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Psychiatry Year 3 Dundee > Schizophrenia > Flashcards

Schizophrenia Flashcards

(73 cards)

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1
Q

What are the primary symptoms of schizophrenia?

A

Thought Disorders
Delusions of control influence and passivity
Hallucinatory voices - running commentary or voices from distinct body parts
Persistent culturally inappropriate or impossible delusions.

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2
Q

What are the secondary symptoms of schizophrenia?

A

Persistent hallucinations in any modality for >1 month
Neologism incoherent or irrelevant speech
Catotonic behaviour waxy posturing and flexibility
Stupor
Negative symptoms

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3
Q

What are the negative symptoms of schizophrenia?

A

Blunted affect

Incongruity of emotional response

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4
Q

What are positive symptoms of schizophrenia?

A

Hallucinations
Delusions
Disorder of thought
Passivity phenomena

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5
Q

80% of schizophrenic patients are….

A

Paranoid

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6
Q

Hepephrenic schizophrenia

A 
Shallow innapropiate mood
Unpredictable fragmentary hallucinations and delusion
Incoherent speech
Social isolation
Negative symptoms
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7
Q

Paranoid schizophrenic

A

1st rank symptoms

positive schizophrenia symptoms

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8
Q

20% of schizophrenic patients are…

A

Hepephrenic

Catotonic

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9
Q

Catotonic schizophrenia

A

Movement disorder - swing between hyperkinesis and stupor

Automatic obedience in Waxy posturing and flexibility

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10
Q

What is pathophysiology behind schizophrenia?

A

Excessive and abhorrent firing of dopaminergic neurones.

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11
Q

List the dopamine pathways found in the brain.

A 
Mesolimbic
Mesocortical
Nigrostriatal
Tuberoinfundibular 
Hypothalamospinal
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12
Q

What drugs are initially prescribed with a first episode of psychosis?

A

Haloperidol
Raclopride
Aripiprazole

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13
Q

If extra-pyramidal side effects are of a great concern or the psychosis is resistant to treatment what 2nd generation anti-psychotic is used?

A

Clozapine

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14
Q

Which medication when used in psychosis is linked to an increase in cognition and concentration?

A

Lurasidone
Dopamine Adrenoreceptor antagonist
Seretonin partial agonist

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15
Q

What medication is used in the treatment of Schizophrenia?

A

Anti-psychotics - usually antidopaminergic

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16
Q

What are the main symptoms of the antipsychotic drugs used in schizophrenia?

A

Extra pyramidal
Neuroleptic Malignant Syndrome
Hyperprolactinaemia
Akanthesia

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17
Q

Why do patients of antipsychotics develop extra pyramidal side effects?

A

Blocking of the nigrostriatal pathway

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18
Q

What are the main symptoms of the extra-pyramidal side effects?

A

Acute dystonia
Parkinsonism
Tardive dyskinesia

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19
Q

What is Acute dystonia?

A

Gradual increase in muscle tone

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20
Q

What is the time scale of acute dystonia ?

A

minutes to hours

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21
Q

What are the main symptoms acute dystonia?

A

Jaw locking
Eyes roll back
Tongue protrudes
Body twists to the side of the stronger muscles

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22
Q

What percentage of patients on antipsychotics reports extrapyramidal side effects?

A

50%

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23
Q

What are the main symptoms of Parkinsonism?

A 
bradykinesia 
Cogwheeling rigidity
Resting tremor
Shuffling gait
Dead pan face
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24
Q

What is tardive dyskinesia?

