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Y4 - Medicine - Psychiatry > Schizophrenia > Flashcards

Schizophrenia Flashcards

(45 cards)

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1
Q

CLINICAL FEATURES

Positive symptoms

A
  • Delusions
  • Hallucinations
  • Formal thought disorder
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2
Q

CLINICAL FEATURES

Delusions

A
  • Commonly persecutory, thought interference or passivity delusions
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3
Q

CLINICAL FEATURES

Hallucinations

A
  • Usually auditory commenting on subject or refering to them in third person
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4
Q

CLINICAL FEATURES

Formal thought disorders

A
  • Loss of normal flow of thinking usually shown in subjects speech or writing
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5
Q

CLINICAL FEATURES

Negative symptoms

A
  • Impairment or loss of volition, motivation and spontaneous behaviour
  • Loss of awareness of socially appropriate behaviour and social withdrawal
  • Flattening of mood, blunting of affect and anhedonia
  • Poverty of thought and speech
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6
Q

DIAGNOSTIC CRITERIA

A
  • At least one of
    • Thought echo, insertion, withdrawal or broadcasting
    • Delusions of control, influence or passivity
    • Hallucinatory voices giving running commentary
    • Persistent delusions of other kinds that are culturally inappropriate or implausible
  • Or two of
    • Persistent hallucinations in any modality
    • Breaks in train of thought causing incoherence or irrelevant speech
    • Catatonic behaviour
    • Negative symptoms

Duration of >= 1 month

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7
Q

Categories of schizophrenia

A
  • Paranoid schizophrenia
  • Hebephrenic schizophrenia
  • Catatonic schizophrenia
  • Undifferentiated schizophrenia
  • Post-schizophrenic depression
  • Residual schizophrenia
  • Simple schizophrenia
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8
Q

Paranoid schizophrenia - key symptoms

A
  • Delusions and hallucinations
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9
Q

Hebephrenic schizophrenia - key symptoms

A
  • Disorganised speech behaviour and flat affect
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10
Q

Catatonic schizophrenia - key symptoms

A
  • Psychomotor disturbance
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11
Q

Undifferentiated schizophrenia - key symptoms

A
  • Meeting general criteria but no specific symptom subtype predominates
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12
Q

Post-schizophrenic depression - key symptoms

A
  • Some residual symptoms, but depressive picture dominates
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13
Q

Residual schizophrenia - key symptoms

A
  • Previous positive symptoms less marked, prominent negative symptoms
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14
Q

Simple schizophrenia - key symptoms

A
  • No delusions or hallucinations - a defect state (negative symptoms)
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15
Q

DIFFERENTIALS

A
  • Substance induced psychotic disorder
  • Psychotic disorder due to general medical conditions
  • Mood disorders with psychotic features
  • Acute/transient psychotic disorder
  • Sleep related disorders
  • Delusional disorder
  • Dementia and delirium
  • Body dysmorphic disorder
  • Pervasive development disorder
  • OCD
  • Hypochondriasis
  • Paranoid personality disorder
  • Schizotypical personality disorder
  • Misidentification syndromes
  • Anxiety disorder
  • Factitious disorder
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16
Q

Examples of substance induced psychotic disorder

A
  • Alcohol
  • Stimulants
  • Hallucinogens
  • Steroids
  • Antihistamines
  • Sympathomimetic
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17
Q

AETIOLOGY

Hypothesis

A
  • Neurochemical abnormality hypothesis
  • Neurodevelopmental hypothesis
  • Disconnection hypothesis
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18
Q

AETIOLOGY

Neurochemical abnormality hypothesis

A
  • Dopaminergic overactivity
  • Glutaminergic hypoactivity
  • Serotonergic (5-HT) overactivity
  • a-adrenergic overactivity
  • GABA hypoactivity
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19
Q

AETIOLOGY

Disconnection hypothesis

Study These Flashcards
A
  • Frontal-temporal/parietal connectivity may be final common pathway for the development of schizophrenia
20
Q

EPIDEMIOLOGY

Incidence (x/100000)

21
Q

EPIDEMIOLOGY

M:F

22
Q

EPIDEMIOLOGY

Prevalence - lifetime risk (x/100,000)

Study These Flashcards
A

15-19/100,000

23
Q

PROGNOSIS

Reduction in life expectancy

Study These Flashcards
A

20% reduction

24
Q

PROGNOSIS

Most common cause of death

Study These Flashcards
A

Suicide (10-38% all deaths)

