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Year 4 - Psychiatry > Schizophrenia > Flashcards

Schizophrenia Flashcards

(63 cards)

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1
Q

What is Schizophrenia?

A

Chronic relapsing condition, form of psychosis with distortion to thinking and perception and inappropriate or blunted affect

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2
Q

When does schizophrenia present?

A

15-30

Earlier in men than women

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3
Q

How long must symptoms be present for schizophrenia to be diagnosed?

A

1 month

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4
Q

What is Schizoaffective disorder?

A

Symptoms of schizophrenia with bipolar disorder

Patients have psychosis and symptoms of depression and mania

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5
Q

What is Schizophreniform disorder?

A

Same features as schizophrenia but less than 6 months

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6
Q

How would you explain schizophrenia to a patient?

A

Condition that affects how the brain processes information

Brain struggles to understand the world and makes mistakes deciding what information is important and organises thoughts in a confused way

This causes strong beliefs that do not fit with reality called delusions and experience voices that are not there called hallucinations

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7
Q

What is psychosis?

A

Individual is experiencing a reality different to everyone else
Lack of insight

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8
Q

How long does it take for a psychotic episode to happen?

A

Can begin suddenly or gradually

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9
Q

How long do psychotic episodes last?

A

Days, weeks or months

Longer the psychosis, more damaging effects

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10
Q

What is a hallucination?

A

Perception in the absence of an external stimulus

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11
Q

Are voices in the head psychosis?

A

No, pseudohallucination

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12
Q

What is formal thought disorder?

A

Problem of speech, which means each sentence does not follow on from the next

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13
Q

What can a psychotic episode cause?

A

Personality change

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14
Q

What can cause psychosis?

A

Psychotic depression
Stroke
Hyperthyroidism
Cushing’s syndrome
Huntington’s
Steroid induced’
Brain tumours
Drugs
Mania

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15
Q

What causes schizophrenia?

A

Genetic and environmental factors

Family member affected is a large risk factor

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16
Q

What is the chance of schizophrenia in identical twins if one twin is affected?

A

50%

Environmental factors also contribute to risk of development

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17
Q

How does schizophrenia first present?

A

Prodrome phase
Precedes full symptoms of psychosis

Patient experiences subtle symptoms

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18
Q

What are the central features of schizophrenia?

A

Delusions
Hallucinations
Thought disorder (disorganised thoughts causing abnormal speech and behaviour)

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19
Q

What is lack of insight?

A

Important feature of psychosis

Lack awareness that delusions and hallucinations are not based in reality

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20
Q

What are the key positive symptoms typical in schizophrenia?

A
  • Auditory hallucinations
  • Persecutory delusions (someone is going to harm them)
  • Somatic passivity (external entity is controlling their sensations and actions)
  • Thought insertion or withdrawal
  • Thought broadcasting
  • Ideas of reference (events or details relate to them)
  • Delusional perceptions
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21
Q

What are the key negative symptoms of schizophrenia?

A

5 As

Affective flattening (minimal emotional reaction to emotive subjects or events)
Alogia (reduced speech)
Anhedonia
Avolition (lack of motivation towards goals)
Asociality (no desire for social interaction)

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22
Q

What is a delusional perception?

A

Delusion formed in response to external stimulus without any logical sense

e.g. watching TV and believing you were chosen to meet the president

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23
Q

What does a reduced level of functioning involve in schizophrenia?

A

Social engagement
Productivity and achievement at work or school
Self-care

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24
Q

What are the patterns of schizophrenia?

