Pscyhosis And Schizophrenia Flashcards
What is psychosis?
Mental state in which reality is greatly distorted.
Presents commonly with:
Delusions- fixed, firm belief which differs from individual cultural and social norms.
Hallucinations
Thought disorder- patient unable to form thoughts from logically linked ideas.
More common amongst black and ethnic minorities.
What are the causes of psychosis?
Non-organic- Schizophrenia Schizotypal disorder Acute psychotic episode Mood disorders with psychosis Drug induced psychosis Delusional disorder Induced delusional disorder Puerperal psychosis
Organic-
Drug induced I.e. amphetamines, cocaine, ketamine, LSD, cocaine, alcohol etc
Iatrogenic (medication) I.e. anti-malarials, methyldopa, L-dopa, steroids
Complex partial epilepsy
Delirium
Dementia
Huntington’s disease
SLE
Syphilis
Cushings, metabolic disorder, B12 deficiency etc.
What is schizophrenia?
Most common psychotic disorder characterised by hallucinations, delusions and thought disorder resulting in functional impairment.
Occurs in absence of organic causes, alcohol/drug related disorders and is not secondary to elevation or depression of mood.
What are the causes of schizophrenia?
Genetic and environmental
Increased stimulation of dopamine pathways, as demonstrated by dopamine agonists (anti-Parkinsonism drugs) and amphetamines
Obstetric complications, feta, injury or LMBW which can lead to abnormal mature brain
Adverse/stressful life events
Expressed emotion- more likely to relapse when overly criticised by family/friends
Childhood abuse
High dopamine, low glutamate, low serotonin, low GABA
FHx
Low socioeconomic status
Cannabis
Male
What is the difference between positive and negative symptoms of schizophrenia?
Positive symptoms present in the acute phase i.e. hallucinations and delusions.
Negative symptoms present chronically i.e. loss of function.
What are the positive symptoms of schizophrenia?
Delusions Held Firm Think Psychosis:
Delusions including ideas of reference I.e. feel the news is about them
Hallucinations usually 3rd person auditory
Formal thought disorder
Thought interference I.e. insertion, broadcast, withdrawal
Passivity phenomenon- the belief that a patients actions, feelings and emotions are controlled by someone else.
What are the negative symptoms of schizophrenia?
6As
Avolition- lack of motivation
Anhedonia
Alogia- poverty of speech both qualitative and quantitative
Asocial behaviour
Attention deficit- may have problems with language, executive function, attention and memory
Affect blunted
How is schizophrenia classified?
Paranoid Psychotic Humans Can’t Supply Understandable Reasoning
Paranoid schizophrenia- most common. Mainly positive symptoms.
Postschizophrenic depression- mainly depression in this combo, over last 12 months, may have some schizophrenic symptoms present.
Hebephrenic schizophrenia- mainly thought disorganisation. Early teens. Poor prognosis.
Catatonic schizophrenia- rare, catatonic symptoms.
Simple schizophrenia- rare, negative symptoms without psychotic
Undifferentiated schizophrenia- is schizophrenia but doesn’t meet criteria of other subtypes.
Residual schizophrenia- psychotic episode followed by 1 yr of negative symptoms.
What is the ICD 10 criteria for diagnosis of schizophrenia?
Group A
Thought interference
Delusions of control/influence/passivity phenomenon
Running commentary auditory hallucinations
Bizarre persistent delusions
Group B Hallucinations of other modalities Catatonic symptoms Negative symptoms Thought disorganisation
Schizophrenia is diagnosed when-
No organic brain disorder +
1 clear Group A or 2+ Group B
For at least 1 month
How is schizophrenia investigated?
Hx asking questions which may allude to symptoms of schizophrenia.
Bloods- FBC (anaemia, infection), TFTs (dysfunction can present with psychosis), glucose and HbA1c (atypical anti-psychotics can cause metabolic syndrome), Ca (hyperCa can present with psychosis), LFTs and U+Es for baseline before antipsychotics, B12 and folate (deficiencies can cause psychosis).
Using drug test- illicit drugs inducing psychosis
ECG- antipsychotics can cause prolonged QT
CT scan rule out SOL
EEG- rule out temporal lobe epilepsy
How is schizophrenia managed?
Risk assessment is vital
Multidisciplinary team approach
First episode should be referred to early intervention in psychosis team to reduce duration of untreated.
Biopsychosocial management
Biological-
Antipsychotics. These are either typical or atypical. In the case of schizophrenia use atypical antipsychotics I.e. risperidone or olanzapine. If the patient has poor compliance or prefers a depot formulation this can be offered. Clozapine is the most effective for treating schizophrenia BUT is only usd in treatment resistant (failure to respond to 2 other antipsychotics)
Adjuvants I.e. benzodiazepines (short term behavioural disturbance relief, insomnia, agitation), antidepressants, lithium.
ECT- effective if treatment resistant or catatonic symptoms
Psychological- CBT- reduces any residual symptoms Family intervention- by providing them with psychoeducation this reduces the levels of expressed emotions and so reduces relapse rate. Social skills training Art therapy
Social-
Support groups for rehabilitation i.e. Rethink or SANE
Peer support- from a now stable previous sufferer of schizophrenia
Supported employment programmes
What are the poor prognostic factors for schizophrenia?
Strong FHx Gradual onset Low IQ Premorbid history of social withdrawal No obvious precipitant
