Schizophrenia
Epidemiology
Aetiology
Clinical Features (≥ 2; 6 months)
Prodromes
Positive symptoms
1. Delusions
2. Hallucinations
3. Formal Thought Disorder (FTD)
4. Gross disorganisation/ catatonia (eg holding a bizarre position)
5. Negative symptoms
a. Affect (lack of display of emotions)
b. Avolition (lack of self initiated purposeful activity)
c. Anhedonia (lack of experiencing pleasure from a previously pleasurable activity)
d. Alogogia (lack of speech)
e. Asociality
* At least 1 condition to be from 1, 2 or 3
Management
Non-pharmacological
Notes
Causes of non mental d/o hallucination
Causes of mental d/o hallucination
Prognosis
1/3 full remission, 1/3 recurrence but feel well in between episodes, 1/3 no recovery
Source
Toronto Notes 2012
Medscape
Prof Saxby Pridmore
- Prevalence: 0.5%-1 %; M:F = 1:1
- Mean age of onset: females -27; males -21
Aetiology
- Multifactorial: biological (including genetics) and environmental factors
Clinical Features (≥ 2; 6 months)
Prodromes
Positive symptoms
1. Delusions
2. Hallucinations
3. Formal Thought Disorder (FTD)
4. Gross disorganisation/ catatonia (eg holding a bizarre position)
5. Negative symptoms
a. Affect (lack of display of emotions)
b. Avolition (lack of self initiated purposeful activity)
c. Anhedonia (lack of experiencing pleasure from a previously pleasurable activity)
d. Alogogia (lack of speech)
e. Asociality
* At least 1 condition to be from 1, 2 or 3
Management
Non-pharmacological
- Psychotherapy (individual, family, group): supportive, CBT
- Assertive community treatment (ACT)
- Social skills training, employment programs, disability benefits
- Housing (group home, boarding home, transitional home)
- Acute treatment and maintenance with anti psychotics ± anticonvulsants ± anxiolytics
- 1st generation (extrapyramidal sefx: akathisia, dystonia, hyperprolactinemia, NMS, parkinsonism, TD)
- Chlorpromazine (D2 antagonist)
- Haloperidol (D2 anatagonist)
- 2nd generation (atypicals)
- Clozapine (most effective. sefx: Agranulocytosis)
- Olanzapine (D1-4, H1, α-1 antagonist)
- Quetiapine (DA, 5HT antagonist)
- Risperidone (D2, 5-HT2 antagonist)
Notes
Causes of non mental d/o hallucination
- Bereavement
- Temporal lobe epilepsy
- Sensory deprivation (eg loss of sight)
- Fatigue, hypnogogic/ hypnopompic
- Neurocognitive d/o (eg Dementia)
- Drugs (Amphetamines, LSD), Meds (Ketamine)
Causes of mental d/o hallucination
- Auditory (most commonly schizo)
- Visual (most commonly neurological eg epilepsy)
- Tactile (most commonly withdrawal)
- Somatic (most commonly schizo)
- Taste/ smell (most commonly neurological)
Prognosis
1/3 full remission, 1/3 recurrence but feel well in between episodes, 1/3 no recovery
Source
Toronto Notes 2012
Medscape
Prof Saxby Pridmore