Psychosis Flashcards
How may mental disorders vary?
Mental disorders vary in their;
- Manifestations
- Severity
- Duration / course
- Prognosis
What is psychosis ?
Psychosis - any disorder so severe that the patient loses contact with reality
Flashback patent is in touch with reality still, psychosis isn’t behaviour and thoughts aren’t in touch with reality
What are examples of Psychosis ?
Psychosis diseases;
- Schizophrenia
- Schizoaffective disorders
- Persistent delusions disorders
- Bipolar disorder with psychotic symptoms (Bipolar is a mood disorder but with psychotic symptoms hence here again)
Also secondary to drug use, focal epilepsy, dementia and organic brain disease
Who first discovered Schizophrenia ?
Identified as a mental disorder by Emil Kraepelin
Schizophrenia term first used by Eugen Bleuler in 1911
- Schizo - “Split”
- Phrene - “Mind”
These are myths, schizophrenia nothing to do with split mind!
What age are people are most likely to develop Schizophrenia ?
- 1% of the world population has it
Diagnosis is usually quite late;
- Men early 20’s
- Women late 20’s
Could be hormonal, no one knows why tho
Get a Prodromal phase where patients may present with odd behaviours late school, mid school maybe earlier. Described as slightly odd.
E.g patient with severe anxiety, got all A’s S5, S6 failed all exams, couldn’t study due to anxiety, was given antianxiety, then given pregabalin that helped. He explained he kept getting this episode that someone was there just in his peripheral vision (symptoms of focal epilepsy but was normal). Was also a heavy cannabis user, then was diagnosed with schizophrenia. Also usually see in childhood was withdrawn etc
Who are most likely to be diagnosed with Schizophrenia ?
- Inequality and discrimination
- Black people (but not other BAME groups) far more likely to be diagnosed with Schizophrenia than white people (Thought to be differences in up brining, or access to support)
- No biological basis for this
- Differences in life experience discrimination, social deprivation
- Differences in access to early support
- Unconscious bias and lack of cultural competence
- Other cultures think psychosis is being possessed and will do exorcisms so difficult hurdle to cross - lack of cultural competence can be a huge barrier
What are the statistics for those who recover, get worse or die with Schizophrenia ?
- 20% who have a first episode recover - issue is you don’t know which 20% that is
- 80% will suffer either another acute episodes or a more chronic condition
- 10% due by suicide (contrast 0.2% of men commit suicide in normal population, 10% is huge!)
- Patients can believe they have special powers that makes them invincible, e.g jump from window and can contribute to deaths, isn’t disease itself killing them
- Mean years of life loss is 14.5 years in schizophrenia
How many people with Schizophrenia are employed?
19% are employed - financial burden !
What are the 2 systems used to diagnose patients with Schizophrenia ?
ICD-11 - European Criteria
DSM-5 - American Criteria
Don’t learn criteria, just think how diagnostic systems can give you different outcomes for patients and this can affect data from countries depending on what system they use
What are the Positive symptoms of Schizophrenia?
Positive symptoms tend to be transient and during acute episodes
- Delusions - can be bizarre
- Halcuination
- Thought disorder (get thoughts put into head - thought insertion, thought withdrawal - thoughts taken out of head)
- Disorganised / bizarre behaviour
- Disorder of self experience - e.g passivity, control
E.g Andy 21 year old student believing his housemates work for MI5, chip put in head, talking about him - thought disorder
Out with societal norms but that’s where the conflict depending on your culture competence - hence why some ethnic groups are recorded with higher results in different countries
What are the Negative symptoms of Schizophrenia?
Negative symptoms tend to be chronic (absence of stuff, ALL BEGIN WITH A!);
- Alogia (poverty of speech)
- Affective blunting (restricted emotional expression)
- Avolition
- Anhedonia
- Asociality (detached from your environment)
- Ambivalence
- Apathy
Other signs;
- Cognitive deficits - Chronic decline affects cognition
- Episodic
- Lack of insight (Whether acute or chronic - makes treatment compliance very difficult)
What is the Passivity phenomenon?
Passivity phenomenon - feeling something that isn’t there (I.e chip in head, out of control of limb someone else doing it)
What Cognitive defects may you see in Schizophrenic patients ?
Cognitive deficits / decline (Similar to dementia);
- Sustained attention
- Planning
- Verbal and visuo-spatial working memory
- Language skills
- Explicit learning and memory
- Perceptual / motor processing
Start to lose IQ points
Quite frontal, a lil temporal and parietal
Is there subclassifications of Schizophrenia ?
YES!
We previously used Catatonic, disorganised, paranoid, simple, undifferentiated and residual these have changed
These subtypes have been changed in DSM-5 (American) and ICD-11 (European) has moved to domains, gradients and dimensions of schizophrenia (Due to it being difficult to put mental health patients into boxes)
How do Schizophrenic patients compare to the general population ?
Severity and number symptoms schizophrenic patients have compared to population
- Slight increase in depression
- Slight increase in mania
- Increase in impaired cognition
- Significant increase in delusion
- Massive increase in Hallucination
Is there a genetic component to Schizophrenia ?
Lots of people who carry risk genes for disorders but don’t develop due to not having right stressors/environmental risk factors
- Diathesis model (vulnerability - stress)
- Genetics generates a predisposition / vulnerability to developing schizophrenia
- Stressors / environmental risk factors push an individual over a threshold which leads them to develop schizophrenia
Confirmed by twin studies
- 50% chance developing if identical twin will also develop it
- 45% chance developing if both parents have schizophrenia
What would an MRI of a person with schizophrenia show?
- See cerebral shrinkage, get enlarged lateral ventricles
- Fronto-temporal, basal ganglia, hippocampal reduction
For a lot of people schizophrenia is a neurodevelopmental disorder - difficulty making friends when kids, withdrawn along with a strong history of it in family
Difficulty as teenager may have both parents with it, early symptoms to make it preventable but do owe treat them or not? High risk patient, could prevent but also issues with taking these drugs