A

Involuntary repetitive orofacial movements, can involve trunk or limbs

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25
Give some examples of common movements in tardive dyskinesia.
Blinking grimacing Pouting Lip smacking
26
What is the time scale for tardive dyskinesia?
Long term side effect years of use | Often is permanent even with withdrawal
27
Why do patients of antipsychotics develop extra pyramidal side effects?
An imbalance between acetylcholine and dopamine within the brain.
28
How are the extrapyramidal side effects of antipsychotics treated?
Withdrawal of medication and replaced with clozapine. Reducing levels of acetylcholine to balance levels, both low.
29
Why is clozapine the replacement if extra pyramidal side effects are a worry?
It is least likely to cause extra pyramidal side effects
30
What medication is used to reduce the levels of acetylcholine and restore the balance with dopamine?
Procyclidine Oral | Orphenadrine IM
31
Once the symptom of Tardive dyskinesia are present does it respond to removal of medication or anticholinergics?
No it is very unresponsive
32
Why do patients on antipsychotics sometimes develop Neuroepileptic Malignant Syndrome?
Hippocampal dopamine receptors are blocked
33
How many patients on Antipsychotics develop NMS?
Rare but 20 -30% of patients who develop it die
34
What is NMS?
Gradual increase in muscular tone Pyrexia Autonomic dysfunction
35
How does NMS kill you?
Autonomic dysfunction results in a massively varying BP HR. Rhabdomyolysis leads to acute renal failure Coma Death
36
What investigation can aid in the diagnosis of NMS?
Creatine Kinase
37
What is the treatment for hypothalamic NMS?
``` STOP antipsychotic Rapid cooling Renal suport Skeletal muscle relaxants Dopamine agonists ```
38
What dopamine agonist is used in the treatment of NMS?
Bromocriptine
39
Why do patients of antipsychotics present with hyperprolactinaemia?
Dopamine inhibits prolactin release from the pituitary gland so reduced dopamine results in excess prolactin release.
40
Women with hyperprolactinaemi present with....
``` Galactorrhea Reduced libido arousal Anorgasmic Amenorrhea Anovulation ```
41
Men with hyperprolactinaemia present with.....
Gynaecomastia Erectile dysfunction Oligospermia Reduced libido
42
Prolactin affects....
Boobs Balls Bones
43
Hyperprolactinaemia has what affect on the bones?
Reduced bone mineralisation density | Osteoporosis
44
What percentage of patients on antipsychotics complain of akathisia?
20%
45
What is the time scale of initiation of antipsychotic to side effect onset?
Days to weeks
46
What is Akathisia?
Restlessness Pacing Poor sleep
47
What is the particular risk associated to Akathisia?
Due to poor sleep there is an increased risk of suicide.
48
What mediation is used in the treatment of Akathisia?
Beta blockers - Propanolol | BDZ - for severe acute episodes
49
Due to there unknown effect on other receptors throughout the brain what other effects can Atipsychotic drugs have and why?
Anticholinergic - dry mouth constipation blurred vision Anti-serotonergic - weight gain Type 2 diabetes Anti adrenergic - postural hypertension
50
What are some other common side effects of Anti-psychotics?
Hepatotoxicity Prolonged QT Photosensitivity
51
What severe side effects are associated with clozapine?
Agranulocytosis Myocarditis Sever weight gain 10kg in 3 months Severe constipation
52
What is agranulocytosis?
Dangerously low white blood cell count - leading neutropenic sepsis as unable to fight infection
53
What other side effects of clozapine are common?
Sedation | Sialorrhoea
54
Why is constipation considered a severe side effect of clozapine?
Leads to gastroperesis obstruction and perforation of the bowel
55
Apart from reduced risk of extra pyramidal side effects what are the benefits of clozapine?
Reduces risk of suicide | Good for negative symptoms of psychosis
56
How long does someone need to be on the titrated adequate dose before they can be reviewed for alternative treatment?
6-8 weeks
57
Alongside pharmacological treatments what else must be considered ?
optimising social supports | Psychological therapy
58
If someone is unresponsive to both 1st and 2nd generation drugs what must be considered?
Check diagnosis correct | Check compliance
59
If a patient has poor compliance what can be considered?
IM Depots in gluteal of deltoid muscle every 3 months | Haloperidol Risperidone
60
Why do patients with psychosis have many illnesses factors?
``` Poor diet Lack of support poor access to transport Chronic health condition poor concentration - missed appointments prescriptions etc Higher rate of smoking Co morbid drug use ```
61
When is a very rare age period for a diagnosis of schizophrenia?
Old age and adolescence
62
Is there any gliosis present in schizophrenia?
NO
63
What is the biggest risk factor for developing schizophrenia?
Family History
64
What are some other risk factors for developing schizophrenia?
2nd trimester viral illness Obstetric problems - pre eclampsia foetal hypoxia Childhood viral CNS infection Substance misuse
65
Why does substance misuse increase your risk of developing schizophrenia?
Its multi factorial so patient may be genetically predisposed and the substances trigger schizophrenia.
66
What substances carry a particular risk of triggering schizophrenia?
Amphetamines Cocaine Cannabis Synthetics - Spice Ivory wave
67
What may be seen in the brain of a patient with schizophrenia?
Enlarged ventricles reduced frontal lobe volume and grey matter Reduced activation of pre frontal regions
68
Subcortical dopamine hyperactivity leads to...
Psychosis
69
Mesocortical dopamine hypoactivity leads to...
Negative and cognitive symptoms
70
What genes are related to schizophrenia?
Neuregulin Dysbindin DISC-1
71
Neureglin
Signalling protein mediating cell to cell interaction
72
Dysbindin
Essential for adaptive neural plasticity
73
DISC-1
Involved in neural growth | Cortical development

Psychiatry Year 3 Dundee (21 decks)

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