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Jess Nervous > CSFC: Schizophrenia > Flashcards

CSFC: Schizophrenia Flashcards

1
Q

Define psychosis, what are three major clinical features?

A

The alteration of normal links between perception, mood, thinking, behaviour and contact with reality

Clinical Features: delusions, hallucinations, no insight into what’s going on

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2
Q

What is a delusion?

A

Abnormally fixed, usually false beliefs not shaken by reasoning or contradictory evidence

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3
Q

What is a hallucination?

A

A perception without a stimulus and can be in any sensory modality

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4
Q

What are (five) possible causes for schizophrenia?

A

Biopsychosocial factors

  1. Neurodevelopment: genetics or brain injury
  2. Genes and environment
  3. Perinatal factors
    a) excess of obstetric complications; early ROM (rupture of fetal membranes), <37 weeks and use of an incubator

b) winter births
4. Social factors: Urban; migrant communities, isolation, deprivation, low family support
5. Psychological, i.e trauma PTSD

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5
Q

What might be referenced from childhood in an individual developing psychosis after adolescence?

A

Cognitive and behavioural problems in childhood

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6
Q

What is the link between cannabis and the development of schizophrenia?

A

Early use of cannabis may trigger those with a genetic susceptibility

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7
Q

How might an individual with schizophrenia’s brain appear on an MRI?

A

Larger ventricles, changes in brain volume

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8
Q

What is the possible link between immune function and the development of schizophrenia?

A

Over-activation of the immune system in the postnatal period can lead to an inflammatory response that affects brain structure and function

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9
Q

What system in the brain is abnormal in schizophrenia and how is it subsequently treated?

A

Abnormalities mainly in the dopaminergic system, excessive dopamine may cause psychotic symptoms

Medication is mainly dopamine antagonist

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10
Q

Provide the following lifetime risks for developing schizophrenia

a) individual
b) 1 affected parent
c) 2 affected parents
d) monozygotic twins

A

a) 1%
b) 10%
c) 40%
d) 40-50%

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11
Q

Which gender is more commonly affected by schizophrenia and when does onset tend to occur?

A

M:F 1:1

Onset often in early adulthood

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12
Q

Provide four examples of how schizophrenia may present

A
  1. Spouse or partner noticing withdrawn or bizarre behaviour
  2. Onset of personality change; social withdrawal and behaviour changes
  3. Failure to achieve educational potential
  4. Symptoms of other mental illness/risk of suicide
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13
Q

Name the three general pillars for how schizophrenia may present

A
  1. Cognitive skills; changes in memory, attention, interpersonal skills
  2. Mood: often depressed, not congruent mood (meaning they don’t think of memories that associate with their mood, i.e; happy mood - happy memories)
  3. Lack of insight
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14
Q

Define a ‘positive’ and ‘negative’ psychotic symptom, name two positive psychotic symptoms and three negative psychotic symptoms

A

Positive - gains with the illness

a) delusions
b) hallucinations

Negative - symptoms expressing things they lose

a) self-neglect
b) lack of motivation
c) lack of expression

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15
Q

How often do auditory hallucinations occur in patients who hallucinate?

A

3/4 patients that hallucinate will experience an auditory hallucination

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16
Q

Define the following types of hallucinations

a) derealisation

b) depersonalization

A

Derealisation: the world around them doesn’t seem real

Depersonalization: don’t feel themselves (as if they’re out of their body)

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17
Q

What are two types of auditory hallucinations

A

Thought echo, third-person auditory hallucination

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18
Q

Define a ‘delusional perception’

A

A true perception to which a patient attributes a false meaning

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19
Q

How is schizophrenia diagnosed according to ICD10?

*note which of the symptoms are ‘Schneider’s first rank symptoms’

A

Symptoms 1-5 are schneiders first rank symptoms

One symptom if very clear:

  1. Thought echo, insertion, withdrawal or broadcast
  2. Delusions of control or passivity
  3. Auditory hallucinations 3s person
  4. Persistent delusions of other kinds that are not culturally appropriate and impossible

OR 2+ symptoms if less clear

  1. Persistent hallucinations in any modality (somatic, visual, tactile)
  2. Thought disorder:
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20
Q

Define a ‘delusional perception’

A

A true perception to which a patient attributes a false meaning

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21
Q

How is schizophrenia diagnosed according to ICD10?

