Schizophrenia symposium Flashcards
What are some positive symptoms of schizophrenia?
Delusions
Hallucinations
Disorganised speech
Catatonia
What are some negative symptoms of schizophrenia?
Affective flattening
Alogia
Avolition
Anhedonia
What is the risk of family members being affected by psychosis?
Parent - 5% Sibling - 10% Child - 13% Child of 2 affected parents - 46% Monozygotic twin - 45% Dizygotic twin - 15%
What genome wide association studies have been implicated in schizophrenia?
Major histocompatibility complex locus on chromosome 6 Gene encoding microRNA TCF4 Region of chromosome 10 CSMD1 NGRN
What obstetric complications increase the risk of developing schizophrenia?
Premature birth Low birth weight Perinatal hypoxia Intrauterine infection in 1st / 2nd trimester Antepartum bleeding Immune activation
Describe the macro neurodevelopment abnormalities reported in schizophrenia
Ventricular enlargement Widening cortical sulci Cortical grey matter loss Loss of asymmetry Decreased limbic structure & thalamic volume Progressive deficits in some, if not all
Describe the micro neurodevelopment abnormalities reported in schizophrenia
Cortical glial loss Increased neuron density Aberrant neuron migration Synaptic loss Decreased dendritic complexity
What deficits do neuropsychological abnormalities cause?
Attention Arousal (too much) Working memory Executive function Eye movement Social cognition Theory of mind Loss of functional symmetry Receptive language function Subtle motor function, speech, IQ
What effect does blocking dopamine have on prolactin?
It increases prolactin release which leads to breast development in men, lactation & sexual dysfunction
What is reduced frontal glutamate associated with?
Negative symptoms
What is increased stratal dopamine associated with?
Positive symptoms
What drugs have a psychosis influence via dopamine, serotonin & glutamate function?
L-DOPA Amphetamine LSD Cannabis Cocaine Ketamine MDMA PCP Other novel psychoactives
What is the differential diagnosis of psychosis?
Affective psychosis
- Bipolar disorder
- Depressive psychosis
Organic psychosis
- Epilepsy (temporal lobe)
- Infections - encephalitis, subacute sclerosing panencephalitis, HIV
- Cerebral trauma
- Cerebrovascular disease
- Demyelination - multiple sclerosis
- Neurodevelopmental disorders
- Endocrine - thyroid disorders, Cushing’s syndrome
- Metabolic - hepatic failure, uraemia
- Immunological - SLE, autoantibodies
- Drugs
- Toxins - lead
- Dementia
Personality disorder
What drug has the greatest efficacy in resistant cases?
Clozapine
What is the adverse effect of activating H1 receptor?
Histamine leads to sedation & weight gain
What is the adverse effect of activating M1 receptor?
Antagonism - constipation, urinary retention, blurred vision, confusion
Agonism (clozapine) - saliva overproduction
What are the side effects of typical antipsychotics?
Sedation Extrapyramidal symptoms: parkinsonian symptoms, dystonia, akathisia, tar dive dyskinesia Cardiac - hypotension, arrhythmia Temperature dysregulation Neuroleptic malignant syndrome Anticholinergic side effects Weight gain Raised prolactin - galactorrhea, decreased sexual function, osteoporosis
What are some atypical antipsychotics?
Amisulpride Aripiprazole Clozapine Risperidone Olanzapine Quetiapine Lurasidone
What are some long acting injections?
Depixol Clopixol Piportil Paloperidone (risperidone) Aripiprazole
Describe clozapine
Oral medication
Licensed with regular neutrophil monitoring
Slow titration to optimal dose with monitoring of pulse, BP & neutrophil count
Little parkinsonian effects or tardive dyskinesia
Sedation, weight gain
Describe metabolic syndrome
Exacerbated by atypical antipsychotics
Obesity, dysglycaemia, dyslipidaemia, hypertension
Appears more prevalent in schizophrenics pre-treatment than general population
Higher risk of coronary heart disease, cerebrovascular pathology & earlier death
Why can’t we just give medication?
Treatment resistant symptoms Partially resistant symptoms Side effects Service user choice Comorbidity: anxiety, depression, PTSD
CBT plan
12-20 sessions Timeline of events leading to psychosis Relapse signature Early warning signs Crisis plan Problem solving Psychoeducation Self-management
What types of reasoning bias need to be changed?
Jumping to conclusions
External attribution bias
Selective attention
Theory of mind
What is the session content for family intervention?
Sharing information about mental health problems & treatment
Problem solving
Crisis management
Managing medication compliance
Working on good communication between family members
Encouraging family members to refocus on own lives
What family therapy techniques are there?
Sculpting
Reframing
Circular questions
Reflecting teams
Describe the things worked on in art therapy
Negative symptoms Concentration Isolation Self-confidence Creative medium to explore feelings Safe space
