Schizophrenia Flashcards
(36 cards)
What is schizophrenia?
A common, chronic relapsing condition (~1%)
Often presents in adulthood
With psychotic, disorganisation and negative symptoms
Sometimes cognitive impairment
Major implications for patients, work and families
What are examples of psychotic symptoms?
Hallucinations
Delusions
What are examples of disorganisation symptoms?
Incongruous mood
Abnormal speech and thought
What are examples of negative symptoms?
Apathy Lack of motivation Withdrawal Self-neglect Blunted mood
What is psychosis?
Distorted thinking and perception
E.g. hallucinations and delusions
What are the causes of psychosis?
Affective psychosis (bipolar, depression)
Transient psychotic disorders (usually substance misuse)
Organic psychoses (e.g. brain tumour)
Schizophrenia
Schizophrenia-like non-affective disorders (delusional disorder, brief psychotic disorder, schizophreniform disorder)
What are the symptoms of schizophrenia?
Thought insertion/thought broadcast/thought withdrawal
Delusions (e.g. they are being influenced or controlled by external forced)
Hallucinatory voices (e.g. running commentary/discussing amongst themselves)
Persistent delusions of other kinds that are culturally inappropriate and completely impossible
Persistent hallucinations in other modalities
Breaks or interpolations in train of thought resulting in incoherence or irrelevant speech/knights move thoughts/odd logic/neologisms
Catatonic behaviours (strange, purposeless Behavior) e.g. easy flexibility, echopraxia, negativism, mutism
Negative symptoms resulting in social withdrawal
What is a delusion?
A belief held unshakeably irrespective of counter-argument that is unexpected and out of keeping with the patient’s sultry all background
What is the difference between delusional perception and delusional intuition?
Delusional perceptions form around a real perception given a delusional interpretation
Delusional intuition ‘appears out of the blue’ as a fully formed idea
What is the difference between mood congruent and mood incongruent delusions?
Mood congruent delusions tend to be seen in affective psychoses e.g. nihilistic delusions in depression and grandiose delusions in bipolar
Mood incongruent delusions are not related to mood and seen more in schizophrenia
Give some examples of types of delusions.
Persecution (most common) - being spied on/conspired against with the intention to cause harm - causes a feeling of paranoia
Infestation - e.g. formication - seen in organic illness and cocaine use
Religious
Delusional misidentification - belief that people close to them have been replaced by an exact double/are being impersonated
Jealousy
Love - belief that a high status individual/stranger is in love with them and secretly sending messages or signs
Communicated - psychotic person transmits their beliefs to a close relative, usually subservient who now shares them
Reference - coincidental or innocuous events are interpreted to have great personal significance
What is the diagnostic criteria for schizophrenia?
At least one of (thought possession, delusions, auditory hallucinations) OR
At least 2 of (hallucinations in another modality, knight’s move thoughts, catatonic behaviour, negative symptoms)
Needs to be present for at least 6 months
Symptoms present for most of the time for at least 1 month
Marked impairment in social or occupational functioning
Other causes of psychosis ruled out (CNS tumours, drugs/alcohol, head injury, bipolar)
What are the different subtypes of schizophrenia?
Paranoid (commonest) - hallucinations/delusions more prominent
Hebephrenic - onset 15-25Y, poor prognosis, fluctuating affect prominent, fleeting fragmented delusions and hallucinations
Catatonic - stupor, posturing, waxy flexibility, negativism
Simple and Residual - negative symptoms predominate
What are prodromal life symptoms?
Precede most first episodes of psychosis by up to 18 months, sometimes just a few days
Characterised by a gradual deterioration in functioning
Sometimes conceptualised as ‘altered life trajectory’
Give some examples of prodromal symptoms.
Transient/lower intensity psychotic symptoms Odd thoughts, beliefs and behaviours Concentration problems Altered affect Social withdrawal Reduced interest in daily activities
What are the other ‘schizophrenia disorders’?
Schizoaffective (neither/both a variant of schizophrenia and a mood disorder) - symptoms of both experienced within days and of the same intensity without the presence of another medical disorder/substance abuse - give antipsychotic and mood stabiliser
Schizotypal - personality disorder which may represent a partial expression of schizophrenia - not treated with medication
Schizophreniform - subclinical schizophrenia usually by duration - treated with antipsychotics
What are some of the social risk factors of schizophrenia?
Being brought up in the city
Migrant groups
When should antipsychotics be started in schizophrenia and why?
Very soon after diagnosis
Delaying antipsychotics could worsen negative symptoms
What are the psychosocial interventions for schizophrenia?
Drugs and alcohol services if substance abuse
Working with family/family therapy - address blame, shame etc.
Support groups
Address housing, benefits, social skills training
Supported employment
How is aftercare delivered to a patient with schizophrenia?
Coordinated via an allocated key worker and MDT
Performed though CPA (care programme approach)
What are some good prognostic factors?
Sudden onset No negative symptoms Supportive home Female sex (better social integration) Late onset of illness No CNS ventricular enlargement No family history
What advice and monitoring is needed when starting antipsychotics?
Personal/FH of diabetes, HTN and cardiovascular disease
Advise on diet, weight control and exercise
BP, weight, fasting glucose, lipid profile, FBC
ECG (if on clozapine)
6 monthly monitoring - LFT, U&Es, prolactin, weight, HbA1c
What is the only licensed third generation antipsychotic that’s licensed and why does it have a better side effect profile than first and second generation antipsychotics?
Aripiprazole
It is a partial dopamine agonist
What is the first line treatment for newly diagnosed schizophrenia?
Oral SGAs
Olanzapine, quetiapine, risperidone, amisulpride, zotepine
