Psychosis and Schizophrenia Flashcards
What is psychosis?
A mental disorder in which 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
What are the classic characteristic of psychosis?
- Hallucinations
- Delusions
- Disordered form of thought
What are the key factors of psychosis?
- Qualitatively different from normal experiences
- Inability to tell apart subjective experiences from reality
- Lack of insight
- Harmful to the individuals functioning and relationships
Give 4 examples of types of psychotic experiences.
- Hallucinations
- Passivity phenomena
- Delusions
- Formal thought disorder
Define the term hallucinations.
A perception which occurs in the absence of an external stimulus
What is a hallucination experienced as?
Originating in real space, not just in thoughts
Are the qualities of hallucination the same as normality?
YES - they are vivid, solid and compelling
What are hallucinations not subject to?
Conscious manipulation
What is passivity phenomena?
Belief that one is no longer in control of ones body, emotions or thoughts
What can hallucinations occur with?
Any sensory modality
When are hallucinations significant?
Only in the context of other relevant symptoms
Hallucinations can be?
Simple
OR
Complex
What is the pattern of brain activity during auditory hallucinations very similar to?
That in normal people, generating inner speech
What however, is the difference in auditory hallucinations compared to normal inner speech?
- Supplementary motor areas (monitor self-generated actions).
- Hippocampus – parahippocampal gyrus (detects mismatch between perceived and expected activity)
Name 3 types of auditory hallucinations.
- 2nd person
- 3rd person
- Thought echo
What do 2nd person voices do?
Directly address the patient
What do 3rd person voices do?
Discuss the patient, as if they were not there, or provide a running commentary of their actions
What happens in ‘thought echo’?
The patient experiences his own thoughts spoken or repeated out loud.
1st person is a hallucination
FALSE
In order to decide what type pf auditory hallucinations a patient is having, what should you ask them?
‘Do they speak to you, or about you?’
What are visual hallucinations often associated with?
Altered consciousness/organic impairment
Name, and give examples of 2 types of visual hallucinations.
Simple - flashes of lights
Complex - faces or figures
Name the 3 bodily sensations.
- Olfactory
- Gustatory
- Somatic
What is the sensation of insects crawling on the skin called? And what may this be an indication of?
Formication
- cocaine use
What is passivity phenomena?
Where behaviour is experienced as being controlled by an external agency, rather than by the individual.
What can passivity phenomena affect? How?
Thoughts – thought insertion, thought withdrawal, thought broadcasting.
What is the ‘theme’ of a delusion?
What the delusion is about
There are relatively few themes of delusion. Give examples of themes which more commonly occur in i) depression ii) schizophrenia iii) mania
i) Disease, nihilism, poverty, sin, guilt.
ii) Control, persecution, reference, religion, love.
iii) Grandiosity, persecution, religion.
What is the specific content of delusions defined by?
Culture
Delusions are often attempts to do what?
Explain anomalous (un-natural) experiences e.g. hallucinations, passivity experiences, depression. ie. secondary delusions.
“They are being transmitted by the Mafia”
Explanatory delusion
What are self-referential experiences?
The belief that external events are related to oneself
Describe how self-referential thought varies intensely.
From a brief thought, to frequent and intrusive thoughts to delusional intensity (self-referential delusions or delusions of reference).
Give examples of the beliefs people with self-referential thought have.
- The feeling that others are speaking about me / laughing at me
- The belief that TV or the radio are transmitting message for me
- The belief that car registration numbers contain hidden codes
What is a good way to bring up the fact that someone is psychotic when they don’t know they’re psychotic?
“I just want to check that I am understanding this correctly, I don’t want to misunderstand you, I think what you are saying is that ……
What kind of ways can you challenge a psychotic patient?
– “What would you say if someone said to you that [these beliefs] are not true?”
– “Can you just explain to me how this is possible?”
What are the ICD-10 diagnostic guidelines for Schizophrenia based on?
Sx which are suggestive of SZ, in the absence of drug use or organic impairment, but are NOT pathognomic ie. can occur in 1/5 manic episodes.
What are the 3 subtypes of SZ?
- Paranoid
- Hebephrenic
- Catatonic
Name 4 other paranoid psychosis.
Persistent delusional disorder
Schizotypal disorder
Acute and transient psychotic disorder
Schizoaffective disorder
List the +ve syndromes of SZ.
Hallucinations
Delusions
Passivity phenomena
Disorder of the form of thought
List the -ve syndromes of SZ.
Reduced amount of speech Reduction motivation/drive Reduced interests/pleasure Reduced social interaction Blunting affect
What is SZ?
Genetically determined neurodevelopmental vulnerability lateral triggered by environmental stressors
Who gets SZ more?
MALES (but only by slightly)
When is the peak incidence in men of SZ?
15-25
When is the peak incidence of SZ in women?
25-35
List 3 risk factors to developing SZ.
