Schizophrenia

Question 1

positive symptoms

Answer 1

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

Question 2

negative symptoms

Answer 2

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

Question 3

what are the first rank symptoms

Answer 3

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

Question 4

how long must you be experiencing symptoms for for diagnosis

Answer 4

1 month ICD10, 6 DSM

Question 5

types of schizophrenia

Answer 5

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

Question 6

what is paranoid schizophrenia

Answer 6

most common. delusions and auditory hallucinations

Question 7

what is catatonic schizophrenia

Answer 7

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

Question 8

differentials

Answer 8

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

Question 9

aetiology

Answer 9

neurochemical, genetic, neurodevelopmental, social

Question 10

what happens to the chemicals in the brain

Answer 10

increased dopamine, increased serotonin, decreased glutamate

Question 11

neurodevelopmental causes

Answer 11

obstetric complications, neurodevelopmental delay, cannabis, temporal lobe epilepsy

Question 12

genetic causes

Answer 12

50% those with monozygotic twins have it

Question 13

social causes

Answer 13

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

Question 14

what is high expressed emotion

Answer 14

family is overinvolved, critical comments, making it hostile

Question 15

what is schizoaffective disorder

Answer 15

mixture of schizophrenic and affective symptos- equal weighting

Question 16

what is delusional disorder

Answer 16

fixed delusion or delusional system with other areas of thinking preserved

Question 17

what is brief psychotic episodes

Answer 17

lasting less time than required for schizophrenia diagnosis

Question 18

what can be used to treat acute psychotic episode

Answer 18

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

Question 19

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

Answer 19

EPSEs- dystonia, akithisia, tardive dyskinesia, parkinsonism

Question 20

what is the benefit of atypical antipsychotics

Answer 20

less EPSEs as they target D2 less than D1

Question 21

how do antipsychotics work

Answer 21

block D1 and D2 receptors so less dopamine

Question 22

examples of typical antipsychcotics

Answer 22

chlorpromazine, haloperidol, trifluoperazine

Question 23

examples of atypicals

Answer 23

olanzapine, clozapine, quetiapine, amisulpiride, risperidone

Question 24

what are the side effects of risperidone and amisulpiride

Answer 24

hyperprolactinaemia

Question 25

side effect olanzapine

Answer 25

weight gain, increased risk diabetes

Question 26

side effect clozapine

Answer 26

agranulocytosis

Question 27

what is the neuroleptic malignancy syndrome

Answer 27

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

Question 28

what can you give to treat neuroleptic malignant syndrome

Answer 28

bromocriptine

Question 29

what is a neurological emergency from antipsychotics

Answer 29

neuroleptic malignant syndrome

Question 30

what is used for treatment resistant

Answer 30

clozapine

Question 31

definition of treatment resistant

Answer 31

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

Question 32

how does clozapine work

Answer 32

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

Question 33

what are the contraindications of clozapine

Answer 33

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

Question 34

what is the usual dose clozapine

Answer 34

200-450mg

Question 35

what do you measure before initiating clozapine

Answer 35

leukocyte count

Question 36

why do you need to do weekly FBCs in clozapine use

Answer 36

checking for agranulocytosis

Question 37

anticholinergic side effects antipsychotics

Answer 37

dry mouth, blurred vision, urinary retention, constipatiorn

Question 38

anti adrenergic side effects

Answer 38

postural hypotension, tachycardia, sexual dysfunction

Question 39

anti histaminic side effects

Answer 39

sedation, weight gain

Question 40

what is schizotypal disorder

Answer 40

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

Question 41

tests for cognition

Answer 41

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

Question 42

acute v chronic schizophrenia

Answer 42

acute- psychotic, delusions. chronic- negative symptoms

Question 43

psychological and social management

Answer 43

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

Question 44

depot antipsychotics benefits

Answer 44

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

Question 45

depot antipsychotics risks

Answer 45

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

Question 46

suicide risk is higher in

Answer 46

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