Schizophrenia Symptoms

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Questions and Answers

What is the primary characteristic of positive symptoms in schizophrenia?

Social withdrawal

Loss of normal function

Excess distortion of normal function (correct)

Impaired cognitive function

What is the term for strongly held false beliefs that have no basis in reality?

Hallucinations

Delusions (correct)

Inappropriate Affect

Abnormal Thought

Which type of schizophrenia is characterized by a sudden onset of symptoms and a tendency to remain in a fixed position?

Simple

Catatonic (correct)

Hebephrenic

Paranoid

What is the primary method of diagnosing schizophrenia?

Clinical symptoms and observation Signup and view all the answers

What is the term for a lack of motivation or interest in activities?

Avolition Signup and view all the answers

What is the term for a disruption in normal thought patterns, resulting in difficulty expressing oneself?

Poverty of Speech Signup and view all the answers

What is the minimum duration for which at least one symptom from section 1 and at least two symptoms from section 2 should be present to diagnose schizophrenia?

At least 1 month Signup and view all the answers

What neurotransmitter is implicated in the dopamine theory of schizophrenia?

Dopamine Signup and view all the answers

What is the function of serotonergic projections to the prefrontal cortex?

Modulating cognitive effects Signup and view all the answers

What is the primary cause of extrapyramidal side effects in first-generation antipsychotics?

Blockade of dopamine receptors Signup and view all the answers

What is the primary difference between first-generation and second-generation antipsychotics?

Mode of action on dopamine receptors Signup and view all the answers

What is the primary goal of treatment in schizophrenia?

All of the above Signup and view all the answers

What is the name of the scale used to assess the efficacy of drug treatment in schizophrenia?

Clinical Global Impression (CGI) Signup and view all the answers

What is the effect of 5-HT on dopamine release?

Decreases dopamine release Signup and view all the answers

What is the role of glutamate in schizophrenia?

Evidences a glutamatergic hypofunctionality in frontal brain structures Signup and view all the answers

What is the advantage of second-generation antipsychotics over first-generation antipsychotics?

All of the above Signup and view all the answers

What is the mechanism of neutropenia caused by antipsychotic drugs?

Toxic effect to bone marrow Signup and view all the answers

Which of the following is a predictable consequence of weight gain associated with atypical antipsychotic use?

Hyperglycemia Signup and view all the answers

What is the primary goal of monitoring cardiovascular risk factors in patients taking antipsychotic drugs?

To reduce the risk of cardiovascular disease Signup and view all the answers

What is the recommended treatment strategy for patients with resistant schizophrenia who have failed to respond to at least two antipsychotics?

Initiate clozapine and monitor for response Signup and view all the answers

What is a critical factor in predicting a good prognostic outcome for patients with schizophrenia?

Lack of pre-morbid symptoms Signup and view all the answers

What is the primary reason for mandatory monitoring of FBC in patients taking clozapine?

To monitor for bone marrow suppression Signup and view all the answers

What is the primary goal of using long-acting injectable antipsychotics in treatment-resistant schizophrenia?

To increase patient adherence to medication regimens Signup and view all the answers

What is the mechanism underlying the development of hyperprolactinaemia in response to antipsychotic treatment?

Inhibition of dopamine receptors in the tuberofindibular pathway Signup and view all the answers

What is the primary mechanism of action of antipsychotics in the treatment of schizophrenia?

Blockade of dopamine receptors in the nigrostriatal pathway Signup and view all the answers

What is the primary risk factor for the development of torsades de pointes?

Prolongation of the QT interval Signup and view all the answers

What is the primary treatment for acute extrapyramidal side effects?

Benzatropine or Procyclidine Signup and view all the answers

What is the primary mechanism underlying the development of tardive dyskinesia?

Dopamine receptor supersensitivity in the basal ganglia Signup and view all the answers

Study Notes

Symptoms of Schizophrenia

Positive symptoms involve excess distortion of normal functions: hallucinations, delusions, inappropriate affect, abnormal thoughts, agitation/excitement.
Negative symptoms indicate loss of normal functions: social withdrawal, avolition/apathy, blunted affect, thought blocking, poverty of speech, impaired cognitive functions (memory and concentration).
Hallucinations are false perceptions across any senses, predominantly auditory in nature.
Delusions are strongly held false beliefs that conflict with culturally shared beliefs.

Types of Schizophrenia

Includes simple, paranoid, hebephrenic, and catatonic variants.