Genetics
Birth complications
Winter/spring birth
What do people who develop SZ have a higher rate of?
perinatal complications than controls e.g prematurity, prolonged labour, foetal distress, hypoxia
What drug increases your risk of SZ?
Cannabis
Living in the _____ makes you 2x’s more likely to develop SZ
Town/city
What neurodevelopment changes make you more likely to develop SZ?
Enlarged ventricles
+
Thinner cortices
What chemical pathway is altered in SZ?
Dopamine
List bad pre-morbid indicators in SZ.
Poor pre-morbid adjustment Insidious onset Early onset – childhood Long duration of untreated psychosis Cognitive impairment Enlarged ventricles
List good pre-morbid indicators in SZ.
Older age of onset
Female
Marked mood disturbance especially elation
Family history of mood disorder
What premorbid features, can be seen in childhood of those who go on to develop SZ?
Subtle motor, cognitive and social deficits in childhood that become greater as time goes on e.g delay in speech/walking
What does prodromal mean?
The time period between the initial onset of symptoms and the full diagnosis
What features are seen during the prodromal period of someone with SZ?
Gradual onset, non-specific symptoms
Odd ideas + experiences
Eccentricity, altered affect and odd behaviours
Name 3 of the core psychotic symptoms in SZ.
Auditory hallucinations.
Passivity phenomena.
Delusional perception.
Describe the auditory hallucinations in SZ.
- Hearing thoughts spoken aloud - thought echo
- Third person voices - ie. arguing/discussing
In form of running commentary
What does passivity phenomena in SZ entail?
Made acts/impulses/volition/feelings (thought insertion, thought withdrawal, thought broadcasting.
ie. being imposed or controlled by an external agency
What is a delusional perception?
A fully formed delusion which arises from real/genuine perception
What is the suicide rate in SZ?
10-15%
ALWAYS ask about mood when a patient presents which psychosis
What does SZ diagnosis remain based on?
A cluster of symptoms
People with SZ have a HIGHER RATE OF PERINATAL COMPLICATIONS than controls
TRUE
Give examples of perinatal complications that can be a risk for someone developing SZ.
Prematurity, prolonged labour, foetal distress, hypoxia.
- 2nd trimester prenatal exposure to viral infections or malnutrition are also hypothesised
What neurotransmitter has been implicated in SZ?
Dopamine
What 4 changes in brain structure/fn have been suggested to be associated with the development of SZ?
- Enlarged lateral ventricles (little progression over time).
- Reduced fronto-temporal volume (? Due to reduced size and arborisation of neurones).
- Reduced activation of prefrontal areas on specific tasks – impairment of tasks that involve frontal areas (ie. executive function).
- Schizophrenia and neurotransmitters.
What do drugs which release dopamine in the brain or that are D2 receptor agonists produce?
A psychotic state
Give an examples of a drug that releases dopamine in the brain.
Amphetamine
Give an example of a drug that is an A2 receptor agonist.
Apomorphine
What can amphetamine do to the sx of schizophrenia?
Makes them WORSE
What type of drug is used to treat the symptoms of SZ?
Dopamine receptor antagonists.
‘Overactivity of Dopamine pathways in the brain’ is associated with what condition
SZ
Name 3 dopaminergic pathways and state what each is responsible for.
Nigrostriatal – extrapyramidal motor system.
Mesolimbic/cortical – motivation reward systems.
Tuberoinfundibular – control of prolactin release.
3rd person auditory hallucinations suggest
SZ
What is present at diagnosis of SZ and it non-progressive?
Enlarged ventricles
What may cause onset/relapse of SZ?
Stress
What is depressive psychosis typified by?
Mood congruent content of psychotic sx
What does depressive psychosis involve delusions of?
Worthlessness / Guilt / Hypochondriasis / Poverty
What are the hallucinations associated with depressive psychosis like?
Accusing / Insulting / Threatening voices – typically 2nd person
What is mania with psychosis?
Mood congruent content of psychotic sx
What does mania with psychosis involve delusions with?
Grandeur / special ability /persecution / religiosity
What type of hallucinations is mania with psychosis?
Auditory ie. God’s voice
What is delirium?
An acute, transient disturbance
When may delirium occur?
In alcohol withdrawal, infection, medical/surgical in-patients . . .
…..septicaemia, organ failure (cardiac, renal, hepatic), hypoglycaemia, post-op hypoxia, post-ictal, encephalitis, space occupying lesion, drug intoxication (e.g. steroids, digoxin, diuretics, anticholinergics), drug withdrawal (e.g. benzodiazepines)
What happens to consciousness in delirium?
It becomes clouded
What does the parahippocampal gyrus do?
It detects mismatch between perceived and expected activity - so in auditory hallucinations this is faulty compared to normal inner thought
What is nihilism?
Rejection of all religious or moral principles
