Psychosis Flashcards
Define Psychosis
Characterised by fundamental and characteristic distortions of thinking and perception, and by inappropriate or blunted affect. Clear conciousness and intellectual capacity are usually maintained
WHO estimates that the burden of psychosis on a family is only exceeded by quadriplegia and dementia. Real talk?
Aye real talk
What are the ICD-10 criteria for diagnosisng Schizophrenia?
- 1 syndrome or 2 symptoms for most of the time for at least 1 month
- Not manic or depressive episode present
- Not attrbutable to organic brain disease.
- Not attributable to alcohol or drug-related intoxication, dependence or withdrawal.
The lifetime incidence of schizoprenia is 1% and the lifetime incidence of psychotic disorders in general is around 3%. Real talk?
Aye real talk
What are the thought echos, insertions, withdrawals and thought broadcasting tings associated with schizo?
Thought insertion: the feeling as if ones thoughts are not ones own, but rather belong to someone else and have been inserted into one’s mind.
Thought echo: thoughts being spoken aloud just after being thought.
Thought withdrawal: the belief that thoughts have been taken out of the patients mind and they have no power over this.
Thought broadcasting: - thought broadcasting is the belief that others can hear or are aware of an individuals thoughts.
What are the other symptoms of schziophrenia?
- Delusions of control, influence, passivity of thought, action or sensation.
- Delusional perception
- Persistent delusions that are bizarre or impossible (allowing for cultural factors)
- Catatonic behaviour, such as stupor, mutism, posturing, excitement
- Disordered thoughts (derailment, incoherence, neologisms, irrelevance)
- Hallucinatory voices in 3rd person, discussing, running commentary or coming from the body
What are the 7 negative symptoms of schizoprhenia?
Apathy
Avoilition
Anergia
Alogia
Anhedonia
Asociality
Affective Flattening
Impaired Attention
What are the cognitive symptoms of shizophrenia?
- Average UK = 95 and may decline after 1st episode
- Discrepancy in verbal/non-verbal IQ
- Impaired attention
Executive function - problem solving, response inhibition, planning
- Obverinclusiveness, verbal redundancy
What is Liddle’s 3-syndrome model for diagnosing schizophrenia?
Reality distortion - hallucinations, delusions
Disorganisations - thought disorder, inappropriate affect
Psychomotor poverty - poverty of speech, blunt affect
What associated symptomatic findings are found in schizophrenia?
- Increased volume of ventricles
- Decreased volume of cortex
- More neurons with less connections
- Functional imaging shows patterns of activity that reflect symptoms e.g.
Auditory Hallucinations - Brocas Areas
Negative Symptoms - Prefrontal Cortex
- Passivity - Cingulate Gyrus
Describe the epidemiology of scizophrenia
More males than female
Earlier peak onset in males (mean 22v26)
Incidence 1-2/10000/year
Lifetime prevalence approaches 1%
Present in all populations
Urban>Rural (2-3x risk)
Most common in SEC IV & V
What are the prenatal risk factors for scizophrenia?
- Premature births
- Unwanted pregnancy (4x)
- Maternal influenza (xs of spring birthds)
- Rubella
- IUGR or malnutrition
- Associated medical problems e.g. DM
WHat are obstetric and neonatal factors for scizophrenia?
Obstetric complications
Low birth weight
Hypoxia
Associated with structural brain abnormalities
What are the early childhood factors for scizophrenia
- Mixed handedness (crow)
- Mixed hand and eye dominance (canon)
- late milestones
what are the adult risk factros for scizophrenia?
- Age (earlier onset in those with a biological risk factor)
- Gender effects (why do males present earlier)
- Urban vs Rural birth and rearing
- Migrants (norweigians, etc 4-6x greater risk in second generation immigrants, declining in subsequent generations - why?
How is dopamine related to psychosis?
- When individuals are acutely psychotic, there is an excessive striatal release of dopamine
- Dopamine is involved in reward learning and normally mediates attachment of salience to ideas/objects
- Excessive dopamine release leads to aberran assignment of salience to unimportant stimuli
- Delusions may arise from attempts to explain the abnormal salience
What are the treatment approaches to psychosis?
What prevention strategies are there for people with psychosis?
