Chap 6 - Schizophrenia & Psychotic Disorders Flashcards
(23 cards)
First onset of schizophrenia is typically when?
Late teens early adulthood
Lifelong/chronic course
Criteria for the diagnosis of schizophrenia
A. At least two of the following:
- Delusions.
- Hallucinations, particularly auditory hallucinations.
- Disorganised speech.
- Grossly disorganised or catatonic behaviour.
- Negative symptoms, i.e. emotional blunting, alogia or avolition.
B. Deterioration in the level of functioning at work, in social relationships, or with regard to
self-care
C. A duration of at least six months. This period must include at least one month of the active
phase of the illness (symptoms from A) with or without a prodromal or residual phase.
D. Full mood syndrome (depression or mania), if present, only developed after the onset of
psychotic symptoms, or was of brief duration.
E. Not the result of another medical condition or the physiological effects of substances.
The most important symptoms in schizo
a) Delusions: persecutory, grandiose, religious
and somatic delusions. Mood-incongruent and especially bizarre delusions
b) Hallucinations
c) Disorganised speech: Thoughts are vague and circumstantial. There is a loose association of ideas Thought-block and neologisms (making up new words) may also occur.
d) Negative symptoms: Emotional disturbances Emotional blunting The expression of emotion is not appropriate to
what is being said or thought.
There is an inability to make decisions.
e) Catatonia (motor) disorder: This can vary from extreme retardation to severe restlessness
f) Grossly disorganised behaviour.
DSM 5 diagnosis criteria for schizophrenia
The DSM‑5 requires 2 or more of these symptoms (delusions, hallucinations, disorganised
speech, grossly disorganised behaviour or negative symptoms) to be present during a 1-month period
Symptoms of the disturbance must persist for at least 6 months in order
to make the diagnosis
Differential dx for schizophrenia
- psychosis
- Substance induced psychosis
- delusional disorder
- mood disorders
- schizoaffective disorder
- brief psychotic disorder
Favourable prognostic features of schizophrenia include:
▪▪ Acute onset
▪▪ Presence of a precipitating event
▪▪ Later age of onset
▪▪ Good premorbid personality and adjustment
▪▪ Acceptance and support by family and community
▪▪ Positive attitude towards treatment programme
What is the MOA of antipsychotic medications
antipsychotic medications block the neurotransmitter dopamine’s
receptors (DA)
The four important dopamine systems in the brain and the effect of antipsychotic agents on them
** I remember they asked this question
- Meso-limbic DA system: the antipsychotic effect.
- Meso-cortical DA system: Cognitive and negative symptoms.
- Nigrostriatal DA system: Extrapyramidal side-effects.
- Hypothalmic-pituitary DA system: Blocking of prolactin inhibition, with resultant hyperprolactinaemia with galactorrhoea.
first generation antipsychotic agents
- Chlorpromazine (sedative)
- Trifluoperazine (non-sedative)
- Haloperidol (very strong antipsychotic action)
Side Effects of the first line antipsychotic drugs
- Extrapyramidal S/E
- Orthostatic hypotension
- Epileptogenic
- Skin reactions
Extrapyramidal Side Effects of the first line antipsychotics
- Parkinsonism
- Dystonic reactions
- Akathisia
- Tardive dyskinesia
- Neuroleptic malignant syndrome
Name the second generation antipsychotic drugs
- Clozapine
- Risperidone
- Olanzapinne
- Quetiapine
- Amisulpride
- Ziprasidone
- Aripiprazole
NB go look at the table on page 504 they asked a lot of questions of this for us!
What is the most concerning fact about Clozapine
Lethal side effect of agranulocytosis
If administered, weekly monitoring of white cell counts are required
Big indication for Clozapine use
Resistant schizophrenia
Side effects of clozapine
“WEIGHT”
W- Weight gain (metabolic syndrome)
E - Excessive drooling (sialorrhea)
I - Increased seizure risk
G - Granulocytes (Agranulocytosis)
T - Tachycardia & myocarditis
Advantage of Clozapine
No extrapyramidal side effects
The main side effects of the second generation anti-psychotics
Go look at the table on page 504 is NB ! They asked a lot of questions of this for us
Why would we use long lasting injectables over oral antipsychotics
considerable benefit in reducing the
relapse rate in the maintenance treatment of schizophrenia
What is Delusional Disorder?
The major characteristics of this disorder are persistent delusions of persecution or jealousy
that are not due to another psychiatric disorder
Delusions may be bizarre or non-bizarre
The patient’s emotional responses are appropriate and deterioration of functioning does not take place.
social isolation and an
eccentric lifestyle
more common in people with paranoid or schizoid
personality traits
Delusional disorders include:
a) Erotomanic type (a delusion that an important person is in love with the patient)
b) Grandiose type
c) Jealous type
d) Persecutory type
e) Somatic type
What is Schizophreniform disorder
Identical to schizophrenia in all respects, except that the condition has lasted less than six months.
These patients return back to baseline functioning within
six months.
What is Schizoaffective disorder
Schizoaffective disorder has characteristics of both schizophrenia and mood disorder. This diagnosis should be avoided where possible.
What is Brief psychotic disorder
This condition follows immediately on a psychosocial stressor, and is accompanied by subjective emotional turmoil, and resolves within one month
Symptoms of psychosis, such
as delusions, hallucinations and bizarre behaviour, are seen.
