Psychosis Flashcards
Most common symptom of schizophrenia as found by the International Pilot Study of Schizophrenia
Lack of insight
St Louis or Feighner criteria for schizophrenia/Washington University Criteria - 1972
A. At least 6 months of symptoms AND absence of symptoms to qualify for an affective disorder in the same time period
B. Delusions or hallucinations without significant perplexity OR difficult to understand speech due to a lack of logical or understandable organisation
C. THREE OF (or two of for ‘probable schizophrenia’
- Single
- Poor premorbid social adjustment or work history
- Family history of schizophrenia
- Absence of alcoholism or drug use within one year
- Onset prior to age 40
Three aspects to the NIMH Research Diagnostic Criteria for schizophrenia that predated DSM III
Symptom criterion
Duration criterion
Exclusion criterion
Schneider first rank symptoms of schizophrenia
Running commentary Thought echo Voices heard arguing or referring to themselves in the third person Thought insertion Thought withdrawal Thought broadcast Delusional perception (true perception with a false meaning attached) Somatic passivity Made affect Made volition
Duration criterion of the NIMH Research Diagnostic Criteria for schizophrenia
At least 2 weeks
Length of symptoms required for to meet ICD 10 or ICD 11 diagnostic criteria for schizophrenia
1 month
ICD 10 subtype of schizophrenia characterised by delusions or auditory hallucinations
Paranoid
ICD 10 subtype of schizophrenia characterised by disorganised speech or behaviour and flat affect, with markedly impaired social functioning
Hebephrenic
ICD 10 subtype of schizophrenia characterised by motor immobility or excessive mobility, mutism, echolalia or posturing
Catatonic
ICD 10 subtype of schizophrenia characterised by acute onset, episodic course and complete remission between episodes
Catatonic
ICD 10 subtype of schizophrenia more common in developing countries
Catatonic
ICD 10 subtype of schizophrenia characterised by previous full blown acute episode, with ongoing negative symptoms and less clear cut positive symptoms e.g. odd beliefs rather than delusions
Residual
ICD 10 subtype of schizophrenia characterised by insidious development of negative symptoms without positive symptoms
Simple
ICD 10 subtype of schizophrenia characterised by insidious onset, and then severe deterioration over time without remission or recovery
Hebephrenic
ICD duration criteria for schizophrenia (and simple schizophrenia)
1 month
1 year for simple schizophrenia
ICD 11 requirements for schizophrenia
TWO OF
- Persistent delusions
- Persistent hallucinations
- Disorganised thinking
- Experiences of influence, passivity or control
- Negative symptoms
- Disorganised behaviour
- Psychomotor disturbances
FOR ONE MONTH OR MORE WITH AT LEAST ONE OF THE FIRST FOUR
AND not a manifestation of another medical condition
DSM IV and V duration criteria for schizophrenia
1 month of characteristic symptoms
6 months of social/occupational dysfunction
Duration requirements for ICD 11 diagnosis of acute and transient psychotic disorder
No longer than 3 months
Most commonly lasts a few days to one month
Progressing from a non-psychotic state to a clearly psychotic state within 2 weeks
Classification system which uses a dimensional method to rate the severity of schizophrenia, with 8 different dimensions e.g. delusions, depression, abnormal cognition
DSM V
Type of delusions counted towards delusional disorder in ICD 10 vs. ICD 11
In ICD 10 delusions must be ‘non-bizarre’; in ICD 11 this requirement is not present
Affect on daily functioning with delusional syndrome
Not significantly impaired
ICD 11 requirements for a diagnosis of delusional disorder
Delusion or set of related delusions for at least 3 months
Stable although can evolve for each individual
Absence of clear and persistent hallucinations
Affect, speech and behaviour unaffected apart from where directly related to the delusion(s)
Not a manifestation of another condition
Delusional disorder characterised by a conviction that someone is secretly in love with the patient
Erotomania/de Clerambault syndrome
Most common sex to suffer from erotomania
Females
Most common sex to suffer from erotomania in the forensic population
Male
Personality disorder categorised within the schizophrenia category in ICD 10 and ICD 11
Schizotypal
Delusional disorder characterised by a belief that a patient has a special role, special abilities or special relationship to someone - often related to religion or social organisations
Grandiosity
Delusional disorder characterised by a delusion of infidelity by the patient’s partner. May lead to attempting to restrict their partner’s activities and contributes to domestic violence and homicide
Jealousy/Othello syndrome
Delusional disorder characterised by the belief that someone is trying to hurt the patient
Persecutory
Delusional disorder characterised by delusional concerns about the patient’s body. Can include concerns about a bodily infestation, odour or deformity
Somatic
Classification system which divides delusional disorders into subtypes
DSM
Type of delusional disorder where there are shared delusions between two (or occasionally more) people who are emotionally close - one person has genuine delusions due to an underlying disorder
Induced delusional disorder/folie-à-deux
Usual course of induced delusional disorder when the people involved are separated
One retains the delusions, the other loses them
ICD 11 requirements for schizoaffective disorder
All diagnostic requirements for schizophrenia met concurrently with mood symptoms
Onset of psychotic and mood symptoms is within a few days of each other
Duration of at least one month for both mood and psychotic symptoms
Not a manifestation of another medical condition
Type of delusions often seen in schizoaffective disorder that would differentiate it from a psychotic depression
Mood incongruent delusions
Type of delusions often seen in schizoaffective disorder that would differentiate it from a psychotic depression
Mood incongruent delusions
Psychotic disorder classified in ICD 10 but not ICD 11 with sudden onset psychosis, polymorphous delusions and hallucinations, clouded consciousness, rapid return to premorbid level of functioning and if relapses do occur they are separated by symptom-free intervals
Bouffée délirante
Psychiatrist who differentiated between ‘process’ shizophrenia with a poor prognosis, and ‘schizophreniform’ psychosis, with a good prognosis
Langfeldt
True diagnosis of most of Langfeldt’s ‘schizophreniform’ psychotic patients
Affective disorder with psychosis
Term for episodic psychoses with full recovery between episodes, more common in women and associated with the postpartum period. Characterised by mood swings, confusion, mobility disturbance and overwhelming anxiety.
