An introduction to psychotic illness Flashcards
What was the main difficulty of the asylums built in the UK in the 1800’s?
Most people didn’t actually recover and due to their remote locations, it was hard for family to visit so they would often end up just staying there for decades, so the asylums became overwhelmed due to lack or discharge
What did the alienists of the 1800’s realise?
What did Emil Kraepelin discover and hypothesise?
What did Kraepelin think schizophrenia was and how does that compare to Eugen Bleuler?
he thought it was a neurological degenerative condition, Bleuler thought that in many cases it could be psychological reaction rather than an organic disorder
Explain Bleuler’s contribution to schizophrenia and what are his 4 a’s and what are their characteristics?
-coined the term in 1911,
-different groups of schizophrenias
-psychological rather than organic and
-more optimistic about the outcomes than others.
- Affective Flattening
- Alterations of Thought
- Autism
- Ambivalence
What was the difficulty with Bleuler’s ideas about Schizophrenia?
The difficulty with Eugen Bleuler’s ideas about schizophrenia was primarily related to the term “schizophrenia” itself. While Bleuler made significant contributions to our understanding of the disorder the difficulty lay in the broad and sometimes vague way in which the term was used.
Bleuler’s ideas led to challenges in psychiatrists agreeing on the specific characteristics represented by the 4 A’s, particularly in the United States where an overdiagnosis of schizophrenia occurred due to variations in interpretation.
What are these AKA?
What is thought echo according to Schneider?
You think something and then you hear a voice echo it back to you
What did schneider think about Bleuler’s schizophrenia diagnosis and what did he propose instead?
Kurt Schneider, a German psychiatrist who made significant contributions to the understanding of schizophrenia and
He thought it was too complex to detect reliably so he wrote the first-rank symptom list,
including auditory hallucinations,
thought insertion or withdrawal,
thought broadcasting
‘made’ acts, thoughts or feelings (via external force, not common)
delusional perception
What are some of the first rank auditory hallucinations of schneider?
What is delusional perception?
The world seems to be changed. One looks around and. you can’t quite put your finger on it but everything seems different. or you might derive meaning from things you see, e.g someone lights a cigarette and you think it means someone is plotting against you.
What is the difference between positive and negative symptoms?
List examples of Positive symptoms
List examples of Negative symptoms
Are delusions a positive or negative symptom?
positive
is self-neglect a positive or negative symptom?
negative
Are you more or less likely to develop schizophrenia as you get older?
Less likely as it tends to effect young people.
Between what age range does schizophrenia peak in Men?
16-25 years of age.
Who do not have the capacity to go psychotic?
Children. it’s only as they go into adolescence that they are likely to develop psychosis.
When is it more likely for women to develop psychosis? and what is one theory for this?
Later in life
Why might estrogen protect against psychosis?
It has an anti-dopaminergic effect, and dopamine is crucial in psychosis.
What did Kraepelin believe about the course of schizophrenia and was he right?
He thought it was like Alzheimer’s disease and that one eventually deteriorated. But actually, Bleuler said that after 5 years, symptoms hadn’t gotten worse and sometimes even had gotten better
What are the 4 stages in schizophrenia?
Trajectory of disease progression and reoccurance is very variable. What are some of the possibilities after a first acute episode?
What percentage of people will have no upsetting symptoms after 10 years follow up?
What percentage of people will have relapeses after 10 years follow up?
What percentage of people will never properly recover from a first episode as seen after 10 years follow up?
What is the classic and current dichotomy in psychosis?
splitting it into True Schizophrenia and True bipolar disorder
What is schizoaffective disorder and what problems does it cause?
people have both schizophrenic
and affective or mood symptoms.
So you get somebody who has both schizophrenic symptoms and
manic symptoms, schizomania or schizophrenia, and depression, schizodepressive.
It makes it more difficult for psychiatrists to diagnose true Schizophrenia and True bipolar disorder
What are the dimensional grouping of symptoms?
