Schizophrenia and Psychoses Flashcards
Schneider’s first rank Sx of Schizophrenia
1) Auditory Hallucinations
2) Thought Disturbances
3) Somatic Hallucinations
4) Delusional Perception
Auditory hallucinations
Thought echo
Voices arguing
Voices commenting on one’s actions
Thought disturbances
Thought withdrawal
Thought broadcasting
Thought insertion
Thought broadcasting
Often accompanied by delusional explanation
Eg. telepathy, radio transmitters
Schizophrenia aetiology hypothesis
Several susceptible genes + Early environmental events
=>
Increased vulnerability
=> Psychoses (with drug misuse or social factors)
Peri-natal risk factors for schizophrenia
Winter births - maternal infection + lower vit D
Low birth weight
Premature babies
Brain abnormalities in schizophrenia
Not diagnostic
Reduced brain volume
Increased ventricular size
Reduced hippocampus and amygdala volume
Amygdala
Fear and emotion
Hippocampus
Memory
Nucleus accumbens
Reward centre
Dopamine
Prefrontal cortex
Logic
Reason
Personality
Social RFs for schizophrenia
Lower socio-economic class Urban areas Recent immigrants Drug misuse Adverse life events
VTA
Ventricle Tegmental Area
Pathophysiological theory of schizophrenia
Hyperactive mesolimbic pathways
Hypoactive mesocortical pathways
Mesolimbic pathway
VTA to nucleus accumbens
Hyperactivity leads to positive Sx
Mesocortical pathway
VTA to prefrontal cortex
Hypoactivity leads to negative Sx
Schizophrenia Sx categories
Premorbid stage
Prodromal stage
Positive Sx
Negative Sx - usually after 5 yrs
Premorbid Sx of schizophrenia
Subtle motor, linguistic and social dysfunction
Prodromal Sx of schizophrenia
Functional decline Odd ideas Changes in mood/affect Unusual speech Bizarre perceptual experiences
Positive Sx
Delusions
Hallucinations
Thought disorder
Behavior abnormalities
Negative Sx
Flattening of affect
Amotivation
Anhedonia
Attention impairment
Anhedonia
Loss of joy from previously positive activities
Definition of schizophrenia
Sx lasting at least one month
With at least one of Schneider’s frist rank Sx
OR at least two Second rank Sx
Second rank Sx
Persistent hallucinations
Catatonic behavior
Negative Sx
Neologisms
Neologisms
Breaks in train of thought
Results in incoherence
Differential Diagnoses of schizophrenia
Manic or depressive episodes
Organic brain disease
Alcohol or drug related
Side effect of Ritilin
Psychotic Sx
Schizophrenia subtypes
Paranoid schizophrenia - most common
Catatonic schizophrenia
Simple schizophrenia
Prognosis options for schizophrenia
Complete remission - one episode only
Episodic remittent
Stable deficit - impaired after first episode
Impairment increasing after each episode
Medical Mx of schizophrenia
Dopamine D2 receptor antagonist
Muscarinic ACh receptor antagonist
Alpha 1 adrenergic receptor antagonist
Histamine receptor antagonist
Side effects of D2 antagonists
Extra pyramidal side effects
Side effects of Muscarinic ACh receptor antagonists
Constipation
Drowsiness
Dry mouth
Blurred vision
Side effects Alpha 1 adrenergic receptor antagonists
Hypotension
Dizziness
Side effects of Histaminic receptor antagonists
Weight gain
Drowsiness
Adjunctive medications for schizophrenia
Anti-depressants
Mood stabilisers
Tranquilizers
Typical antipsychotics
Haloperidol
Fluphenazine
Zoopclopedixol (depo)
Side effects of typical antipsychotics
Extra pyramidal side effects
Weight gain
Sexual side effects
Atypical new generation antipsychotics
Risperidone Olanzapine Amisulpride Quetiapine Aripiprazole (prolactin)
Side effects of atypical antipsychotics
Less extra pyramidal
More weight gain
Metabolic syndrome
Treatment resistant antipsychotics
Clozapine - last resort
Only used if unsuccessful with 2 other antipsychotics
Life threatening management
ECT
NICE guidelines for trial period for antipsychotics
4-6 wks
