Y4 - Schizophrenia Tutorial Flashcards
Additional info only
What is psychosis?
When a person loses touch with reality
What is schizophrenia?
A severe, long term mental disorder, characterised in the acute stage by psychotic symptoms and in the chronic stage by deficits of affect, motivation and thinking
What are the clinical features of schizophrenia?
Delusional beliefs Thought disorder Hallucinations Passivity phenomenon Thought withdrawal, insertion, broadcasting Delusional perceptions
What are the negative symptoms of schizophrenia?
Apathy, amotivation, avolition, affective blunting, alogia (poverty of speech), anhedonia, disturbed attention
May also get occupation decline and cognitive dysfunction
What are the types of delusions?
Persecutory Reference Bizarre Grandiose Depressive Passivity Religious
What are grandiose delusions?
Believing you are famous, a god, or publicly important
What are persecutory delusions?
Suspecting you are being spied on or followed etc.
What are somatic delusions?
Believing you have a medical condition/physical deficit that you don’t
What are delusions of reference?
Thinking random events contain a special meaning for you alone
What are bizarre delusions?
Believing in things that are impossible
What is thought alienation and that are the forms of it?
Where patient feels they no longer have control of their own thoughts
Thought broadcasting
Thought insertion
Thought withdrawal
What is thought broadcasting?
Believing others can hear or are aware of an individual’s thoughts
What are the made phenomena?
“Made” Feeling: the patient has the experience that his feelings are not his own, they have been imposed upon him
Made” Impulses: the patient experiences and generally acts upon a compelling impulse which he believes is not his own
“Made” Acts: the patient experiences his action and his will to be under the control of an outside force
What are passivity phenomena?
People feel that some factor of themselves is under the management of other people
What is derailment?
Thought disorder symptom marked by interruptions to thought and jumping from one thought to another disconnected thought
What are some differential diagnoses for schizophrenia?
Schizotypal, schizoaffective and other delusional disorders Mania Personality Disorder Delirium Drug induced Intracranial pathology Epilepsy Endocrine pathology
What investigations should you do if you suspect schizophrenia?
Physical examination
Bloods - FBC, UE, TFTs
Urine - screen for drugs of abuse, microscopy
CT
EEG
ECG required before starting antipsychotic medications to check QTc
What are the predisposing factors of schizophrenia?
Genetics
Neurodevelopment
What are the precipitating and perpetuating factors of schizophrenia?
Substance misuse Non-adherence with medications Life events High expressed emotion in the family Poor social support
When does the age of onset of schizophrenia tend to be?
Late teen to mid-30s
What is the proposed pathology of schizophrenia?
Dopamine theory
Neurodevelopmental disorder - reduction in brain volume (esp frontal and temporal lobes), functional differences in frontal, temporal lobes and hippocampus
What pathway is responsible for positive symptoms of schizophrenia?
Misolimbic (from ventral tegmental area to nucleus accumbens)
What pathway is responsible for the negative symptoms of schizophrenia?
Mesocortical (VTA to prefrontal cortex)
What pathway is responsible for ESPEs?
Nigrostriatal
What pathway is responsible for hyperprolactinaemia?
Tuberoinfindibular
What are the potential treatments for schizophrenia?
Antipsychotics Benzos ECT CBT Social input - CPN, social work, rehab, housing
Give examples of typical antipsychotics
Haloperidol, chlorpromazine
Give examples of atypical antipsychotics
Olanzopine, quetiapine, risperidone, arirpiprazole
What is a poor prognosis with schizophrenia associated with?
Male, unmarried, early/insidious onset, non-paranoid type, negative/cataonic symptoms, absence of affective symptoms, FH of schizophrenia
