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Psychiatry > Psychosis and schizophrenia > Flashcards

Psychosis and schizophrenia Flashcards

1
Q

What is psychosis?

A

Mental disorder in which the thoughts, affective response or ability to recognise reality, and the ability to communicate and relate to others, are sufficiently impaired to interfere grossly with the capacity to deal with reality

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2
Q

What are the classical characteristics of psychosis?

A

Hallucinations, delusions and disorder of the form of thought with lack of insight

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3
Q

Name conditions that are associated with psychosis

A
  • organic conditions; delirium, dementias, brain injury, stroke etc
  • substance use; acute intoxication, withdrawal, delirium tremens
  • schizophrenia and other paranoid illnesses
  • manic depressive psychosis > unipolar depression, bipolar depression
  • schizoaffective disorder
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4
Q

Name examples of psychotic experiences

A
  • hallucination
  • ideas of reference
  • delusions
  • formal thought disorder
  • thought interference
  • passivity phenomena
  • loss of insight
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5
Q

What is a hallucination?

A
  • a perception which occurs in the absence of an external stimulus
  • is experienced as originating in real space, not just in thoughts
  • is vivid, solid and compelling
  • not subject to conscious manipulation
  • can occur in any sensory modality
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6
Q

What are the different types of auditory hallucination?

A
  • second person voices which directly address the patient

- third person voices which discuss the patient or provide a running commentary on his actions

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7
Q

What is thought echo?

A

The patient experiences their own thought spoken or repeated outloud

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8
Q

What are somatic hallucinations?

A
  • bodily sensations
  • e.g. insects crawling under the skin
  • e.g. being touched
  • haptic > deep sensations i.e. organs moved around etc
  • tactile > bugs crawling
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9
Q

What are ideas of reference?

A

Innocuous or coincidental events will be ascribed significant meaning by the person

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10
Q

Describe examples of ideas of reference

A
  • thinking that there are really messages in the newspaper about them
  • believing that the news report on TV is commenting on their life or talking directly to them
  • knowing peoples conversations or social media posts are about them
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11
Q

What is the pathophysiology behind ideas of reference?

A

Aberrant signalling of dopamine attached to insignificant things therefore adding meaning to the patient

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12
Q

What are self-referential experiences?

A
  • the belief that external events are related to oneself
  • can vary in intensity from a brief thought, to frequent and intrusive thoughts to delusional intensity (self-referential delusions or delusions of reference)
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13
Q

Describe examples of self-referential experiences

A
  • the feeling that others are speaking about me / laughing at me
  • the belief that TV or the radio are transmitting messaged aimed at me
  • the belief that I am the second coming of Christ (grandiose illusion)
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14
Q

What are delusions?

A
  • a fixed, falsely held belief
  • held with unshakeable conviction
  • held out-with the usual social, cultural and educational background of the patient
  • may be bizarre or impossible
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15
Q

What are primary delusions?

A

Arrive fully formed in the consciousness without need for explanation - suddenly they know

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16
Q

What are secondary delusions?

A

Are often attempts to explain anomalous experiences e.g. hallucinations, passivity experiences, delusions. More common, e.g. hear voices next door then think they are talking about you

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17
Q

What are the different types of delusions (themes)?

A
  • paranoid
  • persecutory
  • grandiose
  • religious
  • misidentification >capgras and fregoli
  • sin
  • poverty
  • nihilistic >capgrass
  • erotomanic >declerambault
  • jealousy
  • of reference
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18
Q

What are de-clerambault delusions?

A

Public figure is in love with you and they are trying to communicate that

19
Q

What are capgrass delusions?

A

Walking corpse syndrome (usually combined with haptic or olfactory delusions)

20
Q

What are fregoli delusions?

A

Same person is all the imposters around you, they change their appearance rapidly

21
Q

What are capgras delusions?

A

People have been replaced by imposters

22
Q

What are the different forms of thought disorder?

A
  • clanging and punning
  • loosening of associations
  • knights move thinking
  • neologisms
  • circumstantiality / tangentiality (circle around a point but eventually get there or go on complete tangent)
  • verbigeration / word salad
23
Q

3rd person auditory hallucinations suggest what diagnosis?

A

Schizophrenia

24
Q

Describe the features of depressive psychosis

A
  • typified by mood congruent content of psychotic symptoms
  • delusions of worthlessness / guilt / hypochondriasis / poverty
  • hallucinations of accusing / insulting / threatening voices - typically 2nd person
25
Q

Describe the features of mania with psychosis

A
  • typified by mood congruent content of psychotic symptoms
  • delusions of grandeur / special ability / persecution / religiosity
  • hallucinations; tend to be 2nd person
  • flight of ideas
26
Q

What is delirium and in what conditions can it occur?

