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Psychiatry > Psychosis > Flashcards

Psychosis Flashcards

1
Q

what is meant by psychosis

A
  1. inability to distinguish between subjective experience and reality (delusions, hallucinations
  2. fundamental change in an individuals experience of lived reality
  3. core and persistent feature of schizophrenia
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2
Q

what is meant by psychotic disorder?

A

a person can only be said to be suffering from a psychotic disorder if these experiences are prominent, persistent or are causing the person distress and difficulties in everyday functioning. *psychotic symptoms are common in society. only a small percentage of these people develop a psychotic disorder requiring treatment

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3
Q

clinical features of schizophrenia ? (positive symptoms - presence of abnormal phenomena)

A
  1. delusions
  2. hallucinations
  3. passivity experiences
  4. disorganized thoughts and/or behaviours
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4
Q

clinical features of schizophrenia (negative symptoms - absence of normal behaviour)

A
  1. apathy
  2. blunted affect
  3. avolition
  4. asociality
  5. anhedonia
  6. alogia
  7. attentional impairment
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5
Q

what is the lifetime risk of developing schizophrenia?

A

0.7%

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6
Q

which sex is more commonly affected by schizophrenia? and what is the ratio

A

males (1.4:1)

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7
Q

what sex is more prone to earlier onset schizophrenia?

A

male

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8
Q

Schizophrenia is most common in which groups in society?

A
  1. lower SE groups
  2. urban areas
  3. homeless
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9
Q

what percentage of patients with schizophrenia die by suicide ?

A

5%

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10
Q

people with schizophrenia have a reduced life expectancy by …. years ?

A

15-20

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11
Q

what is the neurobiological aetiology of schizophrenia?

A
  1. when individuals are acutely psychotic, they show an excessive release of dopamine.
  2. dopamine normally mediates the attachment of salience to ideas and objects
  3. heightened Dopamine transmission leads to aberrant assignment of salience to external and internal stimuli
  4. delusions arise from attempts to explain this abnormal salience
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12
Q

what is the salience network?

A

The salience network (SN) is involved in detecting, filtering, and determining the importance of external and interoceptive stimuli, including perceived conflict and discrepancies. Relatedly, the SN moderates physiological arousal via its association with the amygdala, which helps control the autonomic nervous system. As such, the SN is part of a system that guides behavior by identifying the most relevant—or subjectively salient—among the many internal and external stimuli that people encounter at any one time (Menon & Uddin, 2010).

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13
Q

can cannabis cause schizophrenia? examples of statistics

A
  1. 2 fold increased risk with cannabis use
  2. more frequent use; faster progression to high levels of use = increased risk and earlier onset of pscyhosis
  3. younger age of cannabis = younger age at onset of pscyhosis indicating a possible cumulative dose effect
  4. cannabis use by age 15 associated with 11 fold increased risk of schizophrenia by 26
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14
Q

predisposing risk factors for schizophrenia ?(neurodevelopment hypothesis)

A
  1. obstetric complications: premature birth, low birth weight, perinatal hypoxia
  2. maternal infection: influenza, T gondii
  3. winter/spring birth in northern hemisphere
  4. fetal malnutrition/ intrauterine infection
  5. urban birth/rearing
  6. childhood adversity
  7. childhood motor, social, cognitive dysfunction
  8. low social class (both cause and affect)
  9. immigration (first and second generation)
  10. ethnic minority in low ethnic density
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15
Q

precipitating risk factors for schizophrenia?

A
  1. substance abuse (especially cannabis)
  2. stressful life events, high expressed emotion
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16
Q

ICD-11 criteria for diagnosis?

A

2 or more of the following (1 from 1-4 must be present) most of the time for a period of 1 month or more:
1. persistent delusions
2. persistent hallucinations (most commonly auditory, but may be in any sensory modalities)
3. disorganized thinking (formal thought disorder) (e.g tangentiality and loose association, irrelevant speech, neologisms). when severe, the persons speech may be so incoherent as to be incomprehensible (“word salad)
4. Experiences of influence, passivity or control (e.g the experience that thoughts are not generated by the person, are being placed in ones mind or withdrawn from ones mind by others, or that thoughts are being broadcast to others)
5. Negative symptoms such as affective flattening, alogia, or paucity of speech, avolition, asociality, and anhedonia.
6. Grossly disorganized behaviour, which may be noted in any form of goal-directed activity (e.g unpredictable or inappropriate emotional responses, behaviour that appears bizarre or purposeless)
7. Psychomotor disturbances, such as catatonic restlessness or agitation, posturing, waxy flexibility, negativisim, mutism, or stupor.

