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PY366 Depression, anxiety and schizophrenia > Schizophrenia > Flashcards

Schizophrenia Flashcards

1
Q

what is a hallucination

A

perceived in absence of stimuli

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2
Q

what is a delusion

A

fixed false beliefs that no amount of proof to the contrary will alter

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3
Q

what is schizophrenia characterised by

A

range of cognitive, emotional and behavioural problems
- symptoms are classified into positive and negative

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4
Q

what are the positive symptoms of schizophrenia

A
  • hallucinations, delusions
  • disorganised speech/formal thought disorder
  • disordered/catatonic behaviour
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5
Q

what are the negative symptoms of schizophrenia

A

relate to loss of normal functions
- flattening or blunting of affect
- alogia (Reduced production of speech)
- emotional apathy
- social withdrawal
- lack of motiviation
- loss of pleasure

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6
Q

how is schizophrenia diagnosed

A

at least 1 of the following 3 domains for a duration of 1 months
1. positive symptoms
2. negative symptoms
3. reduced social functioning

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7
Q

describe the aetiology of schizophrenia

A

heterogenous

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8
Q

give examples of putative causes of schizophrenia

A
  1. genetic disorders
  2. neurodevelopment problems
  3. neurochemical imbalances (drug misuse)
  4. pyschosocial stressors
    - influenced by psychosocial environment of individual
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9
Q

describe the prevelence of schizophrenia

A

ranges between 0.015-0.1%
- peak incidence of onset in males 15-25 years
- females 25-35 years
- cumulated risks for development are equal in men and women

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10
Q

describe the prognosis of schizophrenia

A
  1. most common presentation is an initial acute epidote with florid positive symptoms followed by the emergence and persistence of negative symptoms
  2. 20% of patients recover fully
  3. 70% have relapsing/remitting disease
  4. 10% seriously disabled by disease
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11
Q

outline the symptoms presenting in the acute phase

A
  1. lack of insight
  2. auditory hallucinations
  3. ideas for reference
  4. suspiciousness
  5. flattening of affect
  6. voices speaking to patient
  7. delusional mood
  8. delusions of persecution
  9. thoughts spoken aloud
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12
Q

describe the management of schizophrenia

A
  1. needs to be holistic for optimal response to ensure best prognosis
  2. following components should be addressed
    - psychological
    - social
    - emotional
  3. pharmacological management should be considered as a 1st line intervention in all cases
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13
Q

describe the use of antipsychotics in schizophrenia

A
  1. response after 2-4 weeks
  2. equal efficacy against positive symptoms
  3. second generation antipsychotics initially thought to show greater efficacy against negative symptoms
  4. clozapine is the only antipsychotic licensed for treatment resistant illness
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14
Q

describe the dopamine theory

A
  1. increased dopaminergic neurotransmission is a pathogenic factor of schizophrenia
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15
Q

what does dopamine blockade lead to

A
  1. antipsychotic effect
  2. extrapyramidal side effects in striatum
    - parkinsonism
    - dystonia
    - akathisia
  3. risk factor for tardive dyskinesia
  4. hyperprolactinaemia in hypothalamus
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16
Q

give examples of first generation antipsychotics

A
  • chlorpromazine
  • haloperidol
  • trifluoperazine
  • sulpiride
17
Q

how do first generation antipsychotics work

A
  1. non selective dopamine D2 blockade
    - but this leads to EPSE and hyperprolactinaemia
18
Q

give examples of second generation antipsychotics

A
  • clozapine
  • risperidone
  • olanzapine
  • quetiapine
19
Q

how do second generation antipsychotics work

A
  1. selective dopamine D2 blockade
  2. variable receptor occupancy of 5HT and alpha 1 sub types
  3. fewer or no EPSEs
  4. less or no hyperprolactinaemia
20
Q

what are predictable adverse effects (type A)

A
  1. predictable from pharmacology of drug
  2. common
  3. dose dependent
  4. decreased severity with time
  5. high morbidity
  6. low mortality
21
Q

give examples of predictable adverse effects

A
  • histamine blockade
  • anticholinergic
  • alpha blockade
22
Q

what are unpredictable adverse effects

A
  1. not predictable from pharmacology
  2. not dose dependent
  3. not common
  4. severity doesn’t decrease with time
  5. low morbidity
  6. high mortality
23
Q

give examples of unpredictable adverse effects

A
  • ocular deposits
  • photosensitivity
  • hepatitis
  • ECG changes
24
Q

what is tardive dyskinesia caused by

A
  1. clozapine helps improve symptoms
  2. olanzapine- incidence 1% per year
  3. FGAs- incidence 10-20% first year, 4-5% per year
  4. other SGAs are all noted to have potential to cause TD
25
Q

what is neuroleptic malignant syndrome

A
  1. rare and potentially fatal
  2. difficult to diagnose
  3. reports with SGAs including clozapine
26
Q

what are the signs and symptoms of NMS

A
  • increased temperature
  • labile blood pressure
  • muscle rigidity
  • leucocytosis
  • altered consciousness
  • increased creatine kinase
27
Q

what does EPSE stand for

A

extrapyramidal side effects

28
Q

which antipsychotic produces the most EPSEs

A

haloperidol, risperidone

29
Q

which antipsychotic is most likely to cause hyperprolactinaemia

A

haloperidol, risperidone, amisulpride

30
Q

which antipsychotics are most likely to cause weight gain

A

clozapine, olanzapine (>6kg), risperidone, quetiapine

31
Q

which antipsychotics are most likely to cause hyperglycaemia

A

clozapine, olanzapine, risperidone, quetiapine

32
Q

describe the antipsychotic efficacy of clozapine, risperidone and olanzapine in refractory schizophrenia

A
  • clozapine= compelling evidence
  • risperidone- no evidence
  • olanzapine- no evidence
33
Q

what should be considered when choosing an antipsychotic

A
  1. balance between efficacy, patient tolerability and how the proposed treatment will impact patients lifestyle
34
Q

outline the pharmacological treatment of schizophrenia

A
  1. SGAs considered to be 1st line in patients with newly diagnosed schizophrenia
  2. SGAs are the treatment of choice for managing an acute schizophrenic episode when discussion with the individual is impossible
  3. an SGA should be considered for any individual suffering unacceptable side effects from a conventional FGA
  4. SGA should be considered in an individual in relapse whose symptoms were previously inadequately controlled
  5. changing to an SGA is not necessary if a conventional FGA controls symptoms adequately and the individual doesn’t suffer unacceptable side effects
  6. clozapine should be introduced if schizophrenia inadequately controlled despite sequential use of 2 or more antipsychotics at optimal dose and with compliance assured for a period of 6-8 weeks each
35
Q

describe the results of the 2GA vs 1GA study

A
  1. overall efficacy- 4 SGA were better than FGAs in ascending order
    - risperidone
    - olanzapine
    - amisulpride
    - clozapine
36
Q

outline NICEs updated guidelines on using antipsychotics for treatment

A
  1. offer oral antipsychotic medication to people newly diagnosed
  2. provide info in a usable format on the benefits and side effects
  3. decide which antipsychotic to use in partnership with the service user
    - consider potential to cause EPSEs or metabolic side effects
  4. don’t start regular combined antipsychotic medication, except for short periods

PY366 Depression, anxiety and schizophrenia (8 decks)

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