Gargi's & Emma's notes - Psychotic Disorders Flashcards
What are the main psychotic disorders?
- schizophrenia,
- schizoaffective disorder,
- delusional disorder
- acute psychoses
Are psycbotic symptoms specific?
non-specific
What are some non-psychiatric causes of psychotic symptoms?
- Organic causes: brain tumour, infarcts, infection, inflammation (HIV, CJD, neurosyphilis, HSV encephalitis), thyroid/parathyroid disorders, temporal lobe epilepsy, B12/niacin/thiamine deficiency, acute porphyria
- Substances: alcohol, cannabis, legal highs, stimulants, hallucinogens, solvents
- Medications: antiparkinsonian drugs, corticosteroids, anticholinergics
What are some other psychiatric causes of psychotic symptoms (not including schizophrenia, etc.)?
- Other mental illness: delirium, dementia, schizotypal PD, neurodevelopmental disorders, depression, mania
What is psychosis?
mental state in which reality is greatly distorted, resulting in symptoms such as delusions, hallucinations and thought disorder
Name some otuer symptoms of psychotic disorder
such as psychomotor abnormalities, mood/affective disturbance, cognitive deficits and disorganised behaviour
What are the symptoms of psychoatic disorders?

What is the definition of schizophrenia?
A psychotic disorder characterised by delusions, hallucinations, thought disorder/disorganised speech, disorganised/catatonic behaviour or negative symptoms
- It must be in the absence of organic disease/alcohol/drugs, and not secondary to elevated/depressed mood
What are the subtypes of schizophrenia?
- Paranoid schizophrenia
- Hebephrenic (disorganised) schizophrenia
- catatonic schizophrenia
- Residual schizophrenia
- Simple schizophrenia
what is Paranoid schizophrenia?
- positive symptoms dominate; negative/catatonic symptoms are not prominent
what is Hebephrenic (disorganised) schizophrenia?
thought disorder, disturbed behaviour and inappropriate/flat affect predominate; delusions/hallucinations are not prominent
What is Catatonic schizophrenia?
- rare form dominated by psychomotor disturbance
What is Residual schizophrenia?
1yr of predominantly chronic negative symptoms which must have been preceded by at least 1 psychotic episode in the past
What is simple schizophrenia?
insidious but progressive decline in social ability and total performance; negative symptoms develop without previous psychotic symptoms , inability to meet the demands of society
What is the aetiology of schizophrenia?

What is the epidemiology of schizophrenia?
- 1% prevalence
- Age of onset: males 28yo, females 32yo
- Men have higher incidence than women (1.4:1) but equal prevalence (possibly due to higher mortality in men)
What are Schneider’s first rank symptoms?
- Auditory hallucinations
- Thought broadcasting
- Controlled thought – delusions of control
- Delusional perception
What 3 stages can the clinical picture of schizophrenia be split up into?
Clinical picture can be divided into 3 stages:
-
At-risk mental state (prodrome)
- Low-grade symptoms, e.g. social withdrawal, loss of interest in work/relationships/etc, irritability, reduction of normal functioning
- No frank psychotic symptoms à difficult to pick up on
- Acute phase: positive symptoms (uncommonly negative symptoms are simultaneous)
-
Chronic phase: negative symptoms
- May last indefinitely can become disabling
What are the ICD-10 diagnostic guidelines criteria for a diagnosis of schizophrenia?
-
One or more of:
- Delusions of thought control: echo, insertion, withdrawal, broadcast
- Delusions of control or passivity
- Running commentary or voices discussing the patient among themselves
- Bizarre delusions
- NB the above are Schneider’s 1st rank symptoms (as well as delusional perception –> normal perception with delusion formed around it, e.g. “red car passed me so I knew I was going to be killed”)
-
OR two or more of:
- Persistent hallucinations in any modality (occur for weeks), or associated with delusions/sustained overvalued ideas
- Thought disorder (e.g. flight of ideas, neologisms etc.)
- Catatonic behaviour
- Negative symptoms
- Symptoms should be present for at least 1 month, and associated with at least 6 months of functional decline
- Should not be diagnosed in the presence of organic brain disease or during acute intoxication/withdrawal
What may the additional motor symptoms be in schizophrenia?
Additional motor symptoms:
echopraxia, mannerisms, stereotypies, tics
What are the possible MSE findings for positive and negative symptoms in schizophrenia?

What are some differentials for ?schizophrenia?

What must be asked in the Hx/MSE/assessment of ?schizophrenia?
- Thorough history, collateral history, MSE, risk assessment
- Do you ever see/hear things that other people don’t?
- Do you ever hear your thoughts spoken aloud? Or have thoughts put into/taken out of your head?
- Are you afraid that somebody is trying to harm you?
- Have you noticed people are doing or saying things that have a special meaning for you?
- Do you have any special abilities or powers?
- Does it seem like you are being controlled/influenced by some external force?
What other investigations must be conducted for ?schizophrenia?
Bloods: UE, LFT, Ca, FBC, glucose, VDRLs (for syphyilis), TFTs, PHT, cortisol, turmour markers
Imaging: CT/MRI, CXR if indicated by Hx
Urine: UDS (urine tox screen), MCS
Other: EEG, 24h urinary cortisol, 24h catecholamines or 5-HIAA if suspected pheo or carcinoid, OT assessment of ADLs, social worker assessment of finances or housing, collateral hx


