Psychosis and schizophrenia Flashcards
Suggest a definition for psychosis and state whether or not they have insight
‘Experiencing a reality that is different to everyone else, it is not true’
In psychosis, they do NOT have insight
List 4 symptoms for psychosis
- Hallucinations
- Delusions
- Formal thought disorder
- Passivity phenomena / fragmentation of the boundaries of ‘self’
Outline the 5 senses that can be involved in hallucinations
- Auditory = most common, especially in psychosis
- Visual - more likely to be delirium or LB dementia
- Olfactory - frontal lobe pathology
- Gustatory
- Tactile
Suggest the difference between hallucinations and pseudohallucinations
Hallucinations:
- Clear, sharp image
- Colourful
- 3D/rotates
Pseudohallucinations:
- Fuzzy/blurred image
- Grey
- ‘Flat’
Pseudohallucinations are not true hallucinations
State the definition of delusion
- A fixed, firmly held belief that is (usually false), cannot be reasoned away despite evidence to the contrary
- Also out of keeping with a person’s sociocultural norms
State some different types of delusions
- Persecution
- Reference
- Control
- Thought possession
- Grandeur
- Poverty
- Guilt
- Nihilism
Briefly explain the following types of delusions:
- Persecution
- Reference
- Control
- Thought possession
- Grandeur
- Poverty
- Guilt
- Nihilism
Persecution - someone is out to get them
Reference - something did happen, but they’re drawing inappropriate meaning from it
Control - ‘made to do things’
Thought possession - everyone else knows their thoughts
Grandeur - they are more superior/important than other people
Poverty - they have no money/possessions
Guilt - they’ve committed an unforgivable sin
Nihilism - belief that something or someone no longer exists
Outline passivity phenomena
Feel that some aspect of themselves is under the control of others
Caninclude thought disorders e.g. broadcast, insertion and withdrawal
Suggest the types of delusions and hallucinations that occur in the following presentations:
- Schizophrenic
- Manic
- Depression
Schizophrenic:
- Persecutory delusions
- 3rd person hallucinations
Manic:
- Grandiose delusions
- 2nd person hallucinations
Depression:
- Guilt delusions
- Poverty delusions
- Nihilistic delusions
- 2nd person hallucinations
State the rough prevalence of schizophrenia in the UK
Approximately 0.7% of population currently
Lifetime prevalence of 1.5%
Rarely begins before 10 years old
Briefly explain the dopamine hypothesis for schizophrenia
States that schizophrenia is secondary to over-activity of mesolimbic dopamine pathways in the brain
Supported by the fact that antipsychotics work by blocking dopamine (D2) receptors
Further supported by notion that Parkinson drugs and Amphetamines activate the pathway leading to psychotic symptoms
State the major classifications of schizophrenia
- Paranoid (positive symptoms dominate)
- Post-schizophrenic depression (depression with schizophrenic illness in the past 12 months)
- Hebephrenic (thought disorganisation predominates)
- Catatonic
Others:
- Simple
- Undifferentiated
- Residual
List some positive features of schizophrenia (acute syndrome)
‘Additional’ features:
- 3rd person auditory hallucinations
- Delusions
- Thought disorders e.g. thought echo, broadcast, insertion, removal
- Passivisity
List some negative features of schizophrenia (chronic syndrome)
Hint: lots of ‘A’s
‘Withdrawn’ features - difficult to differentiate from depression:
- Anhedonia
- Asocial behaviour
- Affect blunted
- Attention (cognitive) deficits
- Avolition (low motivation motivation)
- Alogia (poverty of speech)
List some of Schneider’s first rank symptoms for schizophrenia (4 key ones)
One or more of these symptoms present indicates schizophrenia (alternative to ICD-10)
- Third person auditory hallucinations (usually running commentary)
- Thought interference = insertion, withdrawal or broadcast
- Passivity phenomenon
- Delusional perception (new delusion in response to a real perception without any logical sense e.g. the traffic light turned red so I am the chosen one)
State the bio-psycho-social factors that could contribute to development of schizophrenia
Bio:
- Genetics
- Neurotransmitter levels
- Birth issues e.g. prematurity, infection
Psycho:
- Family history
- Childhood abuse
Social:
- Substance misuse
- Low socioeconomic status
- Migration / asylum seekers
Outline the biological approach to assessment of a patient with suspected schizophrenia (investigations)
Bloods
- FBC (anaemia, infection)
- TFTs (thyroid dysfunction can present with psychosis)
- Serum calcium (hypercalcaemia can present with psychosis)
- Vitamin B12 and folate (deficiencies can cause psychosis)
- CT scan (space occupying lesions)
EEG (temporal lobe epilepsy as possible cause of psychosis)
Outline the bio-psycho-social approach to management of a patient with schizophrenia
Bio:
- Antipsychotics (atypical and typical) e.g. Risperidone or Olanzapine (Clozapine if treatment resistant)
- Consider adjuvant e.g. benzodiazepines (short-term relief), antidepressants or lithium
- ECT if catatonic or treatment resistant
Psycho:
- CBT
- Family therapy
- Art therapy if negative symptoms
- Social skills training
Social:
- Involvement of PIER team if first presentation
- Help to resolve debt / housing issues / financial issues
- Community Psychiatric Nurse (CPN)
- Social worker
Outline some risk factors for development of schizophrenia
- Genetic (risk proportional to the closeness of genetics)
- Childhood trauma e.g. poor maternal bonding
- Heavy cannabis use (esp. in development stage as a teenager)
- Maternal health issues / birth trauma
- Urban living / immigration to more developed countries
- Lower socioeconomic classes (? consequence or cause)
Suggest the general prognosis of schizophrenia (4 quarters!)
- 25% never have another episode
- 25% improve substantially with treatment
- 25% show some improvement
- 25% are resistant to treatment
State some poor prognostic factors for recovery from schizophrenia
- No obvious precipitant
- Poor intelligence (low IQ)
- Strong family history
- Gradual onset
- Social withdrawal prior to illness
State some routine investigations that can be done for individuals presenting with psychosis
- FBC and CRP (WCC for infection or signs of sepsis)
- Thyroid function tests (hyperthyroidism)
- Urinalysis (delirium secondary to UTI)
- Toxicology screen (drug induced psychosis)
- Infectious disease screens (if at risk)
- Neuroimaging (if evidence of neurological dysfunction)
State the prevalence of puerperal psychosis (how many women go on to develop it after birth)
1 in 1,000
When does puerperal psychosis develop
Usually in first few days, up to 2 weeks
Rarely can occur weeks after giving birth (within 6 weeks puerperal period)
State some symptoms of puerperal psychosis
- Mood: elated / severely depressed
- Sleep: difficulties / reduced need for sleep
- Socialness: very active / withdrawn
- Anxiety: irritability / restlessness
- Delusions
- Hallucinations
- Flight of ideas
- Disinhibited
- Severe confusion
State risk factors for puerperal psychosis
- Previous puerperal psychosis
- Family history of mental illness, especially puerperal psychosis
- Known diagnosis of bipolar disorder or schizophrenia
- Traumatic birth or pregnancy
List some complications of schizophrenia
- Suicide (5% lifetime risk)
- CVS disease
- Cancer (late presentation)
- Substance abuse (up to 30%)
- Social isolation
- Reduced life expectancy by 15 -25 years
