Week 4 Flashcards
define the schizophrenia diagnostic class?
schizophrenia spectrum and other psychotic disorders comprises schizophrenia and related disorders, other major psychoses, and disorders with subthreshold psychosis
What are the 5 domains of psychopathology for the schizophrenic spectrum?
- Delusions
- Hallucinations
- Disorganised thinking
- Grossly disorganised or catatonic behaviour
- Negative symptoms
What are ‘negative symptoms’ when referring to the schizophrenia spectrum
symptoms characterised by the absence of something that should be present, such as emotional expression
What is avolition?
absence of verbal expression
What are some causes of schizophrenia (the aetiology)
Neurodevelopmental
Genetic
What are neurodevelopmental causes of schizophrenia?
abnormalities of dopamine and serotonin
atrophy of grey matter
telomere shortening
what are generic causes of schizophrenia?
no single genetic cause found, however
twins are more likely to develop it if the other twin has it
what is the chance of developing schizo in the general population?
0.8%
what is the chance of developing schizo if both parents affected?
40%
What is the diagnostic criteria for schizophrenia?
Two or more of the following present for a significant portion of time during a 1 month period (at least one must be from 1-2).
- delusions
- hallucinations
- disorganised speech
- Grossly disorganised or catatonic behaviour
- Negative symptoms
What are symptoms of schizophrenia?
Positive symptoms
Negative symptoms
what is anhedonia?
lack of finding pleasure
Define delusions?
Fixed beliefs that don’t change in light of conflicting evidence
what are some types of delusions?
- persecutory
- referential
- somatic
- grandiose
- thought insertion
Define hallucinations?
a perception-like experience that occurs without an external stimulus
What is catatonic behaviour?
marked decrease in reactivity to the environment such as:
- resistance to instruction
- maintaining a rigid or bizarre posture
What are the main negative symptoms of schizophrenia
- diminished emotional expression
- avolition
What are some additional negative symptoms of schizophrenia?
alogia - diminished speech
anhedonia - no pleasure
asociality - lack of interest in social activities
avolition - dont wanna do shit
what is a schizotypal disorder?
chronic, attenuated form of schizophrenia in which beliefs stop short of being delusional and the sensort experiences are not quite hallucinatory
What are the general treatments for schizophrenia?
antipsychotic drugs work well for positive symptoms
- clozapine
Most schizo pts need psychological and social interventions as part of management
What are the most common antipsychotic drugs?
Clozapine
Risperidone
Quetapine
Olanzapine
What do antipsychotics do?
almost all atypical antipsychotics are dopamine antagonists
when is clozapine prescribed?
when 2 or more other antipsychotics have failed in the past
What are the most common side effects of Clozapine?
- potentially fatal agranulocytosis
- associations with venous thromboembolism, myocarditis and cardiomyopathy
- seizures
What are examples of extra-pyramidal symptoms?
dyskinesias - repeatitive movements dystonic reactions - muscle contractions parkinsonism - shuffling etc akinesia - loss of involuntary movement akathisia - internal and extrenal restlessness
how long should antipsychotics be used for?
1-2 years after first instance of psychosis
as 98% relapse after 2 years - it is recommended that they take them for 5 years
what are some signals of aggression in patients?
- veiled or overt threats of harm
- outbursts of anger and agression for no reason
- violent and aggressive gestures
- body language
- intoxication
what is aggression usually a manifestation of in patients?
a response to frustration
what are some physical de-escalation strategies?
- calmer personal space
- approach patient with caution
- don’t startle patient
- be aware of exits and never turn your back
remove dangerous objects from your person and be aware of environment - encourage pt to sit but dont force them to
what are some psychological deescalation strategies?
- offer limited choices to allow pt to retain sense of control
- encourage pt to gain control over their behaviour
- try to identify and understand the reasons for their anger
- use of distraction and redirection
- suggest more appropriate behaviour
- allow person an ‘out’ so they can back down without losing face
- keep the patient and or carer informed where possible
