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Flashcards in Schizophrenia Deck (35):
1

Positive symptoms of Schizophrenia

Hallucinations
Delusion
Impaired insight
Disorganised thinking and speech eg tangential, LOA

2

Negative symptoms of schizophrenia

Lack of motivation
Poor self care
Blunted affect
Reduced speech output
Social withdrawal
Also known as the 6 A
- Attention impairment
- Affect blunted
- Alogia - poverty of speech
- Anhedonia - inability to experience pleasure
- Asocality - Lack of desire to form relationships
- Avolition - lack of motivation

3

Cognitive symptoms of schizophrenia

Impaired planning
Reduced mental flexibility
Impaired memory - verbal memory
Impaired social cognition
Frontal deficits/executive functioning
Reduce attention
Impaired verbal fluency
Problems with serial learning

4

Excitment symptoms of schizophrenia

Disorganised behaviour
Aggression
Hostility

5

Mood symptoms of schizophrenia

Depression
Anxiety

6

Term used for : Wandering from the topic (thought form)

Tangential

7

Term used for : Rapid, fragmented, unrelated ideas (thought form)

Flight of ideas

8

Term used for thoughts that drift from loosely related to completely off track.

Knights - move thinking or Derailment

9

Disorders of affect

Restricted/constricted = slightly less
Blunted = ++ reduced
Flat = almost absent
Inappropriate = does not fit with speech content

10

Disorders of mood

Emotional lability = abnormal change ability
Depression and mania

11

Negative symptoms of Schizophrenia

Affect blunted - decreased facial expression of emotion
Alogia - poverty of speech
Anhedonia- inability to experience pleasure
Asociality- Lack of desire to form relationships
Avolition- and lack of motivation
Attention - impairments
-Ve symptoms have bigger impact on QOL, functional disability and burden to other then +Ve symptoms.

12

What make negative symptoms worse

Comorbid depression or anxiety
Extra pyramidal side effects
Environmental deprivation
Secondary to positive symptoms
Cognitive deficits

13

Extrapyramidal side effects of antipsychotic medication


1st - mins to hrs Acute dystopia - Involuntary sustained muscular contractions or spasm. Mx: Benztropine
2rd - hrs to days Akathisia- Subjective feeling of inner restlessness and muscular discomfort. Mx stop and swap
3rd - days- wk - M Parkinson like symptoms - muscular rigidity, bradykinesia and resting tremor. Mx Propanolol, Benztropine
4th - Months - Yr Tardive dyskinesia - rhythmic, involuntary movements of head, limbs, and trunk, especially chewing, grimacing of mouth and protruding darting movements of tongue. Mx switch to Clozapine

14

Phases of schizophrenia

Prodrome - deterioration of function
Active psychotic (1month) - Delusion, Hallucinations, Disorganised speech, Grossly disorganised behaviour, Negative symptoms.
Residual - functional impairment, abnormalities of affect, cognition and communication.

15

Post injection syndrome caused by Olanzapine depo

Profound sedation with dizziness, weakness, altered speech, HTN, and seizure, coma or delirium.
0.07%
Monitoring every 30 mins for the first 3 hours.

16

Risk factors of relapse in psychosis

Poor insight into purpose of medication
Psychosocial stressors, substance use and premature lowering of the dose
Or discontinuation of antipsychotic tx.

17

General side effect of antipsychotic drugs both first and second generation

Anticholinergic effect: Dry mouth, Blurred vision, Increase intraocular pressure, Constipation, Urinary hesitancy, Overdose - Delirium, enlarge pupil, hot, dry, flushed, skin and increase HR.
Alpha adrenergic anlog: orthrostatic hypotension, Impotence and failure to ejeculate
D2 antagonist: EPSE, increase prolactin: Hyperprolactinaemia: Gynaecomastia, Galactorrhea, Menstrual cycle disturbance, Anovulation, Impaired spermatogenesis, Decrease Libido, Decreased sexual arousal
- Impotence and anorgasmia
H antagonist: sedative
Haematological: agranulocytosis
Endocrine: Dyslipidaemia, Metabolic syndrome:
Other: LFT dysfunction, NMS, Rash, Temp.

