psychosis Flashcards
define psychosis
a state in which there is loss of contact with reality and includes:
delusions
hallucinations
formal thought disorder
What are positive symptoms of schizophrenia
Delusions
Hallucinations
Disorganised behavior
Thought disorder
What are negative symptoms of schizophrenia
Blunted affect Poverty of speech Social withdrawal Reduced attention Avolition
What are Schneider’s First Rank symptoms
ABCD
Auditory Hallucinations (thought echo or third person)
Broadcasting of thought (thinks that everyone can hear thoughts)
Controlled thought (thinks that his thoughts are controlled by someone else)
Delusional perception
What are the organic types of psychosis
Delirium (eg. sepsis)
Medication-induced (stimulants, dopamine agonists)
Endocrine disorders (Cushing’s, hypo and hyperthyroidism)
Neurological disorders (temporal lobe epilepsy, multiple sclerosis, movement disorders, Huntington’s)
Other systemic diseases (porphyria, SLE)
Psychiatric types of psychosis
Schizophrenia (if symptoms for longer than 28 days, first rank symptoms, no organic cause)
Schizoaffective disorder (mix of first rank and mood symptoms)
Delusional belief (non-first rank delusional belief with minimal hallucination)
Schizotypal disorder
Acute and transient psychotic disorder (<28 days)
Mood disorder (Mania, severe depression)
epidemiology of schizophrenia
Highest incidence at:
23M
26F
Rare under 16
Lower social class
urban>rural
Aetiology of schizophrenia
Biological:
FH, obstetric complications,
Psychological:
cognitive errors - jumping to conclusions
Pre-morbid personality disorder - schizotypal disorder
Social: Urban living Migration Life events (physical and sexual abuse) Ethnicity
Define prodrome
This refers to the period of time when the individual is gradually developing symptoms but has not yet met the criteria for diagnosis
non-specific negative symptoms
emotion distress/ agitation without reason
transient psychotic symptoms
Which factors effect prognosis in schizophrenia
The longer the DUP (duration of untreated psychosis) the worst the outcome.
Good prognostic factors: Female Married Family history of affective disorder Acute onset Good Premobid personality Early treatment Prominent mood symptoms Good response to treatment
Poor prognostic factors: Generally opposite of the “good outcome” factors Family history of schizophrenia High expressed emotion (more later) Substance misuse Prominent negative symptoms Early onset Lack of insight/non-compliance
What is generally the prognosis for schizophrenia?
1/3 become completely healthy
1/3 get better but symptoms recur
1/3 progressively gets worse
Biological treatment of schizophrenia
Antipsychotics (typicals, atypicals)
Depots if compliance is poor
Physical checks
drug for treatment resistant schizophrenia
clozapine
What needs to be monitored for schizophrenic patients every year?
Physical health (5x higher mortality):
smoking and drinking status
personal/ family history of diabetes/ coronary heart disease
BP, BMI
blood for FBC, RFT, LFT, glucose and lipid
ECG
What is treatment resistant schizophrenia?
Lack of response to adequate doses of 2 different antipsychotics (over their required time period)
Before diagnosing with TRS:
review diagnosis (is the diagnosis correct?) rule out co-morbid substance misuse ensure dose, duration and compliance with previous treatment
