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CP2 Psychiatry > Psychosis and Schizophrenia > Flashcards

Psychosis and Schizophrenia Flashcards

1
Q

Define Psychosis

A

Mismatch between representation of reality in individual’s mind and representation supported by objective evidence

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2
Q

Classify psychosis

A

Perception and thought

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3
Q

Define Delusion

A

Unshakeable belief (fixed form belief), derived by erroneous inference, out of keeping with social or cultural beliefs

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4
Q

Themes of delusion

A

Persecution, infidelity, erotomania, grandiosity, ill-health, guilt, nihilistic, poverty

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5
Q

Symptoms of psychosis

A
  • Delusions
  • Hallucinations
  • Formal thought disorder
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6
Q

Define hallucination

A

Hallucination is a percept without object i.e. a sensory experience without an external stimulus

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7
Q

Types of hallucination

A

Any sensory modality

  • Auditory (hearing)
  • Visual (vision)]
  • Tactile (Touch)
  • Olfactory (smell)
  • Gustatory (Taste)
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8
Q

Formal Thought disorder

A

A pattern of disordered language that reflects disordered thought form

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9
Q

Examples of formal thought disorder

A
  • Loosening of association (derailment)
  • Flight of ideas
  • Circumstantial thoughts
  • Tangential thoughts
  • Thought block
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10
Q

Most common form of hallucinations within schizophrenia and psychosis

A

Auditory hallucinations

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11
Q

What % of the population are estimated to be experiencing hearing voices?

A

5-28%

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12
Q

List positive symptoms of schizophrenia

A
  • Thought disorder
  • Disorganised behaviour
  • Delusions
  • Hallucinations
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13
Q

List negative symptoms of schizophrenia

A
  • Social withdrawal
  • reduced attention
  • Blunted affect
  • Avolition
  • Poverty of speech
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14
Q

Scheider’s First Rank Symptoms

A 
ABCD 
Auditory Hallucinations
Broadcasting of thought
Controlled thought (delusions of control)
Delusional Perception

(Thought echo, third persona auditory hallucination, delusional perception, made volition, somatic passivity)

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15
Q

Clinical features of Schizophrenia

A 
Reality distortion (Positive)
Disorganisation (Positive)
Psychomotor poverty (negative)
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16
Q

Characteristic reality distortions of schizophrenia

A

Third person auditory hallucinations

Alien influence over thought

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17
Q

Organic causes of psychosis

A
  • Delirium
  • medication-induced (corticosteroids, stimulants, dopamine agonists)
  • Endocrine disorders (Cushing’s, hypothyroidism, hyperthyroidism)
  • Neurological disorder (temporal lobe epilepsy, MS, movement disorders, Wilson’s disease, Huntington’s disease)
  • Systemic diseases (porphyria, SLE)
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18
Q

Schizophrenic cause of psychosis presentation

A
  • Symptoms present for longer than 28 days
  • First rank symptoms present OR persistent hallucinations and delusions
  • Negative and cognitive symptoms
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19
Q

Other psychiatric causes of psychosis

A
  • Schizoaffective disorder (mix of first rank symptoms and mood symptoms)
  • Delusional disorder (non-first rank delusional belief with minimal hallucination)
  • Schizotypal disorder
  • Acute and transient psychotic disorder (symptoms <28 days)
  • Mood disorder (Mania, severe depression)
  • Substance misuse (alcohol withdrawal, intoxication with stimulants, cannabis)
20
Q

Epidemiology of schizophrenia

A
  • 1/100 lifetime risk
  • M=F
  • Very rare <14y/o
  • Rare 14-16 y/o
  • Peak incidence = 23y/o male; 26 y/o female (second peak between 30-40)
  • Urban > rural
  • Lower social class
21
Q

Biological aetiology of schizophrenia

A
  • Genetic - family history (possible multiple genes)
  • Obstetric complication (increased risk)
  • Dopamine theory
  • Neurodevelopmental theory
22
Q

Risk of schizophrenia increases by __ if ___ has schizophrenia

A 
46% - Identical twin 
40% - Both parents
15% - One sibling/fraternal twin
15% - One parent
6% - One grandparents
1% - No relatives
23
Q

Psychological aetiology of schizophrenia

A

Cognitive errors - jumping to conclusions (especially in delusions and paranoia)
Premorbid personality - schizotypal disorder

