1 - PSY - Psychosis and Schizophrenia Flashcards
define psychosis - including?
state in which there is a loss of contact with reality - including hallucinations, delusions, formal thought disorder
define hallucination
percept without object - experienced in external space
define delusions
pathological belief - cannot be rationalised away, held with no proof, personal significance, not based in pts culture/faith
define formal thought disorder
pattern of disordered language reflecting disordered from of thought - derailment, flight of ideas, circumstantial/tangential thoughts
positive symptoms of schizophrenia
delusions
hallucinations
disorganised behaviour
thought disorder
negative symptoms of schizophrenia
social withdrawal avolition poverty of speech reduced attention blunted affect
schneiders first rank symptoms of schizophrenia…
A - auditory hallucinations
B - broadcasting of thought
C - controlled thought (delusions of control including passivity)
D - delusional perception
Give examples of these symptoms: Thought echo- Third person auditory hallucinations- delusional perception- made volition- somatic passivity
- hearing thought spoken aloud
- voices referring to pt as “he/she”
- ascribes a delusional idiosyncratic value to a percept - “heard bell ring and I knew i would win wimbledon”
- pt reports their will is under external control
- sensations in body believed to be controlled by external force
Organic causes of psychosis - 5 areas
- delirium
- medication - steroids, stimulants, dopamine agonists
- endocrine - cushings, hyper/hypothyroidism
- neuro disorder - ms, huntingtons and wilsons, epilepsy
- systemic diseases - SLE
Schizophrenia diagnostic criteria
Sx > 28 days
no organic cause found
first rank symptoms/persistent hallucinations and delusions
may also have negative/cognitive symptoms
Schiz epidemiology - lifetime risk? m to f? peak incidence?
1/100 roughly m=f m 23yo f 26yo urban>rural
Schiz aetiology
- bio - 3
- psycho - 2
- social - 4
bio - genetic factors FHx, obstetric complications increase risk, dopamine theory (how AP meds work)
psycho - cognitive errors, premorbid person (schizotypal disorder)
socail - migration, urban living, life events, ethnicity
Prodrome
when pt gradually develops symptoms before meeting diagnostic criteria - negative Sx, distress/agitiation, transient psychotic Sx
Good prognostic factors for schiz
female
acute onset
early Tx
prominent mood Sx
Poor prognostic factors
high expressed emotion substance misuse prominent negative Sx early onset No insight/compliance
Investigations - physical?
examination bloods urine for drugs (probs most important) ECG others if indicated
Investigations - psychosocial
collateral history
if indicated - OT assessment, social assessment, carer assessment
common reasons for non compliance
lack of insight, SE of meds, med/prescriber delusions, pt feels better when “ill”, pt think meds not required after remission
what physical health problems are schiz pts more at risk of
CV disease, diabetes, stroke
due to AP increasing risk of metabolic syndrome, smoking, poor diet and exercise
Treatment resistant schiz - define?
lack of response to adequate doses of 2 diff AP’s
Treatment resistant schiz - do what before diagnosing?
review diagnosis
rule of co morbid substance misuse
ensure dose,duration and compliance with prev treatment
Treatment resistant schiz- what drug? risks? monitoring? other SE’s?
Clozapine, neutropenia + (rare) fatal agranulocytosis
FBC for 18weeks, then every 2 weeks for a year, then every 4 weeks
hypersalivation, cardiomyopathy, myocarditis, dm and sezures
Psychological treatment of schiz
Cbt, family intervention therapy, psychoeducation
