Psychosis Flashcards
What is schizophrenia and how is it characterised?
Group of brain disorders characterised by disorders of thought, behaviour, perception and emotion
What is the one pathognomonic symptom of schizophrenia?
There isn’t one!
Having more than one symptom increases the risk
There is a strong genetic link to schizophrenia. True/False?
True
Triggered by environmental stressors
List 4 “positive” symptoms of schizophrenia
Delusions
Hallucinations
Thought disorder
Passivity phenomena
List 4 “negative” symptoms of schizophrenia
Reduced amount of speech Reduced motivation/ drive Reduced interest/ pleasure Reduced social interaction Blunting of affect
Positive symptoms are harder to treat than negative symptoms in schizophrenia. True/False?
False
Positive symptoms are often easier to treat
According to Schneider’s first rank symptoms for schizophrenia, list some thought interferences
Thought withdrawal
Thought broadcasting
Thought insertion
Thought blocking
What is passivity phenomena?
Experience where acts/emotions/feelings are being controlled by an external party
A patient must have Schneider’s first rank symptoms to be diagnosed with schizophrenia. True/False?
False
They are not pathognomonic and can be seen in other psychoses
What is a delusion?
A fixed belief that cannot be changed by logical thought or evidence
Primary (arises out of the blue) or secondary (attempt to explain anomalous experiences)
What is a hallucination?
Perceptual, fantastical experience that is believed to be real in absence of external stimulus
List the different modalities by which hallucinations can occur
Auditory (most common) Visual Olfactory Gustatory Tactile Haptic (feel deep organs)
Which type of auditory hallucination - 1st, 2nd or 3rd person - is more typical of schizophrenia?
3rd person
According to Schneider’s first rank symptoms for schizophrenia, list some thought disorders
Neoligisms (own dictionary) Circumstantiality/ tangentiality Clanging and punning Loosening of associations Word salad
What is meant by thought withdrawal?
Belief that thoughts are being removed by an external party - a delusional explanation for thought blocking
What is meant by thought broadcasting?
Belief that people have access to and understand your thoughts without you having to voice them
List features of emotional disorder that can occur in psychoses such as schizophrenia
Blunted affect Incongruent mood Apathy Lack of motivation Anhedonia
What is the main motor disorder that may occur in schizophrenia?
Catatonia
What is catatonia?
State of increased tone of muscles at rest, abolished by voluntary activity
What are the main treatments for catatonia?
ECT
Benzodiazepines
What is the peak incidence of schizophrenia for men and women?
Men: 15-25
Women: 25-35
List factors that indicate good prognosis for schizophrenia
Older onset
Female
Marked mood disturbance e.g. elation
FHx of mood disorder
List factors that indicate poor prognosis for schizophrenia
Long duration of untreated psychosis
Insidious early onset
Cognitive impairment
Enlarged brain ventricles
Psychosis is a diagnosis. True/False?
False
Description of symptoms rather than diagnosis
List psychotic experiences
Hallucinations Delusions Thought disorders Emotional disturbance Passivity phenomena Idea of reference
List the main differential diagnoses of psychosis
Schizophrenia Schizoaffective disorder Drug toxicity or withdrawal Mania Depression Delusional disorder Puerperal psychosis Delirium Dementia
How does tangential thinking differ from circumstantial thinking?
Tangential: wander off from topic/question and never return
Circumstantial: excessive detail relating to topic, eventually return to topic
What is meant by idea of reference vs. self-referential experience?
Innocuous events will be ascribed significant meaning by the person
Belief that environment is reacting to you, i.e. external events are related to oneself
e.g. TV/radio is talking to you specifically
List some common drugs that can cause drug-induced psychosis
Steroids Cannabis Amphetamine Cocaine Tobacco Alcohol Opioids
How is depressive psychosis classically typified?
Mood congruent with psychosis - delusions of guilt/pessimism/worthlessness on top of depressed mood
Can be accusing/ insulting/ threatening voices (usually secondary hallucinations)
List types of delusions
Paranoid Persecutory (somebody is trying to harm you) Grandiose Religious Misidentification Guilt Sin Nihilistic (delusion about something non-existent) Love Jealousy
What is schizoaffective disorder?
Mixed picture of schizophrenia + bipolar disorder where someone displays schizophrenia but their mood is also affected
At what time of day is delirium typically worse at?
Night
What are the 3 main cortical changes that occur in schizophrenia?
Reduced frontal lobe volume
Reduced frontal lobe grey matter
Enlarged (lateral) ventricles
Which neurotransmitter causes a psychotic state when in excess?
Dopamine
List the 3 main dopaminergic pathways in the brain
Nigrostriatal (extrapyramidal)
Mesolimbic (motivation and reward system)
Tuberoinfundibular (control of PRL release)
Which dopaminergic pathway is typically involved in schizophrenia?
Mesolimbic system
Subcortical dopamine hyperactivity/hypoactivity leads to psychosis
Mesocortical hyper/hypoactivity leads to cognitive symptoms
Subcortical dopamine hyperactivity leads to psychosis
Mesocortical hypoactivity leads to cognitive symptoms
List the 3 main subtypes of schizophrenia and give a brief description of each
PARANOID: most common, typical, 1st rank symptoms
HEBEPHRENIC: youth and frivality - tells jokes a lot, pranks
CATATONIC: movement disorder predominates
An acute and transient psychotic disorder can be attributed to two main causes. State these.
Stress
Substance misuse
What is meant by the term ‘schizoaffective disorder’
Symptoms of both schizophrenia and either depression or bipolar disorder - episodes of low mood and/ or mania
List risk factors for schizophrenia
Genetics
Birth complications and/or illness in pregnancy
Drug use
Urban dwelling
Social adversity or deprivation
Neurodevelopmental or neurochemical changes
Outline the natural history of schizophrenia
Motor, cognitive or social deficits in childhood
Gradual onset of prodromal features - odd ideas, experiences, behaviours, eccentricity, altered affect
When is suicide risk in schizophrenia the highest?
1st week of discharge from hospital
List signs to watch out for in a schizophrenic patient, that could lead to homocide
Command hallucinations
Delusions of jealousy
What is psychosis and how is it characterised?
Inability to distinguish subjective experience from reality, characterised by lack of insight and harm to functioning
Hallucinations, delusions, thought disorders
List phrases that can be used to confront someone about their psychotic beliefs
‘I just want to check I’m not misunderstanding you’
‘What would you say if someone said they’re not true’
‘I think there’s evidence you are unwell and need to be in hospital for treatment although I recognise you disagree with this’
How is depressive psychosis classically typified?
Mood congruent with psychosis - delusions of grandeur/ special ability/ persecutions/ religiosity and flight of ideas
Can be secondary auditory hallucinations e.g God’s voice
How is delirium classically typified?
Acute treatment disturbance with fluctuating severity
Clouding of consciousness, disorientation to time and place, impaired concentration/ memory, irritability
Can be secondary hallucinations (usually visual, or auditory) and persecutory delusions
Which recreational drug has the highest risk for developing schizophrenia with use?
Cannabis
Which recreational drug releases dopamine and therefore produces a psychotic state?
Amphetamine