A
  • acute, transient disturbance
  • e.g. in alcohol withdrawal, infection, septicaemia, organ failure, hypoglycaemia, post-op hypoxia, post-ictal, encephalitis, stroke, SOL, drug intoxication, drug withdrawal
27
Q

Describe the features of delirium

A
  • clouding of consciousness; ranges from subtle drowsiness to unresponsive
  • disorenientation in time, place and person
  • fluctuating severity over time (lucid intervals)
  • worse at night
  • impaired concentration / memory, especially new info
  • visual hallucinations / illusions
  • persecutory delusions
  • psychomotor disturbance; agitation or retardation
  • irritability
  • insomnia
28
Q

What are the core psychotic symptoms of shizophrenia (shneiders symptoms of first rank)

A
  • delusions
  • auditory hallucinations; audible thoughts, voices arguing or discussing, or commenting on patient
  • thought interference; passivity of thought, withdrawal, insertion, broadcasting
  • passivity phenomena; control, affect, impulse, volition, somatic passivity
29
Q

What is the ICD-10 criteria for schizophrenia diagnosis?

A

At least one;
-though echo, insertion or withdrawal or broadcasting
- delusions of control, influence or passivity clearly referred to a body or limb
- halluinatory voices
- persistent delusions of other kinds
Or at least 2;
- persistent hallucinations in any modality when occuring every day for at leas one month when accompanied by delusions
- neologism, breaks or interpolations in train of thought
- catatonic behaviour
- negative symptoms such as marked apathy, paucity of speech and blunting of emotional responses

Should be present for most of the time during an episode of psychotic illness lasting for at least one month

30
Q

What are the sub-types of schizophrenia?

A
  • paranoid; typical, most common form, 1st rank symptoms predominate
  • hebephrenic; affective changes are prominent, delusions and hallucinations fleeting and fragmentary, behaviour irresponsible and unpredictable
  • catatonic; movement disorder predominates
  • simple
  • undifferentiated
  • residual
  • other
31
Q

What is persistent delusional disorder?

A
  • a paranoid psychoses

- systematised, fixed delusions the major or only feature

32
Q

What is schizotypal disorder?

A
  • a paranoid psychoses
  • eccentricity and aloofness, social withdrawal, paranoid quasi-delusional ideas, magical thinking and transient auditory hallucinations
33
Q

What is acute and transient psychotic disorder?

A
  • a paranoid psychoses

- schizophrenia like symptoms, lasting

34
Q

What is schizoaffective disorder?

A
  • a paranoid psychoses

- first rank symptoms +depression or mania

35
Q

What are the positive and negative symptoms of paranoid psychoses?

A 
\+ve;
- hallucinations 
- delusions 
- passivity phenomena 
- disorder of the form of thought 
-ve;
- reduced amount of speech 
- reduced motivation / rive 
- reduced interest / pleasure 
 reduced social interaction 
- blunting of affect
36
Q

Describe the aetiology of schizophrenia

A
  • lifetime risk about 1%
  • male to female 1.4:1
  • onset in young adults
  • peak incidence 15-25 years for men, 25-35 for women
  • higher incidence in lower socioeconomic class
37
Q

Name risk factors for schizophrenia

A
  • drug use
  • urban dwelling
  • social adversity or deprivation
  • neurodevelopmental changes; enlarged ventricles, thinner cortices
  • neurochemical changes; altered dopamine signalling
  • maternal infecction?
  • genetics
38
Q

What are the indicators of poor prognosis of schizophrenia?

A
  • poor pre-morbid adjustment
  • insidious onset
  • early onset; childhood/ adolescence
  • long duration of untreated psychosis
  • cognitive impairment
  • enlarged ventricles
39
Q

What is the drug treatment pathway for schizophrenia?

A
  • 2nd generation antipsychotic; adequate dose for 6-8 weeks
    if not sufficient
  • 1st or 2nd generation antipsychotic; adequate dose for 6-8 weeks
    if not sufficient
  • check diagnosis, consider psychological input, optimise social supports, check compliance
    if all suitable above
  • consider clozapine
    if not sufficient
  • higher dose? combine two antipsychotics?
40
Q

Name substances that increase the risk of psychosis

A
  • amphetamines
  • cocaine
  • cannabis
  • novel psychoactive substances (e.g. ivory, wave, spice)
41
Q

What anatomical changes in the brain are present in patients with schizophrenia?

A
  • reduced frontal lobe volume
  • reduced frontal lobe grey matter
  • enlarged lateral ventricle volume
  • reduced activation of prefrontal areas on specific tasks
42
Q

Describe the dopamine hypothesis of schizophrenia

A
  • drugs which release dopamine in the brain (e.g. amphetamine) or D2 receptor agonist (apomorphine) produce a psychotic state
  • amphetamine can make symptoms of schizophrenia worse
  • dopamine receptor antagonists are used to treat the symptoms of schizophrenia
  • it is assumed that schizophrenia is related to overactivity of dopamine pathways in the brain
43
Q

What are the identified gene alterations in patients with schizophrenia?

A
  • neurregulin; a signalling protein that mediates cell-cell interactions and plays critical roles in the growth and development of multiple organ system
  • dysbindin; essential for adaptive neural plasticity
  • DISC-1; involved in neurite outgrowth and cortical development through its interaction with other proteins

Psychiatry (13 decks)

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