*note which of the symptoms are ‘Schneider’s first rank symptoms’

A

Symptoms 1-5 are schneiders first rank symptoms

One symptom if very clear:

  1. Thought echo, insertion, withdrawal or broadcast
  2. Delusions of control or passivity
  3. Auditory hallucinations in 3rd person
  4. Persistent delusions of other kinds that are not culturally appropriate and impossible

OR 2+ symptoms if less clear

  1. Persistent hallucinations in any modality (somatic, visual, tactile)
  2. Thought disorder
  3. Catatonic behaviour or abnormal movements
  4. Negative symptoms: apathy, scarcity of speech, blunting and incongruity of effect
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22
Q

What is thought echo?

A

When a patient has a hallucination of hearing aloud their own thought a short while after thinking it

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23
Q

Describe a thought disorder

A

Breaks in train of thought resulting in incoherent speech, going off on tangents, illogical connections between ideas and loosening of associations

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24
Q

Describe catatonic behaviour

A

A significant decrease in someone’s reactivity to their environment, i.e; stupor, mutism, motor rigidity and even purposeless excitement

25
Q

In addition to using IDC10 to evaluate the kinds of symptoms, how is schizophrenia diagnosed?

A
  1. Symptoms present for at least 1 month for most of the time
  2. Marked impairment in home and/or working function
  3. Symptoms >6m (not a brief psychotic episode)
  4. Rule out other causes; i.e bipolar, brain tumour, drugs, head injury
26
Q

Name the positive and negative signs and symptoms that would be used in an MSE (mental status evaluation) for schizophrenia

Hint: ABCIMP ST

I still think my pillow can be animated

A

Insight: often poor

Speech:
(+) reflecting an underlying thought disorder
(-) poverty of speech

Thoughts:
(+) delusions

Mood:
(+) incongruent
(-) blunted effect

Perception:
(+) hallucinations

Cognition:
(+) impaired concentration and attention
(-) cognitive deficits (IQ, executive function)

Behaviour:
(+) restless, perplexed
(-) poor eye contact, apathy

Appearance:
(+) inappropriate dress
(-) poor self-care, dishevelled

27
Q

Define apathy

A

lack of interest, enthusiasm or concern

28
Q

What kind of investigations can be done for someone with schizophrenia?

A
  1. Physical examination: neurological

2. Urine drug screen:

29
Q

What kind of investigations can be done for someone with schizophrenia?

A
  1. Physical examination: neurological
  2. Urine drug screen
  3. EEG: epilepsy and TLE (temporal lobe epilepsy)
  4. MRI: brain tumour
30
Q

What kinds of things are checked for in a urine drug screen?

A

Screening for other causes, b12 and folate deficiency, VDRL test for syphilis, Liver and renal failure and “myxoedema madness” - hypothyroidism

31
Q

Name five aspects of management for a patient with schizophrenia

A
  1. Risk assessment: self and others
  2. Antipsychotics
  3. CBT for psychosis
  4. Family therapy, family/carer involvement
  5. Social support and functional optimization
32
Q

Name six features associated with a good prognosis in schizophrenia

A
  1. Older age of onset
  2. Female
  3. No FH
  4. High IQ
  5. Marrier
  6. Mood component
33
Q

Name six features associated with a poor prognosis in schizophrenia

A
  1. Poor treatment compliance
  2. Personality problems
  3. Substance impulse
  4. Negative symptoms
  5. Insidious onset
  6. No obvious precipitants
34
Q

Why do environmental factors seem to be very important in developing schizophrenia?

A

Benign course (milder) and better outcomes in developing countries

35
Q

What are the principles of the mental health act assessment?
Hint: 4

A
  1. Minimize the harm done by the mental disorder
  2. Maximize the safety and health of patients and public
  3. Any intervention without the patient’s consent must be the least restrictive alternative intervention
  4. Decision-makers must recognize and respect diversity of patient’s needs and involve the family in the decision-making process
36
Q

What does the mental health act do?

