Psychosis Flashcards
Illusion
Perception triggered by external stimulus (misinterpreted)
E.g. mistaking shadow for person
Delusion
False, fixed belief contrary to evidence and rational argument. Cannot be explained by cultural, religious, or educational background
Biological causes schizophrenia
Genetics–multiple susceptibility genes
Birth: maternal malnutrition, PET, emergency CS
Substance misuse, esp cannabis, amphetamines, cocaine, LSD
Neurodevel: enlarged ventricles, smaller/lighter brains, no gliosis. Low pre-morbid IQ, poor learning/memory/executive function
NTs: Excess Da in mesolimbic (positive sxs), reduced Da in mesocortical tracts (negative sxs)
Psychosocial causes/risk factors schizophrenia
Schizoid personality, schizotypal disorder
Adverse life events
Cognitive behaviors e.g. tendency to jump to conclusions
Fear of madness drives denial and rationalization, and a delusional system to explain persecutory voices
Low socio-economic status
Migrants
Black Afro-Caribbean
High expressed emotion, with highly critical or over-involved relativees
Schneider’s first rank symptoms
Thought echo, insertion, withdrawal, broadcasting
Delusions of control, passivity
Delusional perception
3rd person auditory hallucinations
Persistent delusions of other kinds that are culturally inappropriate
Dx-schizophrenia
At least one of Schneider’s first rank sxs or two of following (lasting at least 1/12):
- Fleeting/half-formed delusions without clear affective content, persistent over-valued ideas
- Incoherent speech/thought
- Catatonic behavior
- Negative sxs
- Signif and consistent change in overall quality of aspect behavior or interest
Schizophrenia prodrome
Low grade sxs e.g. social withdrawal, loss of interest.
No frank psychosis
Chronic schizophrenia
Mostly negative sxs
Negative sxs
Apathy Blunted affect Anhedonia Social withdrawal Poverty of speech/thought Self-neglect Catatonia
Difference between affective disorder with psychotic symptoms and schizoaffective disorder
Schizoaffective=50/50
Affective with psychotic features–e.g. hx depression getting worse and eventually developing psychotic sxs
Schizotypal personality disorder
Odd, eccentric
No delusions
Delusional disorder
At least one non-bizarre delusion without thought disorder, prominent hallucinations, mood disorder, flattening of affect
Hypnagogic hallucinations
When going to sleep
Normal
Hypnapompic hallucinations
When waking up
Often normal
Ix-schizophrenia
Bloods: U&Es, LFT, Ca, FBC, gluc, VDRL, TFT, PTH, cortisol, tumor markers
Imaging: CT or MRI, CXR as indicated by hx
Urine: drugs, MCS
Others: EEG, 24 hr urinary cortisol, 24hr catecholamines/5-HIAA if suspected pheo, OT assess ADLs, social worker assessment
Biological Tx-schizophrenia
- atypical antipsychotic or long acting benzo to control non-acute anxiety/behavioral disturbance
- typical antipsych, titrating upwards
Atypicals used to be first line but now a joint decision between doc and pt considering sxs and SEs
Atypical anti-psychotics (2nd generation)
Work better on negative sxs than typicals (but positive still more so than negative)
Fewer EPS side effects, more anti-cholinergic SEs than typicals
Olanzapine (SE weight gain) Risperidone Quetiapine Ziprasidone (prolongs QT) Clozapine (extremely effective esp with negative sxs but can cause agranulocytosis so requires regular monitoring and is only indicated if at least two other antipsychs have failed)
Psychological treatment-schizophrenia
Family treatment to reduce expressed emotion, psychoeducation
CBT: less evidence, focus is reality testing. Gently challenge thinking and aid awareness of illogical thinking
Concordance therapy
Social treatment schizophrenia
Rehabilitate, including trial at rehab facility
Appropriate housing
Community psych nurse input. Consider OT, PT
Refer to helpful organizations
Carer support
Extrapyramidal side effects
Acute dystonia–acute sustained painful muscle spasm
Akathisia–restlessness lower limbs
Parkinsonism
Tardive dyskinesia. Irreversible.
Neuroleptic malignant syndrome
Muscle stiffness and rigidity, altered consciousness, autonomic disturbance (fever, tachy, labile BP)
Raised CK and WCC. May get ARF
Schizophreniform disorder
Schizophrenia
Otehello syndrome
Obsession that spouse/partner is unfaithful
Part of delusional disorder
Hallucination
Perception without external stimulus
Affect illusion
Perception altered depending on mood state. E.g. frightened kid on Halloween thinks tree branches are attacker
Completion illusion
Lack of attention paid
E.g. reading a book when tired and misinterpret
Pareidolic illusion
See shapes in other objects
E.g. animals in clouds
Functional hallucination
Hallucination in same modality.
E.g. hears voices only when listening to classical music
Neologism
New words created by pt
Echolalia
Repeats words/phrases back, sometimes continuously or incessantly.
Often organic cause
Catalepsy
Rigid limbs
May have wavy flexibility (can move arms into different positions and they’ll stay like that)
Cataplexy
Sudden, transient loss of muscle tone
Clanging
Words based on sound/rhyming
E.g. “A cat pat on my hat sack, ate the bait and skated”
Delusional atmosphere
Feels like something is “going on” but can’t say what
Derailment
Formal thought disorder. Disjointed thoughts, no meaningful connections
Negativism
Catatonic patients do opposite of what asked
Cotard’s syndrome
Belief that part of body has ceased to exist
Seen in psychotic depression
Ekbom’s syndrome
Delusional parasitosis
Fregoli’s syndrome
Complete strangers are actually well-known to them…but in disguise.
Hebephrenic schizophrenia
Aka disorganized Predominantly thought and affective sxs Social withdrawal common Affect often fatuous and child-like Prominent negative sxs May have delusions but not prominent sxs
Clerambault’s phenomenon
Aka erotomania
Sufferer, usually single female, becomes delusionally convinced that someone of exalted status (e.g. celebrity) has become infatuated with them
Often part of schizophrenic illness
Drug for rapid tranquilization
2g IM lorazepam
Capgras syndrome
Person close to them replaced by doppleganger
Schizophrenia and organic illnesses, e.g. dementia
