7. Psychosis Flashcards
Mental disorders vary in their:
– Manifestations
– Severity
– Duration
– Prognosis
What is phychosis?
Any disorder so severe that a victim loses contact with reality
Examples of psychosis?
– Schizophrenia
– Bipolar disorder (previously known as manic- depressive illness)
– Dissociative identity disorder (split-personality)
– Schizoaffective disorders
– Persistent delusional disorders
Naming of schizophrenia?
– Schizo - ‘split’
– Phrene – ‘mind’
I.e. the thought fragmentation NOT split personality. That is a different disorder
Epidemiology of schizophrenia?
• 1% of the world population
• Diagnosis usually quite late: – menearly20’s
– womenlate20’s
Outcomes for patients with schizophrenia
• 20% who have a first episode recover
• 80% will suffer either another acute episodes
or a more chronic condition
• 10% of schizophrenics successfully commit suicide
Symptoms of schizophrenia?
Either positive or negative
Positive: – Pervasive thought disturbance – Delusions – Hallucinations – Emotional disorder – Behavioural disruption
Negative: (so deficits..)
– Difficulty in ignoring irrelevant stimuli (external or internal). Disorganised throught
– Cognitive deficits
– Withdrawal from personal contact
Symptoms can be episodic and between psychotic episodes there is a lack of insight, making treatment adherence challenging
In the cognitive deficits found in schizophrenia patients, what abilities are impaired?
– Sustained attention – Planning – Verbal and visuo-spatial working memory – Language skills – Explicit learning and memory – Perceptual / motor processing
Early signs/predictors for people who could develop schizophrenia and how it encourages disease progression?
Few early friends –> Delusional social interpretation
(leads to little opportunity for social reality testing. Misconceptions of social situations not addressing so leads to an individual who cannot distinguish between reality and fantasy)
Social reality testing= Testing our interpretation of a social situation with another person’s.
Difference between delusions and hallucination?
Hallucination is from internal stimuli i.e. no external source
Delusion is an idiosyncratic belief that is contradicted by reality and rational argument
What are the characteristics of the delusions of schizophrenia?
- Ideas of reference and changes in salience. e.g. New’s broadcast is actually targeted specifically at them
2. Delusional system: Often stemmed from the above. Giving weight to something that is actually meaningless
Main hallucinations of schizophrenia?
Auditory
Note not always voices but also noises
What is the progression of abnormal emotions in schizophrenia?
Starts of emotional reactivity
leads to a anhedonia (lack of emotions) and inappropriate emotions
Describe the 2 categories of behavioural disruption in schizophrenia?
- Catatonic
Extreme!
Freezing in position for a v prolonged period (catatonic part), followed by period of freed movement.
Also presents are repeated stereotypical movements for prolonged time period - Disorganised
Thoughts behind movement/speech are disorganised so the actions/speech are also disorganised.
Is schizophrenia a unitary disorder?
What are the subtypes?
Subtypes in previous literature include: • Catatonic • Disorganised (Hebephrenic) • Paranoid • Simple (fewer positive symptoms and severe negative) • Undifferentiated • Residual (both pos and neg present)
Recently, advances now see disorder in domains, gradients and dimensions in DSM-5
Causes of schizophrenia:
Genetics?
– Genetics
By twin studies, there is a heightened risk if twin is affected.
Causes of schizophrenia:
– Physiological?
First theory was Dopamine hypothesis: i.e. overstimulations of the dopamine system. Treated with classical antipsychotics, which only successfully treated positive symptoms
Second theory is Dopamine-serotonin interaction hypothesis:
Developed the atypical antipsychotics
Role of Ach, Glut and GABA??
Causes of schizophrenia:
– Anatomical?
Reduction is global volume.
Changes due to disease or drugs, thought to do disease.
Esp in those who develop disease after foetal hypoxia episode
Atrophy location @ cortico-striatal-thalamo-cortical loop involved in stimuli detection and processing
Causes of schizophrenia:
– Psychosocial?
- Social class: lower
- Minority position
- Urban environment
- Family environment
- Cannabis use? Potentially self-medicating
Treatment of schizophrenia, options?
• Early intervention tend to result in better long-term outcomes **
• Drug therapies
– Classical antipsychotics
– Atypical antipsychotics
Psychological interventions:
– Family intervention
– Cognitive Behaviour Therapy (challenging behaviour and delusions thought process)
– (Social-skills training)
Issues of treatment side effects in schizophrenia?
• Side effects = Severe (cardiac arrhythmia, weight gain, movement abnormalities) Potential impair drug adherence
In early intervention and assessment of potentially schizophrenic patients, what is looked at?
NICE guidelines
– Psychiatric – Medical – Physical – Psychological – Developmental – Social – Occupational and educational – QOL – Economic
NICE guideline recommendation after first psychotic episode?
Oral antipsychotic medication in conjunction with psychological intervention (family intervention and individual CBT)
NICE guideline recommendations for continuing treatment and care?
– Offer CBT to assist in promoting recovery (particularly if persistent symptoms or in remission)
– Offer family intervention
– Consider offering depot or long-acting antipsychotic medication if the patient would prefer it after an acute episode or to avoid covert non-adherence as a clinical priority
– Monitor physical health regularly, particularly in relation to potential side effects of medication, but also overall physical health.
Dependence proportions of schizophrenic patients?
– Independent (30%)
– Relatively dependent (50%) – Highly dependent (20%)
Wee schizophrenia assessed in domains, gradients and dimensions in DSM-5 of the symptoms. What are they?
Negative symptoms:
- Impaired cognition
- Depression
- Mania
Abnormal psychomotor behaviour:
- Delusion
- Hallucination
- Disorganised speech
Scored 1-4 depending on symptoms.