Diagnosis Criteria

Diagnosis requires clinical symptom evaluation, often utilizing assessment scales and mental state examinations.
No singular laboratory test exists; CT scans may support diagnosis along with family health histories.
Differential diagnoses must rule out organic brain disease and substance-induced psychosis.

ICD Diagnostic Criteria

At least one symptom from the positive symptoms list and two from the negative symptoms list must be present for at least one month.

Assessment Scales

Brief Psychiatric Rating Scale (BPRS): 18 items rated on a 7-point scale.
Positive and Negative Syndrome Scale: 30 items rated similarly for severity.
Clinical Global Impression scale assesses treatment efficacy.
Abnormal Involuntary Movement Scale (AIMS): Assesses drug-induced side effects.

Causal Hypotheses

Changes in brain neurotransmitters, particularly dopamine and glutamate, contribute to schizophrenia's development.
Structural brain changes observed, notably in a smaller and disorganized limbic forebrain.
Brain insults during development, such as obstetric complications and hormonal changes, may be risk factors.

Dopamine Theory of Schizophrenia

Hyperactivity of dopamine in mesolimbic areas leads to positive symptoms.
High doses of D-amphetamine can induce paranoia, delusions, and hallucinations.
Typical neuroleptics act by blocking D2 receptors to alleviate positive symptoms.

Serotonin’s Role

Serotonergic projections influence cognitive effects and inhibit dopamine release.
Second-generation antipsychotics (e.g., clozapine, risperidone) exhibit mixed serotonin receptor action, reducing extrapyramidal side effects.

Glutamate Hypothesis

Evidence suggests glutamatergic hypofunctionality during brain development leads to symptoms of schizophrenia.
Glutamate antagonists can induce symptoms similar to psychosis.

Treatment Objectives

Aims to relieve symptoms, restore or preserve function, minimize side effects, and prolong quality of life.
Involves acute management, prophylaxis, pharmacotherapy, and psychosocial interventions.

Antipsychotics

First Generation: Includes phenothiazines (e.g., chlorpromazine), butyrophenones (e.g., haloperidol).
Second Generation: Includes clozapine, risperidone, quetiapine, olanzapine, and others, with better efficacy for negative symptoms and fewer extrapyramidal side effects.

Blood Dyscrasias and Monitoring

Certain antipsychotics can cause neutropenia; regular FBC monitoring is crucial, especially with clozapine.

Diabetes Risk with Atypical Antipsychotics

Atypical antipsychotics correlate with increased risk of hyperglycemia and diabetes.
Weight management and monitoring of blood parameters are necessary.

Neuroleptic Malignant Syndrome (NMS)

Symptoms include fever, confusion, autonomic dysregulation, and increased creatine kinase levels.
Associated with typical antipsychotic use, rapid dose changes, or anticholinergics withdrawal.
Treatment involves stopping the antipsychotics and managing symptoms.

Resistant Schizophrenia Treatment

Initiate clozapine after failure of two antipsychotic trials.
Incorporate mood stabilizers and psychosocial interventions for comprehensive care.

Clozapine Use

Registered for treatment-resistant schizophrenia; requires strict monitoring protocols.
Common side effects include sedation, hypersalivation, and constipation; laxatives are recommended during treatment.

Prognostic Factors for Schizophrenia

Favorable outcomes linked to abrupt onset, mid-age onset, predominately positive symptoms, and early intervention.
Compliance with medication and avoidance of stressors are critical for relapse prevention.

Long-acting Injection Antipsychotics

Designed for slow-release formulation to enhance adherence and reduce hospital readmissions.
Examples include flupenthixol, risperidone, and aripiprazole long-acting injections.

Extrapyramidal Side Effects

Include parkinsonism, rigidity, and tardive dyskinesia, which may become irreversible.
Commonly associated with first-generation antipsychotics.

Hyperprolactinaemia Effects

Caused by dopamine inhibition in the pituitary gland, leading to increased plasma prolactin levels and associated symptoms like galactorrhea and menstrual irregularities.

Cardiovascular Risks

Certain antipsychotics may lead to cardiac complications such as QT prolongation, requiring careful monitoring.

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Description

This quiz covers the symptoms of schizophrenia, including positive symptoms such as hallucinations and delusions, and negative symptoms such as social withdrawal and poverty of speech. It also touches on impaired cognitive function and key symptom definitions.