Mental health 3: Psychotic spectrum disorders SCHIZOPHRENIA Flashcards
Define aetiology
The cause/s or manner of causation for a disease of condition
•What are the 5 symptoms of schizophrenia according to the DSM-5?
- Delusions
- Hallucinations
- Disorganised speech (formal thought disorder)
- Grossly disorganized or catatonic behaviour (abnormality of movement)
- Negative symptoms
•Schizophrenia diagnosis groups symptoms into Positive symptoms (presence of problematic behaviours) and negative symptoms (absence of healthy behaviours).
Name 5 positive symptoms (nb one is a ‘lack of’ something)!
Positive symptoms include:
- Hallucinations
- Delusions
- Formal thought disorder (disorganised speech)
- Behavioural/Motor disturbances
- Lack of Insight
• What is the prevalence, ratio in bio males and females and age of onset of schizophrenia?
Prevalance is 1-2%
Males/Females: 3:2 ratio
Age of onset: Late adolescence & early adulthood, but this tends to be later for women.
• Describe the clinical course of schizophrenia, and how variable is the presentation and course?
The clinical course is highly variable and includes one or more episodes, with periods of normal (or near normal) functioning between episodes.
Some people have a good response to treatment for schizophrenia, whereas others don’t. Describe the 8 prognostic factors which predict this good response to treatment. These can be divided into 4 categories:
- Conditions before onset (3)
- Circumstances of the onset (4)
- Length of psychotic phase (1)
- Ongoing conditions irrelevant to onset (1)
- Good premorbid functioning (before schizophrenic onset)
- Absence of structural brain abnormalities
- No family history of schizophrenia
- Later age of onset (females)
- Acute (rapid) onset
- Precipitating event (e.g., drug induced psychosis/ watching the exorcist)!
- Brief active (psychotic) phase
- Low substance use
• Are the aetiology factors (cause/s or manner of causation) of schizophrenia well understood?
The implicated vulnerability factors imply environmental interaction with biopsychosocial circumstances. Name the 3 implicated biological vulnerabilities.
The aetiological factors of schizophrenia are not well understood.
Implicated Vulnerability factors:
• Biological
- Genetic
- Neurochemical
- Neuroanatomical
• Environmental/ Psychosocial
• Pharmacological & psychological interventions
TBC….
There are 4 phases of schizophrenia. Premorbid phase (childhood), prodromal phase (adolescence, between the initial symptoms and full development), psychotic phase and the recovery phase.
What are the characteristics and level of functioning of these phases?
Premorbid phase (childhood): Cognitive motor or social defecits
Prodromal phase (adolescence/ young adulthood): Brief/ attenuated (reduced) +ve symptoms (presence of problematic behaviours) /functional decline
Psychotic phase (adolescence/ young adulthood): Florid (fully developed) symptoms
Recovery phase:
-ve symptoms, cognitive/ social deficits, functional decline
Some people have a poor response to treatment for schizophrenia. Describe the 8 prognostic factors which predict this poor response to treatment. These can be divided into 4 categories:
- Conditions before onset (4)
- Circumstances of the onset (2)
- Length of psychotic phase (1)
- Recovery type (1)
- Poor premorbid (before symptom onset) functioning
- Lower socioeconomic class
- Migrant status
- Poor social support network
- Slow insidious (gradual but w very harmful effects) onset
- Prominent negative symptoms (deficits in healthy behaviour)
- Long duration of untreated psychosis
- Slower or less complete recovery
What percentage of people w schizophrenia experience hallucinations? Auditory hallucinations are the most prevelant. What percentage of hallucinations do they account for?
75% of patients with schizophrenia report experiencing hallucinations, 60-70% of those are auditory.
Schizophrenic delusions can be separated into 4 types:
- Referential delusions
- Grandiose delusions
- Nihilistic delusions
- Erotomanic delusions
Describe each of these.
- Referential Delusions
Neutral event interpreted to have personal meaning eg news presenter is talking to me personally - Grandiose Delusions
False belief that one has special powers, abilities, fame - Nihilistic Delusions
Belief of non-existence of self, part of the body, others or the world - Erotomanic Delusions
False belief that another person (a stranger, high status or famous) is in love with him/her
Formal Thought Disorder has 6 expressive qualities for people with schizophrenia:
Circumlocution or circumstantiality Derailment Tangentiality Echolalia Word salad (think Wernickes) Clang associations
Define these
- Circumlocution or circumstantiality (very indirect, long-winded descriptions)
- Derailment (comments slipping from one to next, only partially-related topic). My mother, England, fish and chips, chips are made from potatoes
- Tangentiality (irrelevant responses to questions)
- Echolalia (involuntary parrot like repetition; acute phase)
- Word salad (incomprehensible stream of words: Think Wernickes aphasia)
- Clang associations (phrases linked through sound rather than meaning; e.g., “Pass me the spoon, moon, I’m cocoon.”)
There are 7 symptoms of Grossly Disorganised & Abnormal Motor Behaviour for people with schizophrenia. These are:
- Stupor
- Catelepsy
- Waxy flexibility
- Echopraxia
- Echolalia (also a formal thought disorder)
- Grimacing
- Mutism
Define these
§ Stupor (no psychomotor activity; not actively relating to environment)
§ Catalepsy (a rigid posture/positions of limbs despite gravity)
§ Waxy flexibility (remaining in a posture even when limbs moved into place by another person)
§ Echopraxia (imitating another’s movement)
§ Echolalia (imitating another’s speech)
§ Grimacing
§ Mutism (no, or very little response)
Define ‘catatonic behaviour’ and state the efficacy of medication for schizophrenia in reducing this
Catatonic behaviour is a marked decrease in reactivity to the environment, from childlike stillness to unpredictable agitation.
Medication reduces prevalence but ~ 32% are still affected. There’s a 70% efficacy reduction
