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Mental Health > W4_Schizo > Flashcards

W4_Schizo Flashcards

1
Q

Schizophrenia Spectrum Disorder is commonly confused with ???

A

Multiple Personality Disorder

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2
Q

Psychosis

Think HDD!

A

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

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3
Q

Delusions

A

Fixated, False & Unshakeable personal belief

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4
Q

Hallucinations

A

False perceptions in the absence of a real external stimulus

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5
Q

Disorganized Thinking

A

Thoughts that doesn’t make sense or follow an idea.

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6
Q

Schizoaffective Disorder

A

Symptoms of schizophrenia with addition of a **mood disorder ** (Depression, Bipolar)

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7
Q

Brief Psychotic Disorder

A

Symptoms of schizophrenia for < 1 month

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8
Q

Schizophreniform Disorder

A

Symptoms of Schizophrenia for 1-6 months

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9
Q

Schizophrenia

A

Persists > 6 months

Positive Symptoms: Delusions, Hallucinations, Disorganized speech, Catatonic behavior
Negative Symptoms: 5As

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10
Q

Schizoid Personality Disorder

A

Avoid social interaction
Lack friends
Lack of sexual interest
Lone Wolf
Not caused by paranoia or social anxiety
(Overlaps with negative symptoms of Schizophrenia)

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11
Q

Schizotypal Personality Disorder

A

Excessive Magical Thinking
(linking unrelated events, fixation on personal destiny)
Beliefs cause overconfidence, poor social perception,
still want to maintain relationships.

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12
Q

Delusional Disorder

A

Fixed False Belief that lasts > 1 month without other schizophrenia criteria.

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13
Q

Rank the following in terms of duration of symptoms.

  • Delusional disorder
  • Schizoaffective disorder
  • Schizophrenia
  • Brief psychotic disorder
  • Schizophreniform disorder
A

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

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14
Q

Schizoaffective Disorder should not be mistakened as _

A

Mood Disorder

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15
Q

Positive Symptoms of Schizophrenia

A

Hallucinations
Delusions

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16
Q

Negative Symptoms (5As)

A

Lack of facial expression (Flatten Affect)
Lack of speech (Alogia)
Lack of drive and energy (Apathy)
Lack of interest (Avolitional)
Lack of pleasure (Anhedonia)

17
Q

Diagnostic Criteria of Schizophrenia
A
B
C
D

A

Different symptoms dimensions

Schneider 1St Rank Symptoms
ABCD:
Auditory Hallucinations
Broadcasting of Thoughts
Controlled Thoughts (Delusions of Control), Delusional Perception.

18
Q

Diagnostic Criteria for Schizophrenia
A,B,C

**A. Characteristic Symptoms **
**(2 or more of the following) in < 1 month **

HDD NG

A

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

19
Q

Do we really need to follow the Diagnostic criteria strictly?

A

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.

20
Q

Exclusions for Schizophrenia

A

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)

21
Q

Significant observations during MSE
for Schizophrenia patients

A

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

22
Q

Cause of Schizophrenia

A

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
23
Q

What are the pharmacology treatment goals in treating Schizophrenia patients?

To treat positive/ negative symptoms?

A

Manage acute positive psychiatric symptoms

24
Q

What are the common medical treatment for schizophrenia?

A

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.

25
Q

Side effects of 1st Gen anti-psychotics

A

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

26
Q

Long term adverse effects of 1st Gen anti-psychotics

A

Involuntary Movements of Tardive Dyskinesia

Involuntary movement of arms and jaw
(stiff and jerky movements that can’t be controlled

27
Q

Side effects of 2nd Gen anti-psychotics
(Atypical)

A

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.

28
Q

Comparison between Typical & Atypical anti-psychotics

A

1st-Gen(Typical) –> Anticholinergics, rigidity, tremors, restlessness, drowsiness, dizziness, Tardive dyskinesia.

2nd-Gen(Atypical) –> T2DM, weight gain, drowsiness

29
Q

Predictors of Medication Adherence for Schizophrenia patients

A

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

30
Q

Other treatment options for Schizophrenia

A

ECT
(Usually for treatment resistant, effective for acute schizophrenia, mania, depression)
- Administered under a light GA.

**Psychosocial Treatment **
(Must be holistic & multidisciplinary)

31
Q

Prognosis and background of Schizophrenia

A

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.

32
Q

Negative Symptoms of Schizophrenia (5As)
- Flatten Affect

Name the other 4

A

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)

33
Q

Alogia

A

Lack of speech

34
Q

Anhedonia

A

Lack of pleasure

35
Q

Apathy

A

Lack of drive and energy

36
Q

Avolitional

A

Lack of interest

Mental Health (10 decks)

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