Schizophrenia/Psychosis Flashcards
Schneider’s first rank symptoms
DAPT
- delusions
- auditory hallucinations
- passivity phenomena
- thought disorderS
define Psychosis
A severe mental disorder in which thought and emotions are so impaired that contact is lost from reality
5 differentials for Psychosis
- brain tumour
- temporal lobe epilepsy
- thyroid disease
- high dose steroids
- encephalitis
3 infections of the nervous system that can cause psychosis
- AIDS
- neurosyphylis
- encephalitis
2 endocrine causes of psychosis
- cushings syndrome
- thyroid disease
investigations in someone presenting with psychosis
- fbc
- lfts
- tfts
- bone function
- renal function
- routine MRI (if presence of neurological symptoms)
management of 1st episode of psychosis
- oral antipsychotic medication
- psychological interventions: 1) CBT 2) family intervention
average age in males + females for schizophrenia
men = 22 women = 26
prevalence of schizophrenia
1%
4 Positive symptoms of schizophrenia
- hallucinations
- delusions of: control, passivity, sensations, perceptions
- thought alienation
- persistent delusions
5 negative symptoms
- thought disorders
- self neglect
- blunted mood
- reduced speech + withdrawal
- decreased motivation
Delusion is ___
fixed, false belief that is unshakeable despite evidence of the contrary
Hallucinations are ___
perceptions with no external stimulus
types of thought disorders (4)
- thought insertion
- thought withdrawal
- thought broadcasting
- repetition of thoughts
presentation of catatonic behaviour
- waxy flexibility
- negativism
- sudden excitement
following the first episode of psychosis, what percentage of patients experience a relapse within
a) 1 year
b) 5 years
a) 30%
b) 80%
precipitating factors for psychosis (2)
Life events
Street drug use: amphetamines + cannabis
maintaining factors for schizophrenia (3)
- street drug use
- disruptive family environment
- poor adherence to medx
4 susceptibility genes
- Neuregulin
- DISC
- Dysbindin
- ZNF804A
birth risk factors for developing schizophrenia (4)
- birth asphyxia
- childhood encephalitis/brain injury
- winter birth
- urban birth
ethnicity risk factor for Schizophrenia
africo caribbean ethnicity
childhood risk factors for developing schizophrenia (4)
- cannabis use at age 15
- separation from parents
- childhood brain injury/encephalitis
- childhood sexual abuse
area of brain responsible for negative symtoms
prefrontal cortex
area of brain responsible for hallucinations
superior temporal gyrus
area of brain responsible for positive symptoms
medial temporal lobe: hippocampus
4 dopamine pathways
1) nigrostriatal pathway
2) mesolimbic pathway to midbrain
3) mesocortical pathway
4) tuberoinfundibular pathway
pathological dopamine pathway in schizophrenia
mesolimbic pathway to midbrain; to regions associated with: reward, motivation, memory, affect
3 typical antipsychotics
- Haloperidol
- Pimozide
- Fluphenazine
4 atypical antipsychotics
- Clozapine
- Olanzapine
- Risperidone
- Quitiapine
- Apriprazole
extra pyramidal side effects of antipsychotics (4)
- akathisia
- dystonia
- tardive dyskinesia
- parkinson like rigidity
akathisia is
restless legs
dystonia is
painful muscle contractions
metabolic side effects of antipsychotics (3)
- raised cholesterol
- T2DM
- weight gain
rare but serious side effect of Clozapine
Agranulocytosis
antimuscarinic SE of antipsychotics (4)
- dry mouth
- blurred vision
- urinary retention + constipation
which antipsychotic initially requires weekly blood tests
clozapine
monitoring required prior to commencing antipsychotics
- cardiovascular
- endocrine
- activity + diet
- FBC, U+E, LFTs
- BP + pulse
- ECHO + ECG
- fasting blood glucose
- HbA1c
- prolactin
- lipids
- waist circumference
- assess nutritional status, diet + physical activity
antipsychotic that reduces seizure threshold
- clozapine
rare but potentially fatal side effect of antipsychotics
neuroleptic malignant syndrome
signs of neuroleptic malignant syndrome
- fever
- tachy
- muscle rigidity
- pallor
- urinary incontinence
management of neuroleptic malignant syndrome
- active cooling
- ICU
- stop antipsychotics
- amantadine for rigidity
- benzodiazepine for agitation
- aggressive IV fluid resus
complications of neuroleptic malignant syndrome (4)
- raised potassium
- renal failure
- rhabdomyolysis
- seizures
psychological treatments for Schizophrenia
CBT
Family interventions
aim of CBT
focuses on helping patients understanding their symptoms better + develop ways of coping
