Schizophrenia Flashcards
what are the death rates of schizophrenia like?
• Schizophrenic patients die on average 15-20 years earlier than the rest of the population
o Very poor awareness and monitoring of physical health
o Risk of death 2.5x rest of population, and increasing over time
o 12x risk of suicide
o Other mortality is due to lifestyle such as smoking and alcohol
o Less likely to seek health care assistance
what are the positive symptoms of schizophrenia?
delusions
hallucinations
thoughts
what are the negative symptoms?
poverty of speech
lack of motivation
emotional flattening
what are the cognitive symptoms?
memory difficulties
attention deficit
executive functioning
what is prodromal state?
before you have the full blown schizophrenia. This usually happens in the younger population
o Less able to think, agitated, fixated on certain things
o Not all these people will have full blown schizophrenia usually only a third
o The earlier we treat the better it is
how do you diagnose schizophrenia?
- there is usually overlapping with other mental illnesses
- role of family, empolyers, friends is crucial
- ICD-10 and DSM-V diagnostic criteria
what is the role of antipsychotics?
- Do not CURE schizophrenia, they only ALLEVIATE symptoms
- Have a high response rate in first episode schizophrenia, but may not prompt symptom recovery
- Do not prevent relapse of illness in everyone, as after first episode schizophrenia, only 20-30% are relapse free after 5 years despite treatment – but they are much better then not taking them at all. After 2 years if you have stopped treatment people 100% would relapse
- Work best when taken regularly, poor adherence increases the risk of relapse by 5 times
what is the NICE guideline pathway?
- predromal phase you would offer CBT
- first episode you would need to rule out other causes, give a full assessment, offer antipsychotics along side CBT
- Maintenance treatment you need to continue for 1-2 years as a risk of relapse if you suddenly stop
- subsequent acute episodes treat as if it was the first episode, review diagnossis, may need to switch to other medication
- treatment resistnace you need to offer clozapine if not responded
how should you use antipsychotics?
- Therapy should be prescribed on a trial basis, for 4-6 weeks at optimum dosage
- Record expected benefits and risks of treatment
- Inform patient that treatment may take 2-3 weeks to work
- Start at lower doses and titrate up according to tolerance/efficacy
- Record the rationale for continuing, changing or stopping medication
- Record the reason if high doses are used
what is CBT?
- can be as effective as any antipsychotic treatment
- can be used for positive, negative and cognitice symptoms
- multiple sessions needed with a therapist
- focuses on changing behaviour
what are first generation antipsychotics?
sulpiride flupenthixol haloperidol chlorpromazine zuclopenthixol trifluoperazine perphenazine
what are second generations?
amisulpride quetiapine risperidone olanzapine clozapine aripiprazole paliperidone lurasidone asenapine
which have less effects first or second generations?
- Generally less extra-pyramidal side effects (EPSEs) and hyperprolactinaemia for second generation drugs – with notable exceptions
- Metabolic side effects with second generation drugs – ‘metabolic syndrome’
- Antipsychotics have limited effects on negative and cognitive symptoms of schizophrenia
what are EPSE side effects?
• EPSE’s are dose related and more likely to occur with typical antipsychotics
• However, higher doses of risperidone and amisulpride can also cause EPSEs (second generations)
• Generally speaking, there are 3 main treatments depending on the type of EPSE
o Anticholinergic
o Switch – sometimes the actual drug, sometimes the route of admin
o Swap
what is dystonia?
muscle spasms in any part of the body eg eye rolling, head or neck twisting
