Schizophrenia Sutherland Flashcards
What precedes the onset of classical psychosis?
Cognitive impairment
What are the negative symptoms of shcizophrenia?
apathy, flat affect, withdrawal, social avoidance, poor motivation, self neglect
What are positive symptoms of schizophrenia
Hallucinations (auditory >visual> other), Delusions (paranoid, nihilistic), Odd behavior
What are top three risk factors for schizophrenia?
Positive family hx, perinatal complications (infxn), late winter/early spring births
When is the onset of schizophrenia?
Late teens/20’s (30’s for women
What are the most common causes of death for schizophrenia
90-95% of pts die of other causes other than suicide, 4-5% (up to 10) die of suicide
What is the pathophys of schizophrenia?
Increased brain dopamine, loss of brain mass, loss of white matter, “neurodevelopmental” disorder
T/F: You have an increased risk of having schizophrenia with a 1st degree relative?
True; 10-12x higher risk
T/F: increased risk of schizophrenia with perinatal complications?
True; late winter/early spring, maternal infxns, birth complications, Rh incompatibility, nutritional deficiencies, famine
What do drugs that increase DA do to psychosis?
Cause psychosis (hallucinations, paranoia, manic symptoms)
What do drugs that decrease DA do to psychosis?
Reduce psychotic symptoms
What is the mechanisms of PCP (for fun)?
Blocks glutamate, which increases DA and increases psychotic symptoms
What is the effect of schizophrenia on Basal ganglia?
Contributes to paranoia and hallucinations. Anti-DA meds also cause motor side effects
What is the effect of schizophrenia on frontal lobe?
difficulty planning actions and organizing thoughts
What is the effect of schizophrenia on limbic system?
agitation
What is the effect of schizophrenia on auditory system
auditory hallucinations
What is the effect of schizophrenia on occipital lobe
difficulties interpreting complex images, recognizing motions, reading emotions on faces
What is the effect of schizophrenia on hippocampus
difficulty learning and memory formation
What are psychotic sx of schizophrenia?
delusions, hallucinations, incoherence, catatonic or hyperactive behavior, flat affect
What are key features for schizophrenia Dx?
Chronic illness (>6 mos), Deterioration from previous fxn level, complex psychotic symptoms
What should be included in a DDx of schizophrenia?
Other psychotic disorders, substance use disorder, general medical disorder
What are other psychotic disorders to include on a DDx of schizophrenia?
Schizophreniform disorder (
What are general medical disorders to include in a DDx of schizophrenia?
Metabolic and hepatic diseases, Endocrine (hypo/per thyroid), infection (neurosyphillus), Neurologic (tumor, MS), DA agonists, Heavy metal poisoning
What are key recent history findings for schizophrenia
Cognitive problems, behavior problems, Positive Sx, social isolation, unable to manage complex challenges
What are labs you can do for schizophrenia?
CT/MRI of head, STD screening, CBC, urine drug screen, plasma drug levels, B12 levels, Thyroids functions
What is acute management for schizophrenia?
Psychiatric care, psychotherapy, outreach and case management in community, medication
What are the antipsychotic medications for schizophrenia?
D2 blockers (FGA: Chlorpromazine, haloperidol, thioridazine, trifluoperazine) (SGA: Clozapine, Risperidone, Paliperidone)
What types of Sx of schizophrenia are D2 blockers effective at treating?
Positive symptoms
What are side effects of first gen antipsychotics?
Acute Parkinson-like symptoms, movement disorders (tardive dyskinesia, tardive dystonia), sedation, CV, GI, sexual side effects, urinary retention, weight gain
What is the advantage of using second gen antipsychotics?
No Parkinson Sx or TD
What can clozapine cause?
agranulocytosis
Why are second gen antipsychotics more effective?
D2 blockade plus 5HT2 blockade
What are adverse effects of second gen antipsychotics?
weight gain, diabetes, premature death, stroke and pneumonia in elderly
T/F: Metabolic syndrome is a major concern with antipsychotic meds?
True; monitor fasting glucose, lipids, BP, waist/BMI
When is onset of schizophrenia?
early adulthood after years of vague “prodromal” symptoms
what are key Sx of schizophrenia?
Cognitive impairment, affective Sx, perceptual & thought disturbance, social fxn impairment
Are more males or females affected by schizophrenai?
Males > females (1.4:1)
