Schizoprehnia Flashcards Preview

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Flashcards in Schizoprehnia Deck (36)
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1
Q

Etiology

A
  1. Genetics 2. Biochemical ++dopamine in mesocortex/mesolimbic, reduction elsewhere Serotonin excess->negative symptoms NE reduction->anhedonia GABA->loss of inhibitory (+DA) 3. Neuropathology: Excessive pruning of synapses. Reduced symmetry Enlarged ventricles Loss of density in limbic, BG, cortex, thalamus. Neural circuit abnormalities. Brain metabolism.
2
Q

Epidemiology

A

1% population Men=women Men tend to present earlier Women have better prognosis

3
Q

Learning theories

A

Learn irrational reactions and ways of thinking by imitating parents with own emotional problems

4
Q

Psychosocial/psychoanalytical theories

A

Distortion in ego development, the various symptoms seen to have importance/meaning to the patient +Expressed emotion

5
Q

Does a specific family dynamic predispose to developing schizophrenia

A

No evidence to suggest this

6
Q

Premorbid

A
  1. Few friends 2. Passive, odd behaviour 3. Lack funtional 4. Altered speech 5. +Interest in abstract ideas, cultural, religion 6. Abnormal affect
7
Q

MSE

A
  1. General Disheveled, agitation, violent, lack spontaneous speech, purposeless moveM, inappropriate dress 2. Mood and affect Hallucinations, illusions, anhedonia, inappropriate extremes of emotion 3. Thought content–>delusions (loss of ego boundaries), form–> loose associations, derail, tangentiality, concequentiality process–>flight of ideas, inattention, poverty of thought 4. Sensorium and cognition Orientation: well oriented Cognitive impairment Generally intact memory 5. Judgement and insight impaired
8
Q

Criteria

A
  1. Symptoms 6 months with 1 month active including prodrome (negative + 2 attenuated) Delusions Hallucinations Disorganised speech Grossly disorganised or catatonic behaviour Negative (diminished emotional expression or avolition) 2. not affective/mood (not concurrent, or sx for minor duration), not substance, not GMC +impaired function, social withdrawal, Austism spectrum disorder
9
Q

Subtypes

A
  1. Disorganised 2. Paranoid 3. Catatonic 4. Residual 5. Undifferentiated
10
Q

Disorganised

A

Younger Regression ++Thought disorder Appearance disheveled Poor social behaviour Inappropriate responses Incongruous grinning

11
Q

Paranoid

A

Younger Auditory hallucinations Delusions Persecutory, gradiose delusions

12
Q

Catatonic

A

Marked motor disturbance Stupor Mannerisms Extremes of excitement

13
Q

Residual

A

not meeting criteria, however have emotional blunting, social withdrawal, eccentric behaviour, illogical thinking, loose associations

14
Q

Investigations in first psychotic episode

A
  1. full blood count; 2. serum electrolytes, 3. calcium, creatinine and urea concentrations; 4. liver biochemistry; 5. fasting blood glucose and 6. serum lipid concentrations; 7. thyroid function tests; 8. prolactin concentration; 9. urine toxicology; 10. computerised tomography (CT) / magnetic resonance imaging (MRI)
15
Q

Management of first psychotic episode

A
  1. Risperidone 0.5 to 1 mg orally, at night initially, increasing to 2 mg at night. Maximum daily dose is 6 mg 2. For agitation/irritability->diazepam 5-10 mg PO 3. amisulpride 100 mg orally,nocte, increasing to 200 mg twice daily. Maximum daily dose is 1200 mg. Dose adjustment is required in patients with kidney impairment. Negative symptoms 4, Check response in 6-12 weeks->if not chlorpromazine 5. If still not managed->clozepine
16
Q

Recovery, relapse and prevention ongoing management

A
  1. Physical, nutrition, smoking, alcohol, physical activity 2. Manage co-morbidities->obesity, diabetes, CVD, COPD. substance abuse 3. Antipsychotic 4. Psychosocial therapy 5. Manage side effects 6. Psychoeducation 7. Liase with GP and community teams
17
Q

Management of prodromal and progression

A
  1. Monitoring 2. CBT 3. Low dose antipsychotic 33% will progress to psychosis within a year
18
Q

What must you actively ask about with schizophrenic on medication

A
  1. Motor 2. Weight gain 3. Appetite 4. Breast enlargement 5. Sexual dysfunction
19
Q

What are the 6 A’s of negative symptoms

A

Affect blunted Alogia Anhedonia Asocial Avolition Attention impaires

20
Q

When is clozepine used

A

Suitable for treatment resistanct ++Suicidal ideation Substance abuse EPSE Aggression