17
Q

what are differential psychiatric diagnoses for schizophrenia?

A
  1. affective psychosis (mania or depression with psychotic features)
  2. schizoaffective disorder
  3. substance-induced psychotic disorder (including alcohol, stimulants, and hallucinogens)
  4. persistent delusional disorder
  5. acute transient psychotic disorder
  6. schizotypal personality disorder
  7. paranoid personality disorder
  8. induced/ shared psychotic disorder (folie a deux)
  9. factitious disorder
18
Q

what are differential organic diagnoses for schizophrenia?

A
  1. delirium, including alcohol withdrawl state and metabolic or endocrine derangement
  2. medication induced psychosis (including corticosteroids, antihistamines, dopamine agonists, sympathomimetics)
  3. autoimmune encephalitis (VGKC and NMDA receptor antibody mediated)
  4. neurodegenerative conditions (e.g alzheimers, wilsons disease
  5. epilepsy: post-ictal and inter-ictal psychosis; particularly temporal lobe seizures
  6. brain injury
  7. CNS neoplasm
  8. CNS infection (neurosyphillis, HIV seroconversion, herpes encephalitis)
  9. SLE
19
Q

features of schizoaffective disorder ?

A
  1. fulfills criteria for schizophrenia and major mood disorder simultaneously
  2. affective component can be depression, mania, hypomania, or mixed episode
  3. differentiate from mood disorder with psychotic symptoms
  4. symptoms must last 1 month
20
Q

features of acute/ transient psychotic disorder

A
  1. acute onset/ no prodrome
  2. can occur in relation to a stressor - onset within 2 weeks
  3. short duration - psychotic illness of 1 day to 1 month duration
  4. 1+ of; delusions, hallucinations, disorganized behaviour, disorganized speech
    - this is followed by return to full premorbid functioning
21
Q

features of schizotypal personality disorder

A

enduring pattern (several years) of:
1. eccentricities in behaviour, appearance and speech
2. inappropriate affect
3. paranoid ideas, ideas of reference, perceptual disturbances
4. psychotic symptoms including hallucinations do not meet diagnostic criteria for a psychotic disorder
5. reduced capacity for interpersonal relationships
6. symptoms cause distress across broad areas of functioning
*under psychotic disorders in ICD-11 but a personality disorder in DSM-5

22
Q

features of delusional disorder ?

A
  1. a delusion or sets of delusions in the absence of an affective disorder
  2. lacking characteristic features of schizophrenia
  3. may have perceptual disturbances but not persistent auditory hallucinations
  4. less negative effects on affect, behaviour and speech
23
Q

what is the natural course of schizophrenia ?

A

relapsing remitting course

24
Q

what percentage of patients with schizophrenia respond to treatment at first episode ?

A

80%

25
Q

what percentage of patients with schizophrenia will have only one episode?

A

10-20% will have one episode only

26
Q

what percentage of patients with schizophrenia have treatment resistance course ?

A

20-30%

27
Q

course of psychosis and schizophrenia

A
28
Q

good prognostic factors in schizophrenia?

A
  1. acute onset
  2. obvious psychological precipitant
  3. good premorbid adjustment
29
Q

Poor prognostic factors in schizophrenia ?

A
  1. poor premorbid adjustment
  2. slow insidious onset
  3. long duration of untreated psychosis
  4. prominent negative symptoms
30
Q

modifiable prognostic factors in schizophrenia?

A
  1. duration of untreated psychosis
  2. non-compliance
  3. number of relapses
  4. comorbidities (addiction, mood disturbance)
  5. stress
  6. family expressed emotion
31
Q

course and prognosis of schizophrenia

A
  1. course can be in episodes; with relapses and remissions
  2. acute or chronic
  3. about 1/3 of patients can fully recover
  4. about 1/3 have some relapses
  5. about 1/3 have a more severe course with multiple relapses

Psychiatry (22 decks)

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