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Flashcards in Schizophrenia Deck (46):
1

positive symptoms

delusions- persecutory, passivity, thought interference; auditory hallucinations; formal thought disorder

2

negative symptoms

poverty of speech and thought, flattened mood, anhedonia, loss motivation, blunted affect, social withdrawal

3

what are the first rank symptoms

3rd person auditory hallucinations, thought echo, delusional perception, thought insertion/withdrawal, passivity

4

how long must you be experiencing symptoms for for diagnosis

1 month ICD10, 6 DSM

5

types of schizophrenia

paranoid, catatonic, hebephrenic, residual(chronic), undifferentiated (simple)

6

what is paranoid schizophrenia

most common. delusions and auditory hallucinations

7

what is catatonic schizophrenia

uncommon. psychomotor disturbance, rigidity, posturing, echolalia, echopraxia

8

differentials

substance induced psychosis, psychosis due to general medical condition, mood disorders with psychotic features, sleep related disorder, dementia and delirium, PTSD, OCD, schizoaffective disorder

9

aetiology

neurochemical, genetic, neurodevelopmental, social

10

what happens to the chemicals in the brain

increased dopamine, increased serotonin, decreased glutamate

11

neurodevelopmental causes

obstetric complications, neurodevelopmental delay, cannabis, temporal lobe epilepsy

12

genetic causes

50% those with monozygotic twins have it

13

social causes

socio economic deprivation, excess of life events, living in a family with high expressed emotion- more likely to relapse

14

what is high expressed emotion

family is overinvolved, critical comments, making it hostile

15

what is schizoaffective disorder

mixture of schizophrenic and affective symptos- equal weighting

16

what is delusional disorder

fixed delusion or delusional system with other areas of thinking preserved

17

what is brief psychotic episodes

lasting less time than required for schizophrenia diagnosis

18

what can be used to treat acute psychotic episode

lorazepam and haloperidol (oral first line, IM second line)

19

what are the main side effects of typical (conventional) antipsychotics

EPSEs- dystonia, akithisia, tardive dyskinesia, parkinsonism

20

what is the benefit of atypical antipsychotics

less EPSEs as they target D2 less than D1

21

how do antipsychotics work

block D1 and D2 receptors so less dopamine

22

examples of typical antipsychcotics

chlorpromazine, haloperidol, trifluoperazine

23

examples of atypicals

olanzapine, clozapine, quetiapine, amisulpiride, risperidone

24

what are the side effects of risperidone and amisulpiride

hyperprolactinaemia

25

side effect olanzapine

weight gain, increased risk diabetes

26

side effect clozapine

agranulocytosis

27

what is the neuroleptic malignancy syndrome

muscle rigidity, fever, autonomic, delirium. increased CK levels and WCC

28

what can you give to treat neuroleptic malignant syndrome

bromocriptine

29

what is a neurological emergency from antipsychotics

neuroleptic malignant syndrome

30

what is used for treatment resistant

clozapine

31

definition of treatment resistant

failure to respond to more than 2 drugs for 6 weeks or more

32

how does clozapine work

blocks D1 and D4, lower affinity for D2 so lack of EPSEs

33

what are the contraindications of clozapine

neutropenia, myocarditis, pericarditis, cardiomyopathy, cardiac or renal disorders, hepatic

34

what is the usual dose clozapine

200-450mg

35

what do you measure before initiating clozapine

leukocyte count

36

why do you need to do weekly FBCs in clozapine use

checking for agranulocytosis

37

anticholinergic side effects antipsychotics

dry mouth, blurred vision, urinary retention, constipatiorn

38

anti adrenergic side effects

postural hypotension, tachycardia, sexual dysfunction

39

anti histaminic side effects

sedation, weight gain

40

what is schizotypal disorder

cluster A personality disorder, no delusions or hallucinations. ideas of reference, odd beliefs, odd behaviour or appearance odd speech

41

tests for cognition

stroop test- words and colours, trail making executive planning.

42

acute v chronic schizophrenia

acute- psychotic, delusions. chronic- negative symptoms

43

psychological and social management

psych- CBT, education, family therapy. social- housing and benefits, substance misuse, occupation, lifestyle

44

depot antipsychotics benefits

less frequent than tablets, known compliance, predictable bioavailability, contact and monitoring

45

depot antipsychotics risks

inflexible administration, longer washout if side effects, getting to steady state, patient acceptability

46

suicide risk is higher in

young men, first few years of illness, persistent hallucinations or delusions, hx illicit drug use, prev suicide attempts