wamss notes schizophrenia and psychotic disorders Flashcards
schizophrenia
Mental disorder characterized by abnormal social behaviour and failure to understand what is real. Characterised by disturbances in speech, perception, cognition, volition & with impaired
functioning
epidemiology of schizophrenia
0.7%
Onset M 18-25 F 25-45
Men 4:1
criteria for schizophrenia
A. Two of the following, each present for a significant portion of time during 1 month. At least
one of these must be 1-3 (+6 months Sx total)
- Delusions.
- Hallucinations.
- Speech Disorganised (e.g., frequent derailment or incoherence).
- Behaviour grossly disorganized or catatonic
- Negative symptoms (i.e., diminished emotional expression or avolition).
B. Social / occupational dysfunction
C. Continuous signs of the disturbance persist for at least 6 months, must include 1 month of
symptoms that meet criteria A
D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have
been ruled out
E. Not attributable to the physiological effects of a substance or medical condition.
subtypes of schizophrenia
paranoid type
disorganised type
catatonic type
undifferentiated type
residual type
paranoid type schizophrenia
positive Sx of a persecutory of conspirator nature
disorganised type schizophrenia
disorganisation of thought process, emotional + communication
impairment
catatonic type schizophrenia
dramatic reduction in movement or dramatic increase in activity
undifferentiated type schizophrenia
meets general criteria but nil subtype
residual type schizophrenia
Sx less severe than in acute schizophrenia
pathophysiology schizophrenia
Evidence for involvement of multiple neurotransmitters.
↑ Dopamine, ↑ Serotonin, ↑ a-Adrenergic ↓ Glutamine, ↓ GABA
dopamine hypothesis
Symptoms of schizophrenia largely attributed to disturbed & hyperactive dopamine signal
transduction. Due to the observation that most antipsychotics have dopamine receptor
antagonist effects
- Mesolimbic pathway – Positive symptoms
- Mesocortical pathway – negative symptoms
- Alterations to Brocha’s & Wernicke’s - hallucinations
positive schizophrenia symptoms
- Delusions
- Hallucinations
- Disorders of thought + speech
- Disorganised / catatonic behaviour
- Impaired Insight
negative symptoms
Deficits of normal emotional responses or other through process, less responsive to Tx &
associated with decreasing in functioning
- Avolition- decrease in motivation to complete goals
- Anhedonia – lack of enjoyment
- Flat or Blunted Affect
- Alogia- Poverty of speech- lack of content in speech
- Poor self-care
- Social withdrawal
Ddx for schizophrenia
Substance induced psychosis
Psychosis due to organic causes / medical condition
Mood disorder with psychotic features / Schizoaffective disorder
Dementia & Delirium
Tx for acute psychotic episode in schizophrenia
Atypical Antipsychotics – Olanzapine #1, Quetiapine, Aripiprazole, Risperidone
↓ risk of extrapyramidal effects ↑ metabolic syndrome
second line Tx for acute schizophrenia
Different Atypical Antipsychotic
Typical Antipsychotic – Chlorpromazine, Haloperidol
↑ extrapyramidal symptoms
first line Tx for maintenance therapy for schizophrenia
Atypical Antipsychotics – Quetiapine, Aripiprazole, Olanzapine, Risperidone
second line treatment for maintenance therapy for schizophrenia
Different Atypical Antipsychotic
Typical Antipsychotic – Chlorpromazine, Haloperidol
depo injections for schizophrenia
TA – haloperidol, zuclopenthixol
AA – aripiprazole, olanzapine, paliperidone, risperidone
combination antipsychotic use
Combination antipsychotic use seldom leads to additional clinical improvement & causes
adverse effects
non pharmacological treatment for schizophrenia
Psychoeducation- ↑ compliance as insight usually remains poor
Functional Remediation- group program addressing attention, memory, executive functioning & daily functioning
Lifestyle Improvements
Social support
Employment support programs – 80% unemployed
CBT – useful for residual Sx
Substance abuse management
Tx for acute agitation in schizophrenia
Sedation & Antipsychotic Properties, need to be short acting
Quetiapine: 50-100mg – oral only
Olanzapine: 5-10 – oral & IM
Midazolam – IM or IV – rapid acting, respiratory depression as a side effect
prognosis for schizophrenia
20% reduction in life expectancy
Suicide accounts for 10-30% of deaths
Morbidity – drugs, alcohol. STIs, epilepsy, diabetes
80% reoccurrence
15% functional recovery
brief psychotic disorder
Presence of same Sx as Schizophrenia for at least 1-day bur less than 1-month with eventual return to premorbid level of functioning
1day – 1 month
what should you do for brief psychotic disorder
Treat for 3-9 months then wean & see if psychosis reoccurs
schizophreniform disorder
Meets the same criteria as schizophrenia
1 – 6 months
schizoaffective disorder
Disorder that has features of both schizophrenia & a mood disorder
Major manic, depressive or mixed episode with concurrent symptoms that meet criteria A for schizophrenia
Generally psychotic & depressive symptoms have been present for similar amounts of time
delusional disorder
Presence of one or more delusions with a duration of at least 1month
Criteria A for Schizophrenia is not met
Hallucinations, if present, are not prominent and are related to the delusional theme
Apart from the impact of delusions functioning is not significantly impaired
If mania or major depression has occurred they have been brief compared to the delusions
to qualify for delusional disorder, the delusions have to have been present for at least
one month
catatonia
Essential feature is marked psychomotor disturbance that may involve decreased motor activity, decreased
engagement during interview of physical examination or excessive peculiar motor activity
Usually associated with another mental disorder
to qualify as catatonia, patients must have 3 or more of the following symptoms
- Stupor- no psychomotor activity, not actively reacting to the environment
- Catalepsy- passive induction of a posture held against gravity
- Waxy flexibility- resistance to positioning by the examiner
- Mutism- little or no verbal response
- Negativism- opposition or no response to external stimuli
- Posturing- spontaneous active maintenance of a posture against gravity
- Mannerism- odd, circumstantial caricature of normal actions
- Stereotypy- repetitive, abnormally frequent, non-goal directed movements
- Agitation, not influenced by external stimuli
- Echolalia- mimicking another’s speech
- Echopraxia- mimicking another’s movements
substance / medication induced psychotic disorder
Delusions and/or hallucination that are judged to be due to the physiological effects of a substance/medication
A. Presence of one or both of the following symptoms
- Delusions
- Hallucinations
B. There is evidence that:
- The Sx developed during or soon after substance intoxication or withdrawal after exposure to a
medication
- The involved substance is capable of producing the Sx in criteria A
C. It is not better explained by a psychotic disorder
psychosis due to another medical condition
Delusions or hallucinations that are judged to be attributable to the physiological effects of another medical
condition and are not better explained by another mental disorder