18

Difference between First generation antipsychotic and second generation

More hyperprolactinaemia
More EPSE
More Hyperglycaemia
Same anticholingeric effects
Same dyslipidaeima
Same orthostatic hypotension
Same sedation
Same wt gain

19

Adverse affects of Olanzapine

worse for WT gain sedation and metabolic syndrome
Better for prolactin and EPSE
Post injection syndrome
Don't give with bento

20

What are the CVS AE of antipyschotic

Dyslipidaemia
Hyperglycaemia
HTN

21

Adverse affects of Risperidone

Compared to olanzapine
More hyperprolactin
More orthostatic hypotension
EPSE
less anticholingeric
Less hyperglycaemia
Less dyslipidaeia
Less sedation
Less wt gain

22

Adverse affects of Quetiapine

Compared to Olanzapine
More hyperglycaemia
More orthostatic hypotension
EPSE
Less Anticholingeric effects
Less dyslipidaemia
Less wt gain

23

Adverse affect of Paliperidone

Compared to Olanzapine
Needs dose adjustment in kidney impairment
much More prolactin
Much more orthostatic hypotension
More EPSE
Less anticholinergic effects
Less dyslipidaemia
Less hyperglycaemia
Less sedation
Less wt gain

24

Adverse affects of Aripiprazole

Compared to Olanzapine
Activating so take in mane
less CVS AE
EPSE
less anticholingeric
No hyperglycaemia
No dyslipidaemia
No hyperprolactin
No sedation

25

Adverse affects of Amisulpride

Compared Olanzapine
Precaution in kidney. Need to adjust dose
Good for prominent negative symptoms
Less CVS AE
more prolactin

26

Adverse affects of Sertindole

Compare to olanzapine
High risk of cardiac arrhythmia
Only used if pt unable to tolerate at least one other antipsychotic
Much more QT prolongation. Need ECG monitoring
no anticholingeric
No dyslipidaemia
No EPSE
No Hyperglycaemia
No sedation
Decrease Wt gain.

27

Adverse affects of Clozapine

Good for negative symptoms
Reserved for tx resistance - 6-12 week of at least 2 antipsychotics
Increase Risk of agranulocytosis
Neutropenia
Myocarditis
Cardiomyopathy
More anticholingeric affect
More sedation
more Orthostatic hypotension
Myoclonus
seizure
No EPSE

28

IX for clozapine

WCC and neutrophil 18 wk
Cardiac - BMI, temp, HR, BP, RR, troponin, CRP, 4wks
ECG and Echo baseline
Metabolic - Wt, BMI. waist circumference BGL, Lipids
Clozapine level measured on morning trough

29

Ix prior to starting Antipsychotic

FBC
U&E
LFT
BGL- fasting
Lipid
TFT
Prolactin
Urine toxicology
CT

30

Duration of antipsychotic medication after first episode

Min 2yr after first psychosis then tapered over 3 months.

31

when to add benxodiasepine to a pt psychotic treatment

If using a less sedation antipsychotic to tx anxiety, agitation, insomnia, or activation syndrome (agitation/pacing, irritability, insomnia, N&V)
Short term - Diazepam.

32

Management of schizophrenia

Pharmacological tx
Broadly based tx program
- Psychotherapeutic - active listing, empathic responsiveness, explanation and reassurance
- MDT - GP
- Access to Case Mx, assertive community tx, CBT, Cognitive remediation for cognitive deficits, social skills programs, support employment programs, accommodation, disability support options, education, training assistance, social interventions to combat isolation.
Manage comorbidity
- Monitor substance use - risk of relapse
- assess for and tx comorbid depression, suicidality and anxiety disorder.
Maintain physical health
- Tx of CVS risk factors - Physical fitness, healthy eating, smoking cessation
- prevention - screening for pap smear
- Monitoring - BP, Wt, BMI, Waist circumference, serum lipids and BGL.
Work with family/carers - psychoeducation - early symptoms & signs of relapse, Med and AE, Physical health needs
Management of neg symptoms - psychosocial interventions, augmentation with antidepressant e.g. fluoxetine, lamotrigine.
Omega 3

33

First rank symptoms

- auditory hallucinations:
- thought withdrawal, insertion and interruption.
- thought broadcasting.
- somatic hallucinations.
- delusional perception.
- Passivity experience: feelings or actions experienced as made or influenced by external agents.

34

Initating Clozapine

First day requires hourly obs
First 2 wks requires daily ECG, and bloods
Then weekly ECG and bloods.

35

Differentiating between Seratonin syndrome and NMS

SERTONIN
Restless, twitching,
Flushed and sweating
GIT sym

NMS
Global rigidity
Pale
No GI.