*5 main things

A
  1. Detain in hospital (including prevent leaving of the hospital)
  2. Seclusion, restraint and restriction of liberty
  3. Allows transfer to other hospitals and moving from prison/police stations
  4. Treatment for mental disorder (against patient’s wishes or lacks capacity)
  5. Treatment for some physical health issues (if related to the mental disorder)
37
Q

What is the MHA’s definition of a mental disorder?

A

Any disorder or disability of the mind

38
Q

When would learning disabilities fall under a mental disorder?

A

If they’re associated with abnormally aggressive or seriously irresponsible conduct

39
Q

Describe what is meant when a patient is put into section 2 of the MHA assessment

A

Allows for compulsory admission for assessment and medical treatment, duration of 28 days, requires 2 doctors and an AMHP

40
Q

Describe what is meant when a patient is put into section 3 of the MHA assessment

A

Treatment up to 6 months, requires 2 doctors and an AMHP

41
Q

Describe what is meant when a patient is put into section 5 of the MHA assessment

A

“Doctors Holding Power”

1 doctor can detain a patient already in hospital/prevent patient from leaving for 72 hours

42
Q

Describe what is meant when a patient is put into section 136 of the MHA assessment

A

A police officer can detain a person found in a public place within a place of safety who they believe is suffering from a mental disorder

43
Q

What does AMHP stand for?

A

Approved mental health professional :)

44
Q

What can a patient do if they disagreeing with their treatment? What four safeguards are in place?

A

There is a legal forum for patients to appeal their detention

Other safeguards:

  1. IMHA: independent mental health advocacy, helps users obtain information and understand their rights under the Mental Health Act
  2. Solicitors
  3. Next of kin/nearest relative
  4. CQC: care quality commission focuses on human rights needed by healthcare services when using the Mental Health Act
45
Q

What is meant by a lack of capacity?

A

An individual has an impairment or disturbance that affects the way their mind works and means they are unable to make a specific decision at the time it needs to be made

46
Q

What does the Mental Capacity Act 2005 about?

A

Capacity and decision making

47
Q

Describe the layout of a schizophrenia history taking, how long should a psychiatric history usually take?

A

Psychiatry history taking: allow 30 min-1 hour

  1. Presenting complaint AND history of presenting complaint
  2. Past medical history AND past psychiatric history
  3. DH
  4. FH
  5. SH
  6. Premorbid personality (personality traits existing prior to illness or injury)
  7. Mental state examination and special tests
48
Q

What points would you especially look out for in the past medical history during a psychiatric history taking?

A

Hypothyroidism, head injuries, epilepsy, obstetric complications

49
Q

What points would you especially look out for in the family history during a psychiatric history taking?

A

Have them describe their family relationships in detail (including the quality of these relationships), any FH of mental illness and suicide attempts, any major family events

50
Q

What points would you especially look out for in the social history during a psychiatric history taking?

A 
Finances, housing and legal problems 
Occupation
Marital status/relationships/dependents
Schooling 
Birth early development 
Psychosexual history
Forensic history 
\+ethnic origin and religion
51
Q

What kinds of questions might you ask to determine whether someone has a premorbid personality?

A

How they would describe themselves, if they react emotionally to anything in particular, their moods, religious and moral beliefs

52
Q

Name four things you would assess as part of appearance and behaviour in an MSE

A

Facial expressions/interaction
Cooperation
Abnormal movements
Dress and grooming

53
Q

Name four things you would assess as part of speech in an MSE

A

Rate, tone, fluency, volume

54
Q

Name four things you would assess as part of mood and affect in an MSE

A

Mood: thoughts of harm to self or others
Affect: blunting, emotional state, external expression

55
Q

Name four things you would assess as part of thought content in an MSE

A

Delusions that are persecutory, grandiose, controlling or reference

56
Q

What might you ask a patient when evaluating their insight in an MSE?

A
  1. What do they think is causing their experiences
  2. can they explain their condition
  3. do they accept they are mentally ill
  4. do they want help or believe they need help
57
Q

Name three tests that can be used to assess cognitive function

A
  1. Orientated in Time Place and Person (TPP)
  2. Mini-mental state examination (MMSE)
  3. Attention and concentration
58
Q

Where should a collateral history be obtained and why is it important?

A

From a family member or carer where possible, crucial when the patient has limited insight or cognitive impairment

Jess Nervous (16 decks)

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