Schizophrenia, Schizoaffective Disorder Flashcards
Schizphrenia
-epidemiology and risk factors
30-40s males
Strong genetic component - many genes, each with a small effect size
Pre/perinatal factors
-maternal infections, malnutrition, birth complications
Childhood
-trauma, abuse, neglect
-urbanicity
May affect neurodevelopmental processes => dopamine dysregulation
-overactivity of mesolimbic D transmission => positive symptoms
-underactivity of mesolimbic D transmission => negative symptoms
Schizophrenia
-positive symptoms (1st rank)
-other features
Schneider’s 1st rank symptoms - must have min 1 rank symptom for majority of 1 month
Auditory hallucinations
-multiple voices discussing/commenting on patient in 3rd person
-thought echo
-running commentary
Thought disorder
-insertion, withdrawal, broadcast
Passivity phenomena
-made feelings, impulses, actions
Delusional perceptions
Impaired insight
Neologisms
Schizophrenia
-negative symptoms
Decreased speech
Anhedonia
Alogia
Avolition
Schizophrenia management
-initial
-relapse
-treatment resistant
1st line - PO atypical antipsychotic for 1 year min
-CBT offered
Relapse - may need sectioning/admission
Depots - for poor compliance, OD risk
-risperdal, depixol, clopixol, piportil
-SE risk higher due to longer action
Treatment resistant - clozapine
-must have tried 2 other APs (1 must be atypical)
-dose uptitrated until correct plasma level obtained
-cigarette smoke can reduce clozapine level, dose may need to be adjusted
Atypical antipsychotics
-SE
-risks in older patients
-the best and worst SE profile
Typical antipsychotics
-SE
-examples
Weight gain, T2DM, CVD
High PRL => gynecomastia/amenorrhea
Sedation
Older adults - Increased risk of stroke, VTE
Olanzapine - higher risk of dyslipidemia and obesity
Aripiprazole - good SE profile
Dystonia, tardive dyskinesia, Parkinsonism, akithesia
Highly sedative
Haloperidol, promethazine, chlorpromazine
Clozapine
-SE to be aware of
Agranulocytosis, neutropenia
Reduced seizure threshold
Constipation
Myocarditis - take baseline ECG
Hypersalivation
Differentials for psychotic disorders
Severe depression, bipolar
- predominance of mood symptoms which may trigger psychosis
- schizophrenia dominated by psychosis
Schizoaffective disorder - psychosis and mood symptoms present within 2wks of each other
Puerperal psychosis - acute symptoms within 2 weeks of birth
Persistent delusional disorder - no hallucinations but single delusion that persists
Induced delusional disorder - shared delusion between 2 people with close emotional connection
-disappears when separated
Brief psychotic disorder - symptoms last less than 1 month
PTSD - existence of a traumatic trigger
Drug induced - cannabis, CS, opioids, cocaine, amphetamines
Delirium, sepsis
CVD, brain tumour, temporal epilepsy, PD, HD
Presentation
-prodrome
-acute episode
Not present in everyone
Deteriorate in personal functioning
-disturbed communication and affect
-unusual behaviour and ideas
-apathy, social withdrawal and reduced interest in ADLs
-memory, concentration problems
-transient psychotic symptoms
Auditory hallucinations most common
- delusions
- behavioural disturbance
- agitation, distress
Prognosis
Good
-no FHx
-stable personality and relationships before diagnosis
-acute
-older
-rapid treatment
-fewer negative symptoms
Bad
-strong FHx
-early/gradual onset
-premorbid Hx of social withdrawal
-structural brain abnormalities, prominent cognitive symptoms
Mortality => reduction in life expectancy due to suicide, premature death
Morbidity => increased DM, IHD, HepC, HIV, substance misuseH
How to differentiate between schizoaffective and bipolar
Schizoaffective - psychosis predominates
-psychotic symptoms come first
Bipolar - mood disorder predominates
-mood is affected 1st
Schizoaffective disorder
-types
Symptoms clearly present for the majority of 2wks
Manic type - psychotic and manic in 1 episode
Depressive type - psychotic and depressive in 1 episode
Mixed - both manic and depressive symptoms
-psychotic symptoms are independent and not related to bipolar symptoms
Schizoaffective disorder
-epidemiology and risk factors
Female, older age
Symptoms present in early adults
Depressive type more common in older people
Bipolar type more common in younger people
High genetic, familial component
Stress
-bereavement
-physical illness/trauma
-relationship trauma
-childhood trauma
Schizoaffective disorder
-management
Acute episode - atypical
Depressive type - add antidepressants for duration of symptoms, to prevent triggering a manic or mixed episode
If manic/mixed type - add mood stabiliser
CBT