21
Q

Adverse effects of clozepine

A
  1. Haem->neutropenia, agranulocytosis, eosinophilia 2. CVS->myocarditis, cardiomyopathy->monitor troponins and CRP for first 4 weeks 3. Cardiometabolic->lipids, glucose, HTN 5. GIT: abnormal liver enzymes, pancreatitis, hypersalivation Resp: Pneumonia
22
Q

How long to treat with antipsychotics

A

If first psychotic episode->1-2 years When recurrent->5 years

23
Q

Prognostic factors: good and bad

A

Good 1. Late onset, obvious precipitants 2. Good premorbid functioning->social, sexual and work 3. Acute onset 4. Mood disorder 5. Married 6. FHx mood disturbance Poor 1. Young 2. No precipitating 3. Insidious 4. Poor premorbid functioning 5. Withdrawn 6. single, widowed, divorced 7. FHX schizo 8. -ve, neurol S&S 9. perinatal trauma 10. No remissions 3 years 11. +relapses 12. Hx of assaultiveness

24
Q

Management overview in hospitalisations

A
  1. Diagnose 2. Stabilise on medication 3. Food, clothing, shelter 4. Establish contact between GP, community, family
25
Q

Side effects of antipsychotics and management

A
  1. Metabolic syndrome 2. Hyperprolactinemia->switch 3. Anticholinergic->urinary retention, constipation, dry mouth, blurred vision->lower dose, change 4. Sedation->generally self limiting, reassure or lower dose/change 5. Movement disorders
26
Q

Management of metabolic

A
  1. Monitor: lipids, weight, glucose, BP, waist, cholesterol 2. Education: healthy eating, physical activity, weight loss 3. Switch->antipsychotic with fewer CV effects
27
Q

Management of movement disorders

A
  1. Akathisia->propranolol 2. Acute dystonias->benztropine 3. Parkinsonism->benztropine 4. Tardive dyskinesia->prevention, ensure SGA, clozepine
28
Q

Components of psychosocial therapies

A
  1. Behavioural skills training 2. Motivational interviewing 3. Employment supprot 4. Family therapies 5. Psychoeducation 6. Assertive community treatment 7. CBT
29
Q

Behavioural skills trainign

A

carefully defining the problem behaviours, measuring them and then manipulating aspects of the positive and negative reinforcements that help maladaptive behaviours persist. 1. Video tape watching, replaying, homework 2. Eye contact 3. Delayed responses 4. Odd facial expressions 5. Lack of spontaneity 6. Inaccurate perception of social cues

30
Q

Family oriented therapies

A

Avoiding troublesmoe situations Resolve problems quickly Education Talking openly abut psychotic symptoms Manage the excessive expression of emotion

31
Q

Psychoeducation

A

basic information about mental illness (the symptoms, the aetiology and treatment), the mental health care system (roles of mental health professionals and the relevant mental health legislation) and the principles of caring for oneself.

32
Q

CBT

A

examine the evidence for a psychotic belief, and use reasoning, coping and problem-solving skills to challenge and decrease the salience and threat of their beliefs.

33
Q

Management of clozapine side effects

A
  1. Sedation->usually wears off in 4 weeks. Consider dose reduction if persistent
  2. Hypersalivation->first 4 weeks, wears off. Benztropine, glycopyrrolate
  3. Constipation->usual recommendations
  4. Hypotension->first 4 weeks. Take tie when standing, consider dose reduction
  5. Hypertension->monitor, consider atenolol
  6. TachyC-> very common early, monitor, may indicate myocarditis
  7. Weight gain-> diet + lifestyle
  8. Fever->first 3 weeks, antipyretic, check FBC
  9. Seizures->dose related, withold for one day, restart at reduced dose.
  10. Nausea->first 6 weeks, antiemetic->avoid metoclopramide if previous EPSE
  11. Nocturnal enuresis->manipulate dosing schedule, avoid fluids before bed, desmopressin if severe
34
Q

In relation to antipsychotic use, why is it important to know if a smoker

A

Nicotine can reduce level of antipsychotic

35
Q

Six categories of schizoaffective disorder

A
  1. Patients with schizo + mood
  2. Mood + schizo
  3. Both mood and schizo
  4. Other psychotic + mood
  5. Continnuum between schizo and mood
  6. Continuum of the above
36
Q

Epidemiology of schizoaffective

A

<1 %

Bipolar type-> M= W, +young

2X W depressed type, +older