25
AETIOLOGY Genes
* Neuregulin - NRG1 * Dysbindin - DTNBP1 * DISC1 * Catecholamine O-methyl transferase (COMT)
26
AETIOLOGY Environmental factors
* Complication of pregnancy, delivery and neonatal period * Delayed walking and neurodevelopmental difficulties * Early social services contact and distored childhood behaviour * Severe maternal malnutrition * Maternal influenza in pregnancy and winter births * Degree or urbanisation at birth * Use of cannabis
27
CLINICAL FEATURES Key features in systematic review
* Neurological * Headache, head injury, abnormal mvements of mouth or tongue, diplopia, hearing or visual impairment, fits/faints, altered consciousness or memory problems, stroke, coordination problems, marked tremor or muscle stiffness * Resp * Dyspnoea, orthopnoea * CVS * Chest pain, palpitations * GI * Constipation, nausea, vomiting * Genitourinary * Urinary hesitancy, sexual problems
28
CLINICAL FEATURES Physical examination
* Full neurological most important * Gait inspection, weakness/altered sensation, hand-eye coordination, cranial nerves
29
INVESTIGATIONS
* Blood tests * U&Es, LFT, calcium, glucose * Radiological * CT or MRI with neurological abnormality * CXR where examination suggests resp/CVS condition * Urine * Urinary drug screen * Microscopy and culture * EEG if seizure * 24 hour collection for cortisol if Cushings disease suggested * 24 hour catechlamine collection if phaeochromocytoma/carcinoid syndrome suggested
30
MANAGEMENT Issues affecting initial management decisions
* Risk to themselves and others * Risk of violence * Insight * Hospital admission required * Urgent treatment required * Current social circumstances
31
MANAGEMENT Need for hospital admission
* High risk suicide or homicide * Behaviour endangers relationships, reputation or assets * Severe psychotic, catatonic or depressive symptoms * Lack of capacity to cooperate with treatment * Lack of psychosocial supports * Failure of outpatient treatment * Non-compliance with treatment plan for patients detained under MHA * Need to address comorbidities
32
MANAGEMENT Treatment plan for acute psychosis
* Emergency treatment of behaviour disturbance * Antipsychotic treatment
33
MANAGEMENT Acute - antipsychotic options
* Option 1 * Commence on atypical antipsychotic * Long acting BDZ to control anxiety/behaviour disturbance * Option 2 * Low potency typical antipsychotic * Increase dose if needed over time
34
MANAGEMENT Example of low potency typical antipsychotic
Chlorpromazine
35
MANAGEMENT Choices of atypical antipsychotic for acute management
* Olanzepine * Amisulpride * Risperidone * Quetiapine
36
MANAGEMENT Examples extra-pyramidal SE
* Dystonias * Parkinsonism * Akathisia
37
MANAGEMENT Which class of antipsychotics are extra-pyramidal SE more common
Typical, less likely with atypical
38
MANAGEMENT Prescribe for extra-pyramidal SE
Procyclidine
39
MANAGEMENT Maintanence phase - general plan
* With emergence of stability establish simplication of medicine regime and minimal effective dose * Minimise side effects * Rehabillitation * Possible need to manage depression * Address comorbid substance misuse
40
MANAGEMENT Discharge planning principles
* Medication * Psychological - family therapy and psychoeducation reduce relapse * Social - social work and housing involvement, community psychiatric nurses
41
PROGNOSIS Poor prognostic factors
* Poor premorbid adjustment * Insidious onset * Onset in childhood or adolescene * Cognitive impairment * Enlarged ventricles
42
PROGNOSIS Good prognostic factors
* Marked mood disturbance, especially elation, during initial presentation * Family history of affective disorder * Female sex * Living in developing country
43
MANAGEMENT Acute psychosis first episode treatment algorithm
* 1st - ensure safety patient and self * Adjunct oral benzodiazepine * Adjunct rapid tranquillisation * Plus referal to specialist to start antipsychotic
44
MANAGEMENT Acute psychosis relapse known schizophrenia algorithm
* 1st - ensure safety of patient and self * Adjunct oral benzodiazepine * Adjunct rapid transquillisation * Plus refer to specialist for review of antipsychotic medication
45
MANAGEMENT Long term treatment algorithm
* 1st - continue oral non-clozapine antipsychotic * Plus psychosocial intervention * Plus monitor physical health * 2nd - switch to alternative non-clozapine antipsychotic * Plus psychosocial intervention * Plus monitor physical health * 3rd - clozapine * Plus psychosocial intervention * Plus monitor physical health

Y4 - Medicine - Psychiatry (27 decks)

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