Schizophrenia and related disorders Flashcards
What conditions can psychosis present in?
• Organic states & disorders (delirium, dementia, DT’s, other brain disorders, metabolic disorders e.g. porphyria etc.)
• Psychoactive substance misuse (intoxication and
withdrawal states, DTs)
• Schizophrenia
• Affective disorders
• Sleep or sensory deprivation
• Bereavement
What are the five types of these disorders?
Schizophrenia, schizoaffective disorder, delusional disorder, acute & transient psychotic disorder, schizotypal disorder.
Schizophrenia epidemiology?
Up to 1% of the population.
M>F
Symyptoms >6/12 (>1/12 for diagnosis)
What are the positive symptoms in schizophrenia?
Hallucinations (esp auditory)
Delusions
Thought disorders
These are the focus of drug treatment and have a good prognosis.
What are the negative symptoms in schizophrenia?
Avolition: lack of motivation Anhedonia: unable to experience pleasure Alogia: poverty of speech Asociality: lack of desire for relationships Affect Blunt
Less responsive to treatment
What is schizophrenia characterised by (in general) in the ICD-10?
- fundamental and characteristic distortions of thinking and perception
- affects that are inappropriate or blunted.
What are the most important psychopathological phenomena of schizophrenia?
Thought broadcast Thought withdrawal or insertion Thought echo Delusional perception Delusions of control/passivity/influence 3rd person hallucinatory voices Thought disorders Negative symptoms
When should schizophrenia not be diagnosed?
Overt brain disease (including epilepsy)
States of intoxication or withdrawal
What is schizoaffective disorder?
This is when symptoms of schizophrenia and affect are prominent at the same time.
5 types of schizophrenia
Paranoid (most common) Hebenephric Catatonic Simple Undifferentiated
What are Schneiders first-rank symptoms of schizophrenia?
- Delusional perception
- 3rd person auditory hallucinations
- Thought Echo, Insertion, Withdrawal, Broadcast
- Passivity
* Somatic (experiences of bodily influence)
* Made (Acts, Impulses, Affects (emotions))
What neurotransmitter is thought to be the cause of schizophrenic disorders?
Dopamine
What receptors do most antipsychotics act upon?
Dopamine receptors (all 5 but mostly D2)
What brain system causes positive symptoms, and which one causes negative symptoms?
Positive > mesolimbic
Negative > mesocortical
What risk factors are there for schizophrenia?
Environmental: • Winter births, viral infections • Association with other CNS pathologies • Neurosyphyllis, Encephalitis, Temporal Lobe Epilepsy Life events: • Social exclusion, economic adversity • Childhood trauma/abuse • Migration (higher rates in migrants) • Urban environment (higher rates) • Negative attitudes/ high expressed emotion Substance misuse: • Cannabis, amphetamines Peri-natal trauma: • Hypoxia, maternal stress
What is De Clerambault’s syndrome?
•Erotomania -Delusional belief another (famous, higher social status) is in love with them
•Can’t declare love so via secret signs/
communication
What is Capgras syndrome?
- Delusional misidentification
- Relative/ spouse/ close relation/ friend replaced by identical looking double or impostor
- M:F = 2:3
What is Othello syndrome?
• Delusional belief that partner having affair/sex with others • No evidence/ misinterprets minor evidence • Associated with alcohol dependence/ sexual dysfunction • Risk of stalking and/or violence to partner
What is Fregoli’s syndrome?
• Different people are a single person who changes appearance or is in disguise • Often believe they are being persecuted by that person
What is Cotard’s syndrome?
•Delusion of being dead, dying, nonexistent,
rotting, lost parts of body/organs
•Associated with depression
What is Folie a Deux?
- Induced delusional disorder
* Psychosis shared by two people
What is Ekboms syndrome?
•Delusional parasitosis •infested with parasites •No evidence (only little marks/ freckles/spots) •Associated with formication •Risk of self harm trying to get rid of parasites •Presents to dermatologists •House or home infested: delusional cleptoparasitosis
What is catatonic schizophrenia?
• prominent psychomotor disturbances that may alternate between extremes such as hyperkinesis
and stupor, or automatic obedience and negativism.
• Constrained attitudes and postures may be maintained for long periods.
• Episodes of violent excitement may be a striking feature of the condition.
• The catatonic phenomena may be combined with a dream-like (oneiroid) state with vivid scenic
hallucinations.
What is simple schizophrenia?
• insidious but progressive development of oddities of conduct, inability to meet the demands of
society, and decline in total performance.
• The characteristic negative features of residual schizophrenia (e.g. blunting of affect and loss of
volition) develop without being preceded by any overt psychotic symptoms.
What is undifferentiated schizophrenia?
• Psychotic conditions meeting the general diagnostic criteria for schizophrenia but not conforming
to any of the subtypes or exhibiting the features of more than one of them without a clear
predominance of a particular set of diagnostic characteristics
What short-term (acute) medication can you use to treat schizophrenia?
Antipsychotics
What long-term (maintenance) medication can you use to treat schizophrenia?
Antipsychotics (oral/depot)
Antidepressants
Lithium
What psycho-social short-term (acute) treatment can you use to treat schizophrenia?
Psychoeducation (CBT/family Interventions)
What psycho-social long-term (maintenance) treatment can you use to treat schizophrenia?
CBT Supported employment Family interventions Reduce expressed emotion Relapse signature Art therapy
What side effects are you more at risk of in 1st generation antipsychotics and what are you more at risk on in 2nd generation antipsychotics?
FGA - Neurological side effects
Tardive dyskinesia, extrapyramidal symptoms, D2 antagonists
SGA - Metabolic side effects
Weight gain, hyperglycaemia, dyslipidaemia, 5HT2A/D2 antagonists
What is the main risk of Clozapine?
When do you offer it?
Agranulocytosis, also myocarditis, weight gain, salivation, seizures, sedation.
NICE: Offer clozapine to people with schizophrenia whose illness has not responded adequately to treatment despite the sequential use of adequate doses of at least two different antipsychotic drugs.
What is tardive dyskinesia?
Tardive – delayed or appearing late (because it’s a side effect that usually doesn’t appear until after you’ve been taking medication for a while)
Dyskinesia – abnormal or unusual movements
What are extrapyramidal symptoms?
These symptoms include:
dystonia (continuous spasms and muscle contractions), akathisia (motor restlessness),
parkinsonism (characteristic symptoms such as rigidity), bradykinesia (slowness of movement), tremor, and tardive dyskinesia (irregular, jerky movements).
