Schizophrenia, Schizoaffective Disorder Flashcards

1
Q

Schizphrenia
-epidemiology and risk factors

A

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

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2
Q

Schizophrenia
-positive symptoms (1st rank)
-other features

A

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

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3
Q

Schizophrenia
-negative symptoms

A

Decreased speech
Anhedonia
Alogia
Avolition

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4
Q

Schizophrenia management
-initial
-relapse
-treatment resistant

A

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

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5
Q

Atypical antipsychotics
-SE
-risks in older patients
-the best and worst SE profile

Typical antipsychotics
-SE
-examples

A

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

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6
Q

Clozapine
-SE to be aware of

A

Agranulocytosis, neutropenia
Reduced seizure threshold
Constipation
Myocarditis - take baseline ECG
Hypersalivation

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7
Q

Differentials for psychotic disorders

A

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

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8
Q

Presentation
-prodrome
-acute episode

A

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

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9
Q

Prognosis

A

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

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10
Q

How to differentiate between schizoaffective and bipolar

A

Schizoaffective - psychosis predominates
-psychotic symptoms come first

Bipolar - mood disorder predominates
-mood is affected 1st

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11
Q

Schizoaffective disorder
-types

A

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

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12
Q

Schizoaffective disorder
-epidemiology and risk factors

A

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

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13
Q

Schizoaffective disorder
-management

A

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

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