24
Q

Social aetiology of schizophrenia

A

Urban living (x2/3)
Migration (x3)
Life events (incl. physical + sexual abuse)
Ethnicity (x4 in Afro-Carribeans in UK; higher incidence in South Asians)

25
Prodrome
The period of time where the individual is gradually developing symptoms but has not yet met the criteria for diagnosis
26
Prodromal symptoms
Non-specific negative symptoms Emotion distress/agitation without reason Transient psychotic symptoms
27
What is the average DUP?
DUP = duration of untreated psychosis over a year
28
Aims of management
Establish a diagnosis | Manage condition
29
Management if: Urgent/immediate concerns regarding risk s because of patient's psychotic symptoms BUT risks can be adequately managed in community with intensive input
Crisis Resolution and Home Treatment (CRHT) Team
30
Management if: Urgent/immediate concerns regarding risk s because of patient's psychotic symptoms BUT risks cannot be adequately managed in community with intensive input and patient is willing to come to hospital
Informal Admission to a psychiatric ward
31
Management if: Urgent/immediate concerns regarding risk s because of patient's psychotic symptoms BUT risks cannot be adequately managed in community with intensive input and patient is NOT willing to come to hospital
Mental Health Act (MHA) assessment to determine if patient needs detaining
32
Management if: | NO urgent/immediate concerns regarding risks and patient is aged 18-35 and first episode
Early Intervention in Psychosis Team (EIP)
33
Management if: NO urgent/immediate concerns regarding risks and patient is NOT aged 18-35 and NOT first episode but has Established psychotic illness and needs a period of intensive psychiatric rehabilitation to improve functioning
Community Rehabilitation Service
34
List first generation (typical) anti-psychotics
``` Chlorpromazine Haloperidol Zuclopenthixol Flupentixol Fluphenazine ```
35
List second generation (atypicals) anti-psychotics
``` Olanzapine Risperidone Quetiapine Aripiprazole Clozapine for treatment resistant schizophrenia ```
36
Common reasons for non-compliance in treatment of schizophrenia
``` Lack of insight Side effects Delusions about medication/prescriber Patient feels better when ill Remission from symptoms and no longer thinks medication is required ```
37
Standardised mortality rate in schizophrenia
nearly 5x higher
38
What physical diseases are schizophrenics at increased risk of? What are contributing factors?
Cardiovascular disease, diabetes, stroke CF: poor diet, reduced physical activity, smoking, not engaging with physical health monitoring, antipsychotics increase the risk of metabolic syndrome
39
Physical health monitoring in schizophrenia - Baseline measurements and every year
Smoking and drinking status Personal/family history of diabetes/coronary heart disease BP, BMI blood for FBC, RFT, LFT, glucose and lipid ECG
40
What is TRS? How do you diagnose TRS?
Treatment resistant schizophrenia TRS = lack of response to adequate doses of 2 antipsychotics. Before diagnosis, review diagnosis, rule out co-morbid substance misuse, ensure dose, duration and compliance with previous treatment
41
Psychological Treatment - NICE GUidelines
Cognitive Behavioural Therapy - recent NICE guidelines CG178 have stated that everyone with psychosis/ schizophrenia should be offered CBTp (cognitive behavioural therapy for psychosis). Family Intervention Therapy (FIT) - NICE CG178 also made recommendations on the provision of family intervention therapy to family members and the service user where appropriate, and offering carers education and support programmes.
42
Other psychological therapies
``` PSYCHOEDUCATION -relapse signature/early -relapse signs -Crisis plans -relapse prevention -WRAP (wellness, Recovery and Action Plans) COPING STRATEGIES MAASTRICHT INTERVIEW (voice hearers) CONCORDANCE THERAPY ```
43
Social management of schizophrenia
- Daytime activities/ occupation/ employment/ education/ leisure hobbies - Family - Accommodation - Benefits - Relationships - Cultural needs - Safeguarding
44
Follow-up considerations for schizophrenia
- Monitor mental state - Monitor treatment effectiveness and S/E - Monitor risk - Monitor support system - Further psychoeducation
45
Carer's needs (Expressed Emotion)
Carer's emotional reaction to the individual with schizophrenia: 3 different domains: - criticism - hostility - over-involvement

CP2 Psychiatry (2 decks)

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