What do some people propose instead of splitting between bipolar and schizophrenia?
People with positive symptoms tend to respond to what treatment?
antipsychotics
People with manic symptoms tend to respond to what treatment?
mood stabilisers
People with depressive symptoms tend to respond to what treatment?
antidepressants
What did the study with the SCAN interview conclude?
The SCAN (Schedules for Clinical Assessment in Neuropsychiatry)
structured clinical interview tool used in the field of psychiatry to assess various mental health conditions, including psychosis.
That it wasn’t necessarily better than the traditional evaluation tool even though it gave useful insights, but the best approach might be to have a mix. A categorical diagnosis and then describe the factors.
What percentage of the general public have symptoms that a psychiatrist would consider as psychotic?
10-15%
What is the difference between the DSM5 and the ICD10/11 classification system for schizophrenia?
What did Tim Crow and Eve Johnstone 1976 find when they started scanning the brains of people who had chronic schizophrenia and who had been institutionalised for many years?
Why did the Kraepelian, degenerative view of Schizophrenia make a come back in 2005 with the Lieberman + Olanzapine study?
compared to haloperidol
The study showed that those on haloperidol showed a decline in grey matter in the brain compared to those on olanzapine (modern antipsychotic).
PPl on Olanzepine didn’t show deterioration.
This was interpreted that there was an intrinsic deterioration in the brain, as Haloperidol got worse.
Alt view is that Haloperidol actually caused it.
What did Rene Kahn 2006 think about schizophrenia? He did long-term follow-up studies.
“A-P-C-P”:
Convinced it was a progressive disorder as he found changes in the brain in people who were tracked over a long period of time.
A - Advanced
P - Progressive
C - Changes in Brain
P - Long-Term Period
This mnemonic helps you remember that Rene Kahn believed that schizophrenia advanced progressively, with changes in the brain observed over a long-term period.
What did the 2011 study by Nancy Andreasen show? What questions did that bring to the fore and how was the debate settled…
The smallest dose of 115mL showed a smaller decrease in the cortical volume compared with those that got more.
Q: Was it the illness or the anti-psychotic causing decrease in cortical volume?
Eventually, studies on animals showed a decline in volume in their cortex, so the decline was caused in part by the anti-psychotic.
Ripke 2014, Nature.com 37k ppl with schizophrenia and 36k ‘healthy’ ppl.
What did they find?
genome
Chromosome 6, point of HLA, transplant antigens, immune genes….
Lots of little gene’s that contribute to risk, not just one single gene. Need lots of little genes to increase liability.
108 areas of the genome associated with Schiz. risk.
Until then, most genetic research wasn’t replicable, but this was and is.
What do the Glutamate genes influence?
Dopamine release
Which genes have an impact on vulnerability to pychosis?
How is the polygenic risk score calculated?
By adding the genetic loci that contribute to psychosis vulnerability.
How is the polygenic risk score useful for younger people?
What is the relationship between Polygenic [small] effects, environmental factors and psychosis liability?
What factors might push someone into psychosis or even schizophrenia?
What is it and what does it mean?
Copy Number Variants.
deletion or dupliation, end up with the wrong number.
common in autisism.
What is the continuum and what does it not include?
Doesn’t include bipolar
What’s the proportional split between CNV’s and polygenes in schizophrenia genetics?
What, although rare if found in your genetics, will 10x increase your liability to develop schizophrenia?
What is the first step in the developmental cascade towards schizophrenia?
Pre and perinatal events,
CNV’s
Developmental Genes
Symptoms
What are the second and third stages on the developmental cascade towards schizophrenia?
What’s the simple explanation between Dopamine and schizophrenia?
What can be done to counteract the increase release/production of dopamine in schizophrenic patients?
And what did Howes et al 2009 show?
What did Howes 2011 find?
Does Dopamine dyregulation happen in the prodrome in people who go on to develop psychosis?
yes
What drugs have long been known to push you into psychosis if used?
