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MD4001 Pathology > Psychosis > Flashcards

Psychosis Flashcards

1
Q

How do mental disorders vary?

A
  • Manifestations
  • Severity
  • Duration
  • Prognosis
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2
Q

What are different examples of psychotic disorders?

A
  • Schizophrenia
  • Bipolar disorder (previously known as manic-depressive illness)
  • Dissociative identity disorder (split-personality)
  • Schizoaffective disorders
  • Persistant delusional disorders
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3
Q

When was the term schizophrenia first used?

A
  • 1911 by Eugen Bleular (schizo - split, phrene - mind)

- First identified as a mental disorder by Emil Kraepelin

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4
Q

How prevelant is schizophrenia?

A

1%

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5
Q

When is schizophrenia usually diagnosed?

A
  • Men early 20’s

- Women late 20’s

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6
Q

What percentage of people who have a first acute psychotic episode recover?

A

20%

- 80% will go on to suffer other acute psychotic episodes

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7
Q

What perenage of schizophrenics die by suicide?

A

10%

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8
Q

What percentage of schizophrenics are employed?

A

19%

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9
Q

What are the symptoms of schizophrenia?

A
  • Pervasive thought disturbance
  • Difficulty in ignoring irrelevant stimuli (external or internal)
  • Cognitive defecits
  • Withdrawal from personal contact
  • Delusions
  • Hallucinations
  • Emotional disorder
  • Behavioural disruption
    Happen in an episodic manner
    Lack of insight into their symptoms and behaviour (severe consequence in aprticular in relation to adherence to medication)
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10
Q

What are positive symptoms of schizophrenia?

A

Symptoms that are in addition to what the average person might experience (dellusions, hallucinations)

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11
Q

What are negative symptoms of schizophrenia?

A

Less than or reduced to what the average person might experience (e.g cognitive deficits, depression)

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12
Q

What are the 2 methods of diagnosing schizophrenia?

A
  • DSM-5 (american psychiatry association)

- ICD-10 (2016) (WHO)

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13
Q

How is schizophrenia diagnosed using the DSM-5 criteria?

A

At least 2 of these symptoms for a significant time during a 1 month period
- Delusions
- Hallucinations
- Disorganised speech
- Grossly disorganised or catatonic behaviour
- Negative symptoms (reduced emotional expression)
AND social / occupation dysfunction
AND overt symptoms for 1 month and prodromal features for at least 6 months

Exclusions:
- Dominant mood symptoms, schizo-affective disorder, physiological effects of substance misuse, organic cause of symptoms

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14
Q

How is schizophrenia diagnosed using the ICD-10 criteria?

A 
At least 2 of these symptoms for a significant time during 1 month period
- Thought echo / insertion / withdrawal / broadcasting
- Passivity, delusional perception 
- Voices commenting or discussing 
- Persistent bizarre delusions 
OR less specified symptom of 
- Other persistent hallucinations 
- Thought disorder 
- Catatonia 
- Negative symptoms 
- Significant behaviour change 
AND overt symptoms for more than 1 month

Exclusions:

  • Dominant mood symptoms
  • Schizo-affective disorder
  • Drug intoxication or withdrawal
  • Overt brain disease
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15
Q

What are the cognitive defecits (executive function) of schizophrenia?

A
  • Sustained attention
  • Palnning
  • Verbal and visuo-spatial working memory
  • Language skills
  • Explicit learning and memory
  • Perceptual / motor processing
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16
Q

What is one of the causes / symptoms which may lead to schizophrenia?

A
  • Few early friends
  • Little oppotunity for social reality testing
  • Can’t distinguish between reality and fantasy
17
Q

What do schzophrenic delusions usually consist of?

A
  • Based on external stimuli
  • Ideas of reference (irrelevant, unrelated or innocuous things in the world are referring to them directly)
  • Changes in salience (change in importnace of external stimuli)
  • Create a dellusional system
  • Often paranoid delusions
18
Q

What are the most common type of halucinations in schizophrenia?

A

Auditory hallucinations (65% of those who experience schizophrenia) (internal stimuli)

19
Q

How can schizophrenia affect emotions?

A
  • Emotional reactivity - small rejections can have a profound emotional effect
  • Later on they may have a lack of emotions / inappropriate emotions
20
Q

How can schizophrenia affect behaviour and movement?

A
  • Catatonia (freezing all of a sudden then become extremely active) (catatonic schizophrenia)
  • Disorganised behavoural presentation - movements started but not completed (disorganised schizophrenia)
21
Q

What are the subtyoes of schizophrenia?

A
  • Catatonic
  • Disorganised (hebephrenic)
  • Paranoid
  • Simple
  • Undifferentiated
  • Residual (few positive symptoms)
22
Q

What are the different types of factors which can cause schizophrenia?

A
  • Genetics
  • Physiological
  • Anatomical
  • Psychosocial
23
Q

If an identical twin has schizophrenia what is the risk for the opposite twin has it?

A

50%

24
Q

What are the possible physiological symptoms responsible for schizophrenia?

A
  • Dopamine hypothesis (classical antipsychotics, overstimulation)
  • Dopamine-serotonin interaction hypothesis (atypical antipsychotics)
  • Ach, glutamate, GABA may also play a role
25
Q

What is an increase in dopamine associated with in terms of schizophrenia?

A

Increase in positive symptoms

26
Q

How can schizophrenia affect the anatomy of the brain?

A
  • In some individuals a reduction in volume and increase in size of ventricles may be present (hypoxia at birth may be responsible)
  • Micro anatomical changes (missing or abnormally sized neurons in thalamocortical loop - associated with identifying and processing stimuli)
27
Q

What psychosocial factors may cause schizophrenia?

A
  • Social class
  • Minority position
  • Urban environment
  • Family environment
  • Cannabis use (also nicotine)
28
Q

How can the diathesis model be applied to schizophrenia?

A

Individuals may be vulnerbale to schizophrenia (genetically) but additional stressor results in the development of the disorder

29
Q

What are the main drug therapies used to treat schizophrenia?

A
  • Classical antipsychotics

- Atypical antipsychotics

30
Q

What are the main drug therapies used to treat schizophrenia?

A
  • Classical antipsychotics

- Atypical antipsychotics

31
Q

What can some side-effects of anti-psychotics be?

A
  • Cardiac irregularities
  • Dry mouth
  • Weight gain
  • Motor symptoms (uncontrolable motor movements, ‘ticks’ ‘Tardive dyskinesia’)
32
Q

What are some psychological interventions available for schizophrenia?

A
  • Family intervention (education and coping, work with family)
  • CBT
  • Social-skills training
33
Q

What are the different aspects of early intervention and assessment (ususally following first psychotic episode)?

A
  • Psychiatric
  • Medical
  • Physical
  • Psychological
  • Developmental
  • Social
  • Occupational and educational
  • QOL
  • Economic
34
Q

How is a aptient treated usually after their first psychotic episode?

A
  • Oral antipsychotic medication in conjunction with psychological intervention (family intervention and individual CBT)
35
Q

How is schizophrenia treated long-term?

A
  • Continue treatment and care (psychosis servises or specialist community-based team)
  • Offer CBT to assist in promoting recovery
  • Offer family intervention
  • Consider offering depot or long-acting antipsychotic medication if the patient would prefer it after an acute episode or to avoid covert non-adherence as a clinical priority
  • Monitor physical health regularly, particularly in relation to potential side effects of medication, but also overall physical health
36
Q

What percentage of schizophrenics are independant/dependant?

A
  • 30% independant
  • 50% relatively dependant
  • 20% highly dependant

MD4001 Pathology (18 decks)

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