenic schizophrenia
  4. Residual schizophrenia
  5. Simple schizophrenia
A
  1. Characterised by delusions and hallucinations often with a persecutory theme.
  2. Features motor disturbances and waxy flexibility
  3. Marked by disorganised thinking, emotions and behaviour
  4. Residual sx persist after a major episode
  5. A gradual decline in functioning without prominent positive symptoms

Persecutory = type of delusion where they believe they’re being targeted or harassed by others
Waxy flexibility = psychomotor sx where a person’s limb can be molded ir positioned by another person and will remain in that position for a period of time like wax even if it’s uncomfortable or unnatural.

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4
Q

Describe some environmental and genetic factors that can cause schizophrenia

A

Genetic:
* Positive fhx - (50% of both parents are affected ir an identical twin is affected)

Environmental:
* Childhood trauma (e.g. poor maternal bonding or poverty)
* Heavy cannabis use in childhood
* Maternal health issues (e.g. malnutrition and infections)
* Birth trauma (e.g. hypoxia)
* Immigration to more developed countries

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5
Q

Sx of schizophrenia:

  • Positive sx - (hint: ABCD mnemonic)
  • Negative sx
A

Positive sx:
* Auditory hallucinations (involves 3rd person auditory experiences)
* Broadcasting of thoughts (belief that one’s thoughts are being broadcasted to others)
* Control issues (sense of external control over one’s thoughts or actions)
* Delusional perception (distorted interpretations of reality)

Negative sx - overlaps w/depressive sx:
* Alogia (reduced speech or quality of speech)
* Anhedonia (loss of pleasure)
* Affective incongruity or blunting (mismatch between a person’s emotional expression and the situation)
* Avolition (lack of motivation)

-ve sx MC in chronic and treated schizophrenia

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6
Q

What is organic psychosis?

A

When cdtns typically involving neuro sx or mental status changes such as infections, brain injuries or CNS diseases like encephalitis can lead to organic psychosis.

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7
Q

What is schizoaffective disorder?

A

Has features of both psychotic sx (schizophrenia) and affective sx (mood disorders - depression or bipolar)

Note:
* Has better prognosis than schizophrenia but worse than mood disorders - responds better to meds than schizophrenia
* Depression MC in older pts and Bipolar MC in younger pts

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8
Q

Ix for schizophrenia?

A

Ix done to rule out organic cx:
* CT/MRI
* Bloods - exclude infectious or matabolic (i.e. thyroid)
* Drug screening - substance misuse

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9
Q

Tx for schizophrenia?

A

Pharmacological tx:
If acute:
* Typical antipsychotics (sedatives) → lorazepam, haloperidol
* Oral atypical antipsychotics → risperidone, olanzepine

If resistant to other antipsychotics (not responded to 2 other trials of antipsyhcotics) → Clozapine

Psychological tx:
* Psychotherapy

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10
Q

What are typical antipsychotics?

Give examples of the drugs, drug actions (which 4 receptors are blocked) and side effects of each receptor blocking

A

First-generation antipsychotics (FGAs)

Drug action:
* Antagonists to D2 (dopamine), cholinergic (inhibits actions of acetylcholine), adrenergic (receptors that respond to adrenaline) and histaminergic receptors.

Examples:
* MC - haloperidol
* Chlorpromazine

Side effects:
D2 receptor blocking - extrapyramidal effects:
* Acute dystonia (involuntart muscle contractions)
* Akathasia (restlessness)
* Hyperprolactinaemia (menstrual irregularities, gynaecomastia, sexual dysfunction)

Histamine receptor blocking:
* Sedation (drowsiness and sleepiness)

Alpha-1 adrenergic blocking:
* Orhtostatic hypotension (sudden drop in BP upon standing

Cholinergic (muscarinic) receptor blocking:
* Dry mouth
* Constipation
* Blurred vision

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11
Q

What are atypical antipsychotics?

Give examples of the drugs, drug actions (which receptors are blocked) and side effects of each receptor blocking

A

Second-generation antipsychotics - as effective as FGAs and have a favourable SE profile with dec. extrapyramidal effects but inc. metabolic SE.

Drug action:
* Antagonists to D2 (dopamine), D3 and 5-HT2A

Examples - 1st line for new-onset psychosis:
* Risperidone
* Olanzapine
* Clozapine

Side effects:
D2 receptor blocking:
* Lower risk of causing extrapyramidal effects than FGAs

Serotonin (5-HT2A) receptor blocking:
* Lower risk of causing extrapyramidal effects than FGAs

Metabolic effects - MC in atypical:
* Weight gain
* Impaired glucose metabolism
* Prolactin elevations - menstrual irregularities, gynaecomastia, sexual dysfunction.
* Seizures
* Prolonged QT

Important to constantly monitor metabolic SE and do Ix like ECG and BP before starting atypicals.

