W4_Schizo Flashcards
Schizophrenia Spectrum Disorder is commonly confused with ???
Multiple Personality Disorder
Psychosis
Think HDD!
A form of severe mental disturbance where the individual loses touch with reality
Characterized by:
1. Hallucinations
2. Delusions
3. Disorganized thoughts & behavior
It is possible for patients to display all three of the above
Delusions
Fixated, False & Unshakeable personal belief
Hallucinations
False perceptions in the absence of a real external stimulus
Disorganized Thinking
Thoughts that doesn’t make sense or follow an idea.
Schizoaffective Disorder
Symptoms of schizophrenia with addition of a **mood disorder ** (Depression, Bipolar)
Brief Psychotic Disorder
Symptoms of schizophrenia for < 1 month
Schizophreniform Disorder
Symptoms of Schizophrenia for 1-6 months
Schizophrenia
Persists > 6 months
Positive Symptoms: Delusions, Hallucinations, Disorganized speech, Catatonic behavior
Negative Symptoms: 5As
Schizoid Personality Disorder
Avoid social interaction
Lack friends
Lack of sexual interest
Lone Wolf
Not caused by paranoia or social anxiety
(Overlaps with negative symptoms of Schizophrenia)
Schizotypal Personality Disorder
Excessive Magical Thinking
(linking unrelated events, fixation on personal destiny)
Beliefs cause overconfidence, poor social perception,
still want to maintain relationships.
Delusional Disorder
Fixed False Belief that lasts > 1 month without other schizophrenia criteria.
Rank the following in terms of duration of symptoms.
- Delusional disorder
- Schizoaffective disorder
- Schizophrenia
- Brief psychotic disorder
- Schizophreniform disorder
Schizoaffective Disorder, Schizophrenia + Mood Disorder (Depression, Bipolar)
Schizophreniform >= 6mth, Positive & Negative (5As)
Schizophreniform disorder 1-6mth, w schizo symptoms
Brief psychotic disorder < 1 mth, w schizo symptoms
Delusional Disorder < 1 mth, w/o schizo symptoms
Schizoaffective Disorder should not be mistakened as _
Mood Disorder
Positive Symptoms of Schizophrenia
Hallucinations
Delusions
Negative Symptoms (5As)
Lack of facial expression (Flatten Affect)
Lack of speech (Alogia)
Lack of drive and energy (Apathy)
Lack of interest (Avolitional)
Lack of pleasure (Anhedonia)
Diagnostic Criteria of Schizophrenia
A
B
C
D
Different symptoms dimensions
Schneider 1St Rank Symptoms
ABCD:
Auditory Hallucinations
Broadcasting of Thoughts
Controlled Thoughts (Delusions of Control), Delusional Perception.
Diagnostic Criteria for Schizophrenia
A,B,C
**A. Characteristic Symptoms **
**(2 or more of the following) in < 1 month **
HDD NG
Each present for a significant portion of time during a 1-month period
(or less if successfully treated):
Hallucinations
Delusions
Disorganized speech
(e.g., frequent derailment or incoherence)
Negative symptoms, i.e., affective flattening, alogia or avolition
Grossly disorganized or catatonic behaviour
Do we really need to follow the Diagnostic criteria strictly?
Only One Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person’s behavior or thoughts, or two or more voices conversing with each other.
Exclusions for Schizophrenia
1) Schizoaffective and Mood Disorder exclusion
2) Substance / general medical condition exclusion
3) Relationship to a Pervasive Developmental Disorder (ASD or another pervasive developmental disorder)
Significant observations during MSE
for Schizophrenia patients
A: Unkempt, Dirty, Unshaved, long finger nails
S: Loosening of association, tangential, over-inclusive
E (Mood): Overtly expressive or totally none
E (Affect): Blunted affect
P: Auditory hallucinations, delusion (persecutory, passivity, reference)
T: -
I: Lack of insight of symptoms
C: -
Suicidal ideation may be present
Cause of Schizophrenia
Genetic (Sibling, parents)
Environmental (Maternal viral infection/ malnutrition. Obstetric issues, subtance abuse)
Brain structure & Chemistry (Dopamien hypothesis)
- Cause is unknown
- Caused by interaction of genetic & environmental factors
What are the pharmacology treatment goals in treating Schizophrenia patients?
