Schizophrenia and Personality Disorders Flashcards
Define schizophrenia
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.
Define the following:
- Hallucination
- Delusion
- 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
Define the following suptypes of schizophrenia:
- Paranoid schizophrenia
- Catatonic schizophrenia
- Hebephrenic schizophrenia
- Residual schizophrenia
- Simple schizophrenia
- Characterised by delusions and hallucinations often with a persecutory theme.
- Features motor disturbances and waxy flexibility
- Marked by disorganised thinking, emotions and behaviour
- Residual sx persist after a major episode
- 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.
Describe some environmental and genetic factors that can cause schizophrenia
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
Sx of schizophrenia:
- Positive sx - (hint: ABCD mnemonic)
- Negative sx
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
What is organic psychosis?
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.
What is schizoaffective disorder?
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
Ix for schizophrenia?
Ix done to rule out organic cx:
* CT/MRI
* Bloods - exclude infectious or matabolic (i.e. thyroid)
* Drug screening - substance misuse
Tx for schizophrenia?
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
What are typical antipsychotics?
Give examples of the drugs, drug actions (which 4 receptors are blocked) and side effects of each receptor blocking
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
What are atypical antipsychotics?
Give examples of the drugs, drug actions (which receptors are blocked) and side effects of each receptor blocking
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.
- What are the side effects of clozapine?
- How is it monitored?
mnemonic to remember side effects - MARCH
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
What is schizoid personality disorder?
People who avoid social interaction, “lone wolf”, lack friends, lack of sexual interest.
Not caused by paranoia or social anxiety
What is schizotypal personality disorder?
People with excessive magical thinking
(linking unrelated events, fixation on personal destiny), beliefs cause overconfidence, poor social perception, still want to maintain relationships
What is schizophreniform disorder?
Sx of schizophrenia for 1-6 mths.
What is postpartum psychosis?
Psychiatric disorder that develops within first 2 weeks following childbirth with a range of characteristics such as paranoia, delusions and hallucinations.
Sx of postpartum psychosis
- Paranoia
- Delusions - capgras delusions (belief that a close person is replaced by an imposter)
- Hallucinations
- Mania
- Depressive episodes
- Confusion
Tx of postpartum psychosis
Antipsychotics safe for breastfeeding -
* Olanzapine
* Quetiapine
Mood stabilisers
What are the cluster A personality disorders?
Hint - MAD
- Paranoid personality disorders
- Schizoid personality disorders
- Schizotypal personality disorders
Describe the characteristics of paranoid personality disorder?
- Pervasive + enduring pattern of irrational suspicion
- Mistrust of others
- Hypersenstivity to criticism
- Reluctance to confide in others - fear of information being used against them
Describe the characteristics of schizoid personality disorder?
- Detachment from social relationships
- Restricted range of emotional expression
- Lack of interest in relationships
- Emotional coldness and detachment
- Flat affect
Describe the characteristics of schizotypal personality disorder?
- 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
What are the cluster B personality disorders?
Hint - BAD
- Antisocial personality disorder
- Borderline personality disorder
- Histrionic personality disorder
- Narcissistic personality disorder
Describe the characteristics of antisocial personality disorder?
- 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
Describe the characteristics of borderline personality disorder?
Hint - Think teenage girl going through puberty
- 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)
Describe the characteristics of histrionic personality disorder?
Think - Harley Quinn
- Attention-seeking behaviours
- Excessive emotional display
- Display inappropriate sexual behaviours
- Emotions - shallow, dramatic, exaggerated
- Perceive relationships as being more intimate than they truly are
Describe the characteristics of narcissistic personality disorder?
- 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
What are the cluster C personality disorders?
Hint - SAD
- Avoidant personality disorder
- Dependent personality disorder
- Obsessive-compulsive personality disorder
Describe the characteristics of avoidant personality disorder?
- Intense feelings of social inadequancy
- Fear of rejection + hypersensitivity to criticism
- Self-impose isolation
- Avoid potential criticism
- Strong desire for social acceptance
Describe the characteristics of dependent personality disorder?
Think - Snow White
- 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
Describe the characteristics of obsessive-compulsive personality disorder?
Note - different to OCD
- 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
