5: Psychosis: Schizophrenia, schizoaffective disorders and differentials Flashcards
What is psychosis?
Impaired relationship with reality
What are four features of psychosis?
Delusions
Hallucinations
Disordered thinking
Passivity
Is psychosis a disease?
No
Symptom
In psychosis, our thoughts (match / differ from) reality.
thoughts do not match reality
What is a delusion?
Irrational, deeply held belief about yourself or others
What are some examples of delusions?
Thought insertion - your thoughts are not your own, they’re someone else’s
Thought withdrawal - someone else is removing thoughts from your mind
Thought control - someone is controlling your thoughts
Thought broadcasting - other people can tell what you’re thinking
Delusions of grandeur - you’re someone famous, Jesus etc…
What is a delusion of reference?
Irrational idea that a person, object or idea is more personally significant than it actually is
Do patients with psychosis know that they are ill?
What is this sign called?
No
Lack of insight
What is thought disorder?
A feature of psychosis which include:
difficulty ordering thoughts, words or phrases
poverty of speech i.e not being able to muster anything to say
irrelevancies, tangents
illogical ideas
repetition of particular words or phrases
What is a hallucination?
Perception which occurs in the absence of an external stimulus
What are some forms that hallucinations can take?
Visual
Auditory
Olfactory
Gustatory (taste)
Tactile (touch)
Delusions that your thoughts, actions or perceptions are being controlled by someone else are also known as delusions of ___.
passivity
What type of delusion involves attachment of personal significance to events by a patient?
Ideas of reference
Patients may have ___ beliefs about hallucinations they have experienced.
delusional beliefs
e.g “my visions are being transmitted to me by the Mafia” - thought insertion delusion ABOUT a hallucination the patient has experienced
The content of delusions is often related to the ___ beliefs of the patient.
cultural beliefs
religious, popular culture, current events etc.
What is a neologism?
What symptom of psychosis is it an example of?
Newly invented word or phrase
Thought disorder
What is tangentiality?
Tendency to go off on unrelated strings of thought instead of holding to the same subject
What is Knight’s move thinking?
Tendency to jump from one subject to an unrelated one
compared to a knight jumping around a chessboard
What is word salad?
Strings of seemingly unrelated words or phrases
Give some examples of thought disorder.
Neologisms - new words or phrases
Word salad
Tangentiality
Knight’s move thinking
Clanging and punning - relating words by sound rather than meaning
Delusions that another party is controlling your thoughts, behaviour or perceptions are known as ___ delusions.
passivity delusions
To confirm that a patient’s beliefs are psychotic, you need to challenge them with logic and reason.
What can you lose by doing this?
Patient relationship, rapport
so you need to be careful
Apart from schizophrenia, what other conditions may cause psychotic symptoms?
Acute: delirium, dementia, stroke
Substance use: intoxication, withdrawal, delirium tremens
Mood disorders: dementia, bipolar, schizoaffective disorder
Auditory delusions of schizophrenia often refer to the patient from which point of view?
Third person
(He/she/they are x, y, z)
It’s like you’re being talked about by other people
Auditory delusions of depressive disorders often refer to the patient from which point of view?
2nd person
(You)
Self-criticism
Patients with acute psychotic symptoms caused by an underlying substance abuse problem, delirium or head injury will not have schizophrenia or schizoaffective disorder.
True or false?
False
May be underlying
Name two examples of schizoaffective disorders.
Depressive psychosis
Mania with psychosis
What types of delusions and hallucinations do patients with depressive psychosis experience?
Delusions of guilt, worthlessness, poverty - downer delusions
2nd person auditory delusions - hearing putdowns, criticisms etc.
What type of
a) delusions
b) hallucinations
c) thought disorders
do patients with manic psychosis experience?
a) Delusions of grandeur, reference, superhuman powers
b) 3rd person auditory delusions e.g God’s voice
c) Flight of ideas - tangentiality, clanging and punning, neologisms
What acute psychiatric disorder, common in the elderly, can present as psychosis?
Delirium
Which psychiatric manual is used to diagnose schizophrenia and related disorders?
ICD-10
What are Schneider’s First Rank symptoms?
Symptoms used to diagnose schizophrenia
i.e delusions, hallucinations, thought disorder and passivity
Based on ICD-10, how long must a patient be experiencing symptoms for before they can be diagnosed with schizophrenia?
1 month
What are three important subtypes of schizophrenia?
Paranoid schizophrenia - characterised by paranoid delusions of persecution, threat etc.
Hebephrenic or disorganised - seen more in young patients, characterised by disordered thoughts
Catatonic - characterised by anhedonia, anergia, slowed movements
Schizophrenia is often described in terms of positive and negative symptoms.
What is included under each heading?
Positive - the addition of something e.g delusions, hallucinations, disordered thinking, passivity
Negative - loss of something e.g amotivation, anergia, mutism, flattened affect
Schizophrenia has a ___ period, with minor cognitive and behavioural symptoms.
prodromal period
weeks - months before onset
What is a person’s lifetime risk of developing schizophrenia?
1%
Schizophrenia is more common in (men / women).
men
At what age range does schizophrenia present in
a) men
b) women?
a) 15 - 25
b) 25 - 35
remember than it’s more common in males AND they present earlier
How do we know that schizophrenia has a genetic component?
Concordance in twin studies
What maternal factors seem to have an effect on the child’s risk of developing schizophrenia?
Viral infection
Complicated birth
Fx of psychiatric illness
The use of which drug increases your risk of developing schizophrenia?
Cannabis
Cannabis is a ___ drug which seems to increase your risk of developing schizophrenia.
In which groups especially?
hallucinogenic drug
adolescents - developing brains
Living where increases your chances of developing schizophrenia?
Urban areas e.g large cities
What is the course of schizophrenia?
May be relapsing and remitting or progressively deteriorating, depends
What is the suicide risk in patients with schizophrenia?
10 - 15%
How common is homicide by the hands of patients with schizophrenia?
Relatively uncommon