Cycloid psychosis
DSM subtype of schizophrenia which does not exist in ICD 10
Disorganised
Positive symptoms of schizophrenia
Delusions Hallucinations Formal thought disorder Bizarre behaviour Inappropriate affect
Negative symptoms of schizophrenia
Poverty of speech (alogia) Blunted/flattened affect Avolition Apathy Anhedonia Poor attention
In post-schizophrenic depression the most recent relapse should be within
12 months
Chapter schizoaffective disorders are found in ICD 10 and ICD 11
Schizophrenia
Dream-like state associated with catatonic schizophrenia
Oneiroid state
Medical causes of catatonia
Hypercalcaemia Hepatic encephalopathy Brain tumours Parkinsonism Encephalitis
Drug causes of catatonia
Neuroleptic medication
Phencyclidine - used as a veterinary anaesthetic and in hallucinogenic recreational drugs
Factors associated with a poor prognosis in schizophrenia
Early or insidious onset Male sex Negative symptoms Long duration of untreated psychosis Family history of schizophrenia Continued substance misuse Low IQ of socioeconomic status
Percentage of patients with an acute episode of schizophrenia who display at least one first rank symptom
50%
Percentage of patients with schizophrenia who never display a first rank symptom
20%
Percentage of patients with psychosis but not schizophrenia who display a first rank symptom
10%
The basic symptoms of autism according to Bleuler
Loosening of associations
Disturbances of affectivity
Ambivalence
Autism
Subtypes of schizophrenia in DSM V
None - all subtypes removed
Subtypes of schizophrenia in ICD 11
None - all subtypes removed
Most common cause of hallucinations in the community
Sleep disorders
Most common sign of catatonia among psychiatric inpatients
Mutism
Prevalence of metabolic syndrome in patients with schizophrenia according to the Clinical Antipsychotic Trials of Intervention Effectiveness
41-43%
Prevalence of metabolic syndrome in female patients with schizophrenia according to the Clinical Antipsychotic Trials of Intervention Effectiveness
52-54%
Prevalence of metabolic syndrome in male patients with schizophrenia according to the Clinical Antipsychotic Trials of Intervention Effectiveness
36-37%
Sex more likely to suffer late onset psychosis
Female
Type of psychosis associated with sensory impairment, particularly hearing impairment
Late onset psychosis
Type of schizophrenia no longer diagnosed which was inappropriately diagnosed in political dissidents in the USSR
Sluggish schizophrenia
Substance which has been shown to increase the risk of psychosis when used in adolescence
Cannabis
Aetiological factors in the development of schizophrenia
Family history Obstetric complications Maternal and childhood infections Maternal malnutrition Winter birth Increasing paternal age Delayed developmental milestones Substance misuse especially cannabis Migration Urban living
Subtypes of schizophrenia in DSM V
None - have been removed
Number of specified symptoms required for a schizophrenia diagnosis in DSM IV
One
Number of specified symptoms required for a schizophrenia diagnosis in DSM V
Two
Time frame when postpartum psychosis is most common
2-14 days after giving birth
Subtype of schizophrenia which has been removed from DSM IV
Simple
Time delusions need to be present for a diagnosis of persistent delusional disorder
At least one month
Diagnoses persistent delusional disorder cannot be diagnosed alongside
Paranoid schizophrenia
Dementia
Minimum length of time antipsychotics should be continued in the maintenance phase of schizophrenia
At least one year
Sex more affected by late onset schizophrenia
Female
Type of psychosis often associated with sensory impairment
Late onset
Increased mortality rate of patients with schizophrenia compared to the general population
2-3x increase in incidence
Life expectancy of patients with schizophrenia compared to the general population
10 years less
Percentage of patients with schizophrenia who complete suicide
10%
