Schizophrenia CORE Flashcards
What is the key epidemiology of schizophrenia?
Most common in the 2nd and 3rd decade of life
1% of the global population
Slightly more common in males
What are the risk factors for schizophrena?
FH - genes DRD2, COT, DAT1 and NRG1
Neurodevelopmental - prenatal complications (infections, malnutrition), obstetric (hypoxia, preterm)
Social adversity - ACEs, urban upbringing and migration
Malnutrition
Rubella
Illicit drug use - particularly cannabis in adolescents.
What is the key hypothesis behind the aetiology of schizophrenia?
Dopamine hypothesis - abnormal dopamine function in brain pathways
Inc activity in mesolimbic pathway leads to positive signs
Dec activity in mesocortical pathway leads to negative signs
What abnormalities in brain structure and function can be seen in schizophrenia?
Reduced grey matter
Ventricular enlargement
Altered connectivity patterns
What are the five categories of schizophrenia?
Paranoid
Disorganised
Catatonic
Undifferentiated - not enought or signs of all
Residual - typically in recovery, negative symptoms more common
What are the key features of paranoid schizophrenia?
Delusions
Hallucination
But normal intellect and expression of affect
What are the key features of disorganised schizophrenia?
Disorganised speech
Disorganised behaviour
Flat or inappropraite affect
What are the key features of catatonic schizophrenia?
Notable disturbances in movement
Waxy flexibility
Catatonic stupor
What are key positive signs of schizophrenia?
Positive - signs patient experiences that healthy would not
Hallucinations
Delusions - grandeur or paranoid
Thought disorders - insertion, blockade or broadcasting
Passivity phenomena - actions or mood
What are the key negative signs of schizophrenia?
Decrease congition, memory
Apathy
Inability for ADLs
Anhedonia
Alogia
These are the absence of features that health people would not experience
What are the risk indicators of a schizophrenia patient?
Violence is rare
Command hallucination
History or deliberate self-harm or suicide ideation
Fixation on specific individuals
What initial investigations may be done in a suspected schizophrenia patient?
Brain imaging - rule out structure abnormalities
Blood tests to exclude infection (HIV/syphilis) or metabolic causes (TFT)
Drug screening - identify substance misuse
What is the gold standard treatment for schizophrenia?
Psychological intervention and anti-psychotic medication
Intervention = CBT, family therapy
What additional treatment may be given during acute episodes of schizophrenia?
Sedatives = lorazepam, promethazine or haloperidol
If showing signs of dangerous behaviour
What are the key prognostic features of schizophrenia?
Stong family history
Gradual history
Low IQ
Premorbid history of social withdrawl
Lack of obvious precipitant
