Schizophrenia and Psychosis Flashcards
What is the lifetime risk of schizophrenia in the general population?
1/100
What is the lifetime risk of schizophrenia if one of your parents has the condition?
1/10
What is the lifetime risk of schizophrenia if your identical twin suffers from the condition?
1/2
What is the lifetime risk of schizophrenia if you have a sibling with the condition?
1/8
Give three genes that are thought to be involved in the development of schizophrenia?
Neuregulin
Dysbindin
DISC
What structural brain abnormalities are seen in schizophrenia?
Reduced brain volume
Ventricular enlargement EEG changes
Microscopic changes
What chemical appears to be dysregulated in schizophrenia?
Dopamine
What is synaptic pruning and how does it relate to schizophrenia?
As we get older we lose nerve connections (synapses) that we do not need. In schizophrenia there is too much of this meaning that there is an excessive loss of synapses.
Is schizophrenia more common if you have grown up in an urban or rural area?
Urban
What baseline investigations should be done before starting an antipsychotic medication>
Weight
Waist circumfrence
Pulse/BP
Fasting blood glucose , HbA1c, lipids and prolactin levels
Assesment of any movement disorders such as parkinsons
Assessment of nutritional status and activity status
When should you do an ECG before starting an antipsychotic medication?
If it is specified on the medications SPC
Cardiovascular risk/history
Any patient being admitted as an inpatient
Describe how you would titrate the dose of an antipsychotic medication
- Start the treatment with a dose at the lower end of the treatment range.
- Carry out a trial of the medication at the optimum dose for 4 - 6 weeks. and monitor response and side effects
How often do patients need their weight measured when they are on an antipsychotic?
Weekly for the first 6 weeks then at 12 weeks, at 1 year and then anually
Which anti psychotic has the risk of skin photosensitivity?
Chloropromazine
What are bad prognostic indicators in schizophrenia?
- Poor adjustment pre morbidly
- Insidious onset
- Early onset (childhood/adolescence)
- Cognitive impairment
- Enlarged ventricles
What are the outcomes like in schizophrenia?
20%: One episode with no or minimal impairment
40%: Multiple episodes but with no or minimal impairment
40%: Multiple episodes with significant and progressive impairment
What are good prognostic indicators in schizophrenia?
- Older age of onset
- Female
- Marked mood disturbance especially elation
- Family history of mood disorder
What is the suicide rate of schizophrenia?
10 - 15%
What are the general characteristics of atypical antipsychotics?
- Less likely to induce extrapyramidal side effects
- High 5 HT2A to D2 ratio
- Better efficacy against negative symptoms
- Effective in patients that are unresponsive to typical drugs
Give some examples of atypical antipsychotics.
olanazpine, risperidone, quetiapine, clozapine, aripiprazole, amisulpride
What does the histamine blockade cause in atypical antipsychotics?
Sedation
Increased appetitie