To treat positive/ negative symptoms?
Manage acute positive psychiatric symptoms
What are the common medical treatment for schizophrenia?
1st -Gen anti-psychotics includes:
Thorazine, Fluanxol, and Haloperidol.
Effective in treating the positive symptoms of schizophrenia.
But not useful in treating the 5As.
2nd -Gen anti-psychotics include:
Risperdal, Clozaril, and Aripiprazole etc. Recommended for first-line treatment & are excellent at reducing negative symptoms.
Can target both positive & negative symptoms with better side effect profile.
Side effects of 1st Gen anti-psychotics
S/E for antipsychotics may cause a patient to stop taking them.
Be sure to weigh the risks against the potential benefits that antipsychotic drugs can provide.
Mild side effects:
Dry mouth, blurred vision, constipation, rigidity, tremors, restlessness, drowsiness and dizziness.
These side affects usually disappear a few weeks after the person starts treatment
Long term adverse effects of 1st Gen anti-psychotics
Involuntary Movements of Tardive Dyskinesia
Involuntary movement of arms and jaw
(stiff and jerky movements that can’t be controlled
Side effects of 2nd Gen anti-psychotics
(Atypical)
Can target both positive & negative symptoms with better side effect profile.
2nd -Gen anti-psychotics include
Risperdal, Clozaril, and Aripiprazole etc.
Recommended for first-line treatment & are excellent at reducing negative symptoms.
Common 2nd-Gen antipsychotic medications:
Abilify (aripiprazole)
Risperdal (risperidone)
Zyprexa (olanzapine)
Seroquel (quetiapine)
Clozaril (clozapine)
Common side effects include weight gain and drowsiness. (Incr. risk of T2DM)
It is a common misnomer that atypical antipsychotic medications have less side effects than other drugs.
Atypical antipsychotic medications have significant side effects, it’s just that their side effect profile is different than that of most other drugs used to treat mental disorders.
Comparison between Typical & Atypical anti-psychotics
1st-Gen(Typical) –> Anticholinergics, rigidity, tremors, restlessness, drowsiness, dizziness, Tardive dyskinesia.
2nd-Gen(Atypical) –> T2DM, weight gain, drowsiness
Predictors of Medication Adherence for Schizophrenia patients
Patient (subs. abuse, lack of insight, neg. attitude)
**Family **(ignorance, unrealistic expectation, critically/overly/ relax/no involvement)
Disease (Disease progression)
Doctor (Excessive use of psychotropic drugs, polypharmacy, irrational prescribing, cynicism, negativity etc.)
Healthcare system Lack of continuity, accessibility, lack of social supervision
Social environment: Poverty, social isolation, Itinerancy
Other treatment options for Schizophrenia
ECT
(Usually for treatment resistant, effective for acute schizophrenia, mania, depression)
- Administered under a light GA.
**Psychosocial Treatment **
(Must be holistic & multidisciplinary)
Prognosis and background of Schizophrenia
3/4 cases begins between 17-25 y/o
Schizophrenia is ranked 4th worldwise in terms of disease burden.
Of those with schizophrenia, 95% have the disorder for their lifetime.
Suicide is attempted by 20% to 50 % of person with schizophrenia, 9% to 13% succeed.
Negative Symptoms of Schizophrenia (5As)
- Flatten Affect
Name the other 4
Lack of facial expression (Flatten Affect)
Lack of speech (Alogia)
Lack of drive and energy (Apathy)
Lack of interest (Avolitional)
Lack of pleasure (Anhedonia)
Affect (Flatten affect)
Anhedonia (no pleasure)
Avolitional (no interest)
Alogia (no words)
Apathy (no drive, no energy)
Alogia
Lack of speech
Anhedonia
Lack of pleasure
Apathy
Lack of drive and energy
Avolitional
Lack of interest
