Scz_EO Flashcards
Suicide and scz: what is the risk %
5-6%
20% will attempt suicide on one or more occasions
Suicide and scz: when is risk highest?
Earlier in the illness and after hosp discharge
Suicide and scz: additional risk factors?
DEPRESSED MOOD Young age Male Higher education and IQ good insight Command hall and paranoia Poor med adherence Comorbid subst use Past suicide attemp Family hx depression
Conversion rate of ultra high risk?
10-18% per year
35% sur 10ans
80% convert to mood do, anxiety do, SUD
What are the 3 groups of ultra high risk?
GRD: genetic risk and deteriorating: schizotypal pd or psychotic do in family, decline in functionning within the past yr
BLIPS : brief limited intermittent psychotic sx (episode less than a week, at least several times per week)
APS: attenuated positive psychotic sx
All between age 15-25
What are the scales used for evaluating ultra high risk?
SIPS: structured interview of prodromal sx 4 parts interview 1) scale of prodromal sx (+ and 1) 2) GAF 3) criteria for schizotypal PD 4) family psych Hx
What are relapse rates in scz?
At 1 yr: with tx = 3%, without tx =77%
At 2 ys without tx = 94%
At 5 yr with tx = 825
Cannabis and psychosis: risk factors?
Younger age at onset of cannabis use
Cumulative dose (consommation regulière)
THC potency
Pre-existing vulnerability factors
Cannabis and psychotic episode: causal link in numbers
- 2-6 year younge age of onset of psychosis
- Of those who develop psychotic episode, 50% go on to develop primary psychosis
- Doubles the risk of scz
Characteristics of late onset scz?
- women
- less fam hx of scz
- persecuroty delusion
- less negative sx
- more coherent thought process
- better response to AP (dose necessaire faible)
- possible cluster A PD premorbid
Delusional disorder caracteristics?
Women
Single
Sensorial deficits (surdité partielle)
No cognitive disorders
Definition of recovery in scz?
2 years without major positive sx
Social role (employment, volunteer…)
12-15%
What are the main negative sx in scz?
- alogia
- affect flattening
- associability
- avolition
- anhedonia
Which scale to measure cognitive deficits in scz?
Matrics consensus cognitive battery
7 cognitive domains (social cog, memory, problem solving, processing speed, attention…)
Course of cognitive deficits in scz?
Deficits identified in 1st episode and before antipsy started
Often present before onset of illness, become more severe during FEP, then tend to remain stable during early course of illness
Usually memory, exec functions and attention are most impaired
what are the guidelines for scz in : family interventions
Priority Min 10 sessions over 3 mo Skills: problem solve, psychoed and communivation Reduces re-admissions Highly exprssive = higher relaspe
what are the guidelines for scz in : employment programs
Supported employment is more efficient than prevocation training
Rapid job search
Competitive setting
Supported employment and ongoing support
Integration of vocational and mental health services
what are the guidelines for scz in : CBT?
Can be started during acute, recovery and in patient setting
Min 16 sessions
For patient who remain symptomatic despite AP
Efficacy provent in reducing severity, admission, relapse and depressive sx
Not clear if ind or group bettwer
what are the guidelines for scz in : cognitive remediation
Limited evidence
May be considered
what are the guidelines for scz in : social skills?
Limited impat on positive sx, admissions, relapse
Improves social functionnning and negative sx
what are the guidelines for scz in : life skills?
Low evidence level
what are the guidelines for scz in : psychoed to patient and or family?
Should be an integral part of tx but no robust effect on outcome
Good to empower pt
acute psychotic tx?
If no response after 4 weeks despite dose optimization (adequate dose is defined as >half the therapeutic dose), change rx
If partial response, continue for 8 weeks before considering changing rx
A rx should be continued for at least 2 weeks
For LAI, 6 weeks after reaching steady state
Maintenace of tx?
After FEP: 18 months after no more positive sx
> 1 episode: at least 2 yrs, possible ad 5 or more
Dose: at leat 4-6mg of risperidone (300-400mg chlorpromazine0
What is treatment resistant scz?
Less than 20% change in positive sx after 2 adequate course of non clozapine AP
In 25-30% pt with scz
What is clozapine resistanc scz?
8-12 week trial of clozapine at >400mg (or clozapine blood level 350ng/ml. 1100 nM/L)
And
Less than 20% change in + sx
What is the CATIE study?
- Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Project.
- To determine the long-term effects and usefulness of antipsychotic medications in persons with schizophrenia.
- The study involves the newer atypical antipsychotics (olanzapine, quetiapine, risperidone, clozapine, and ziprasidone)and the typical antipsychotics (perphenazine and fluphenazine).
- For most participants the study will last up to 18 months.
-Conlcusion: Except for clozapine, SGA=FGA, with olanzapine slighlty superior but with greater risk of metabolic sydrome
What’s to know about schizoaffective?
Better prognosis if more affective sx than psychotic sx
Depressive type 2F:1M more older adults; bipolar F+M younger
Apparition plus tardive chez femme
Prevalence a vie 0.5-0.8%
What’s to know about Brief psychitic episode?
2F:1H 50% will end up having a dx of mood do or scz chronic
Good prognostic factor: sudden onset, severe stressor, affective sx, good premorbid funcionning, less restricted affect, few schizoid traits, short duration, no fam hx of scz
Maitenance of tx: few studies, recommend gradual reduction over 6-12 mo
what’s to know about schizophreniform?
5M:1F
Lifetime prevalenc 0.11%
2/3 will convert to scz or scz-aff
More rapid treatment response que scz
Duration of tx 3-6mon
Delusion disorder: risk factors
Advance age sensorial deficits Fam hx Immigration Social isolation Hypersensibilité interpresonnelle
Often an stressful event triggers the disorder
More delusion disorder in family with scz, but not more scz in family with delusional do
50% recovery
30% chronic
20% reduction in sx
Better prognosis when erotmania, perscutory and somatic
Depression is NOT a risk factor
What are good prognostic factors in scz?
Sudden onset Triggering event Late onset \+ sx Women Short period of not treated + sx Type pyknic Fam Hx of mood do
What are worst prognostic factors of scz?
tx non-adherence (Anosognisia is best predictor of tx non adherence) Insidious onset Not precipiting factors Early onset Fam hx of scz Negative sx Perinatal complications Neurological sighs/neurodevelopmental issues Frequent relapse Low IQ Cannabis Aesthenic or athletic type
Difference between male and female in scz
Women:
bimodal and later onset (25-35 and after 40 in 3-10%)
more risk of prolactin increase
More hall, persecutory delusion and affective sx
Better prognosis
Men Onset 18-25 More - sx More fam hx of schizotypal/schizoir PD Worse prognosis
Risk factors of scz?
Urbanicity Migration Winter baby Paternal age>35 Infection (influenza) 1-2 trimester Perinatal complucation (hypoxia at birth) Male Cannabis Trauma during childdood