Meth/Phet and cannabis
What did this study find?
More cannabis intake, high risk of psychosis
What is the usual Odd ration between cannabis consumption and later psychosis?
1.5 & 3
about twice as likely to develop psychosis.
What did the 2002 Arseneault study find about the correlation between age of cannabis use and psychosis diagnosis
Cannabis use by 15 yo, the odds ratio is 4.5 and really pushed up risk. starting in your teens greatly increases risk.
What’s the difference in THC concentration between skunk and hash?
Consuming what pushes your likeliehood of developing psychosis up 5 fold?
SKUNK
What receptors does cannabis affect? and what is the difference between synthetic cannabis and normal grown cannabis?
How does living in a city impact your risk of developing psychosis?
It increases your risk as found by Kirkbridge 2006. The bigger the city, the bigger the risk.
What is the link between cities in the north vs south and psychosis?
Which migrants have the highest risk of developing psychosis?
What is the evidence that explains why black people moving to Europe are at higher risk of developing psychosis?
Discrimination, social status
What did this study show?
What did this study show?
People who has experience childhood abuse or more family rearrangement release more dopamine when stressed
Explain the cycle or psychosis and how early childhood events and stressful events impact this cycle
What biased cognitive schema might a person who’s suffered early childhood adverse events develop?
What is the clinical approach to acute psychosis?
In this WHO study what did they find about Narrow schizophrenia? But what was the limitation.
what did Broad scz show?
No sig diff.
The diffe between Aarhus and Nottingham was double, and the number of people with Narrow, was very small. basically the study was underpowered.
The results for the broad was that it does vary across populations.
And further studies prove that the incidence varies markedly across populations conclusively.
McGrath 2004 did a meta study of 100 studies. What areas did they find higher incidence of psychosis in?
What did this study by Pederson and Mortensen 2001 find?
What did this meta analysis by Kirkbridge 2006 find and what relative risk rates were there for subcategories?
High incidence in migrant poulations
The migrant effect is now wellknown in psychosis incidence rates, but it’s important to remember…
Is there a reduction in rates with 1st and 2nd generation migrants?
What are some of the psychotic experiences around 10% of the population experience that show psychosis is a continuum of experience and not a categorically distinct abnormality…
What are some neighbourhood/area social risk factors and what are individual-level experience risk factors in the development of psychosis?
What was meant by downtown/fragmented areas in the 1925 Chicago research into mental illness.
What did Allardyce 2005 find about social fragmentation and clinical admission rates for schizophrenia?
and it persisted even after adjusting for deprivation. Fragmentation key factor.
What’s the correlation between areas of ethnic density and relative risk os schizophrenia, and what does it suggest?
What is meant by adversity?
What are some of the indicators of childhood adversity?
What are the findings related to psychosis?
What are some of the reasons for this?
What are some of the factors that mean studies on psychotic disorder as poorer than those on psychotic experiences?
little consideration to combined effects of multiple exposures to adversity
or consideration of age, type, length of these adverse experiences.
study design.
What sorts of early life adverse experience might have some specificity to psychotic experience development as found in a study of 2000 twins with exposure to difference events.
What is the relationship between adult life events and psychotic experiences?
What are some of the adult life events that are correlated with an increased rate of psychotic experiences?
What do you see if you separate migrant groups into subcategories of exposure to low, medium and high levels of discrimination?
What do you see when looking at migrant groups and the prevalence of psychotic disorder when exposed to different types of racial harassment…
von Os, Pederson and Mortenson 2004 found amongst those who were both exposed to urban areas and ________ had a higher risk of psychosis…
a family history pf psychotic disorder
What were the findings?
What is the finding of this?
There is an effect for each of these alone, but the effect of the two combined is greater than the sum of each individual effect.
We know that in some people with a psychotic disorder there is dysregulation of what what?
HPA as well as the dopaminergic system
What does attributional style potentially have to do with psychosis?