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12
Q
  • What are the side effects of clozapine?
  • How is it monitored?

mnemonic to remember side effects - MARCH

A

Clozapine has side effects:
* Myocarditis
* Agranulocytosis (neutropenia)
* Reduced seizure threshold
* Constipation
* Hypersalivation

Monitor:
* Weekly FBC first 18 wks of tx then fortnightly for upto 1 year and then monthly
* Blood lipids and weight
* Fasting blood glucose

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13
Q

What is schizoid personality disorder?

A

People who avoid social interaction, “lone wolf”, lack friends, lack of sexual interest.

Not caused by paranoia or social anxiety

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14
Q

What is schizotypal personality disorder?

A

People with excessive magical thinking
(linking unrelated events, fixation on personal destiny), beliefs cause overconfidence, poor social perception, still want to maintain relationships

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15
Q

What is schizophreniform disorder?

A

Sx of schizophrenia for 1-6 mths.

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16
Q

What is postpartum psychosis?

A

Psychiatric disorder that develops within first 2 weeks following childbirth with a range of characteristics such as paranoia, delusions and hallucinations.

17
Q

Sx of postpartum psychosis

A
  • Paranoia
  • Delusions - capgras delusions (belief that a close person is replaced by an imposter)
  • Hallucinations
  • Mania
  • Depressive episodes
  • Confusion
18
Q

Tx of postpartum psychosis

A

Antipsychotics safe for breastfeeding -
* Olanzapine
* Quetiapine

Mood stabilisers

19
Q

What are the cluster A personality disorders?

Hint - MAD

A
  1. Paranoid personality disorders
  2. Schizoid personality disorders
  3. Schizotypal personality disorders
20
Q

Describe the characteristics of paranoid personality disorder?

A
  • Pervasive + enduring pattern of irrational suspicion
  • Mistrust of others
  • Hypersenstivity to criticism
  • Reluctance to confide in others - fear of information being used against them
21
Q

Describe the characteristics of schizoid personality disorder?

A
  • Detachment from social relationships
  • Restricted range of emotional expression
  • Lack of interest in relationships
  • Emotional coldness and detachment
  • Flat affect
22
Q

Describe the characteristics of schizotypal personality disorder?

A
  • Chronic pattern of impaired social interactions
  • Distorted cognitions and excessive magical thinking
  • Eccentric behaviours
  • Odd thinking and speech
  • Shares perceptual distortions with schizophrenia but maintains more intact grasp on reality
23
Q

What are the cluster B personality disorders?

Hint - BAD

A
  1. Antisocial personality disorder
  2. Borderline personality disorder
  3. Histrionic personality disorder
  4. Narcissistic personality disorder
24
Q

Describe the characteristics of antisocial personality disorder?

A
  • Pervasive pattern of disregard and violation of others
  • Psychopaths
  • Lack of empathy
  • Engage in manipulative actions
  • Aggressive, unremorseful behaviour
  • Failure to obey laws and social norms
25
Q

Describe the characteristics of borderline personality disorder?

Hint - Think teenage girl going through puberty

A
  • Abrupt mood swings
  • Unstable relationships
  • Self-image instability
  • Repetitive self-harm
  • Impulsivity - sex, eating, money
  • Inability to control temper
  • Avoid abandonment

Aka - emotional unstable personality disorder (EUPD)

Tx - dialectical behavioural therapy (DBT)

26
Q

Describe the characteristics of histrionic personality disorder?

Think - Harley Quinn

A
  • Attention-seeking behaviours
  • Excessive emotional display
  • Display inappropriate sexual behaviours
  • Emotions - shallow, dramatic, exaggerated
  • Perceive relationships as being more intimate than they truly are
27
Q

Describe the characteristics of narcissistic personality disorder?

A
  • Grandiosity
  • Strong need for the admiration of others
  • Lack of empathy
  • Sense of entitlement + exploit others to fulfil own desires
  • Arrogant + preoccupied with personal fantasies
28
Q

What are the cluster C personality disorders?

Hint - SAD

A
  1. Avoidant personality disorder
  2. Dependent personality disorder
  3. Obsessive-compulsive personality disorder
29
Q

Describe the characteristics of avoidant personality disorder?

A
  • Intense feelings of social inadequancy
  • Fear of rejection + hypersensitivity to criticism
  • Self-impose isolation
  • Avoid potential criticism
  • Strong desire for social acceptance
30
Q

Describe the characteristics of dependent personality disorder?

Think - Snow White

A
  • Excessive need to be taken care of
  • Submissive and clinging behaviour
  • Lack self-confidence and initiative
  • Rely on others for decision-making
  • Urgently seek new relationships
31
Q

Describe the characteristics of obsessive-compulsive personality disorder?

Note - different to OCD

A
  • Not associated with recurrent, intrusive thoughts or rituals like OCD
  • Orderliness - with details, rules and lists
  • Perfectionism - unable to complete projects
  • Rigid, stubborn + believe everyone should follow rules