A

Continuous
Episodic
Single episode only

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25
What is diagnosis of schizophrenia based on?
**ICD-11 criteria only** Below is what DSM5 uses Symptoms present for at least 6 months Symptoms of active phase must be present for at least 1 month
26
How is schizophrenia managed?
**Early intervention in psychosis** For first episodes of psychosis **Crisis resolution and home treatment teams** Urgent support for patients in a crisis **Acute hospital admission** **Community mental health team** Ongoing monitoring and management
27
What are Schneider's first rank symptoms of schizophrenia?
**ABCD** **A**uditory hallucination, about the person in the 3rd person, a voice or voices giving running commentary on the patient's actions or thoughts in 3rd person **B**roadcasting of thought **C**ontrolled phenomenon - feelings, actions or impulses controlled by something or someone else **D**elusional perception
28
How is schizophrenia treated?
Antipsychotics CBT
29
What are antipsychotics also called?
Neuroleptics
30
How do antipsychotic medications work?
Inhibiting dopamine receptors D2 receptors
31
What pathways are targeted?
Mesocortical Mesolimbic
32
Where do unwanted side effects of antipsychotic use come from?
Nigrostriatal Tuberoinfundibular
33
What are some examples of oral antipsychotics?
Chlorpromazine Haloperidol Quetiapine Olanzapine Risperidone
34
What are depot antipsychotics and when are they used?
IM injections every 2 weeks-3 months Useful when adherence is an issue Aripiprazole Risperidone Paliperidone
35
What can happen with chlopromazine use?
Oculogyric crisis Dystonic reaction, causes extrapyramidal effects
36
What do you give for extrapyramidal side effects? e.g. oculogyric crisis
Procyclidine
37
When is clozapine used?
When other treatments do not control symptoms Only available orally Very effective but significant adverse effects
38
What are the adverse effects of clozapine?
Agranulocytosis Myocarditis Constipation Seizures Excessive salivation
39
What are the common side effects of clozapine use?
Constipation Excess salivation Weight gain Sedation Metabolic disturbances
40
Before starting antipsychotics and during what is monitored?
- Weight and waist circumference - BP and HR - Bloods - ECG
41
What are the side effects of antipsychotics?
- Weight gain - Diabetes - Prolonged QT interval - Raised prolactin - Extrapyramidal symptoms
42
What are the extrapyramidal side effects?
Akathisia (inability to stay still) Dystonia Pseudo-parkinsonism Tardive dyskinesia (abnormal movements, particularly affecting face)
43
What can be given for tardive dyskinesia?
**T**etrabenazine **T**=**T**ardive
44
What is the difference in side effects between typical and atypical antipsychotics?
**Typical** More likely to cause extra-pyramidal side effects Dizziness Sexual dysfunction Binds to more muscarinic and histaminic receptors **Atypical** More serotonergic activity Weight gain Dyslipidaemia and diabetes
45
What are some examples of Typical antipsychotics?
Haloperidol Chlopromazine Flupenthixol Zuclopenthixol Sulpiride
46
What are some examples of Atypical antipsychotics?
**Clozapine** Olanzapine Quetiapine- used in BPAD, can increase risk of lithium toxicity Risperidone Amisulpiride Aripipzaole
47
How does clozapine work?
D2 antagonist 5HT-2 antagonist
48
When is clozapine used?
In schizophrenia after two other antipsychotics have not been effective
49
How is clozapine monitored?
Agranulocytosis risk Weekly FBC for first 18 weeks Biweekly for up to a year Then monthly
50
What is the highest cause of fatality in clozapine use?
Significant hypo-mobility of the bowels Constipation causing fatal bowel obstruction
51
How is agranulocytosis treated?
Stop clozapine Stop any other bone marrow suppressors e.g. sodium valproate If antipsychotic needed give aripiprazole Prophylactic ABx Lithium to increase WCC and neutrophil count Consider G-CSF
52
What is neuroleptic malignant syndrome?
Life threatening complication of antipsychotics Typical Triad **Muscle rigidity** **Hyperthermia** **Altered consciousness** Autonomic dysfunction
53
What causes death in neuroleptic malignant syndrome?
Rhabdomyolysis Renal failure Seizures
54
What are the risk factors for neuroleptic malignant syndrome?
High potency dopamine antagonists (typical antipsychotics) High doses Young men
55
What are the key blood findings in neuroleptic malignant syndrome?
Raised creatine kinase Raised white cell count
56
How is neuroleptic malignant syndrome managed?
Stop causative medications Supportive care- cooling blankets, fluids etc Bromocriptine (dopamine agonist) in severe cases with dantrolene (muscle relaxant)
57
How is rhabdomyolysis treated in neuroleptic malignant syndrome?
Fluids and sodium bicarbonate Alkalises the urine
58
What is part of the mesocortical pathway and what does it do?
Ventral tegmental area Prefrontal cortex Executive functions
59
What is part of the nigrostriatal pathway and what does it do?
Substantia nigra Caudate nucleus Putamen Motor function Reward-related cognition Associative learning
60
What is part of the tuberoinfundibular pathway and what does it do?
Hypothalamus Pituitary gland Prolactic secretion
61
Why can gynaecomastia develop in antipsychotic use?
D2 receptor inhibition in the tuberoinfundibular pathway This causes a rise in prolactin as there is reduced regulation from reduced dopamine Increase prolactin leads to gynaecomastia, galactorrhoea, reduced libido
62
What antipsychotic has the lowest risk of hyperprolactinaemia?
Aripiprazole
63
Why does olanzapine not work as well in patients who smoke?
Smoking can induce CYP450 enzymes in the liver This causes increased breakdown up to 50% of olanzapine, so patients will need an increased dose

Year 4 - Psychiatry (23 decks)

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