Psychosis and Schizophrenia Flashcards
What is psychosis?
It is a distorted view or perception of reality
What is a delusion?
An unshakeable belief that is held despite evidence to the contrary and is not held by others of the same culture
What is a hallucination? Which form are most common in psychosis?
What is a pseudo hallucination?
This is a false sensory experience occurring in the absence of a stimulus (visual, auditory, tactile, gustatory, olfactory)
Auditory hallucinations are the most common on psychotic disorders
Visual hallucination are more suggestive of an organic cause
A pseudohallucination is when the person is experiencing the hallucination but they are aware it is not real
What are some organic and easily reversible causes of psychosis?
Delirium (due to infection, dehydration, constipation, retention), Brain disorders, metabolic disorders such as porphyria
Intoxication and withdrawal states can also cause psychotic symptoms (cannabis, opiates, alcohol)
What mental disorders can have psychotic symptoms?
Schizophrenia
Affective disorders (can occur in severe depression and mania)
Sleep or sensory deprivation (hallucinations are not pathological)
Bereavement (hallucination are not pathological)
Dementia (DLB)
Post-partum
What is thought disorder and what are some examples?
Abnormality in the mechanism of thinking Thought INSERTION Thought REMOVAL Though BROADCASTING Thought BLOCKING
How common is schizophrenia? Who is it more common in
It is the most common psychotic disorder
5-50/100,000
M>F (only slight)
Average onset late teens-30s
What are some risk factors for developing schizophrenia?
FH is a VERY STRONG RF Long term cannabis use Living in rural environment Being black or caribbean Being a migrant Winter babies (? second trimester flu vaccine)
What is the neurological aetiology in schizophrenia?
OVERACTIVITY OF DOPAMINE - particularly in the mesolimbic pathway
What are Schneider’s first rank symptom of schizophrenia
Auditory hallucination - usually in the form of voices
Delusions of control and passivity
Thought echo, insertion, withdrawal or broadcasting
Delusions
What factors are important to ask about if someone can hear voices?
Male or female Do you recognise them What do they say How does that make you feel 2nd or third person There all the time (when is it worse/better)? Have they ever issued commands? Insight - any chance these voices might not be real?
What are some common forms of delusion?
Persecutory (that someone is out to get them)
Grandiose (that they have special powers, abilities or importance)
Nihilistic (that they, or a part of their body is dead) - COTARD’S
Delusions of Reference (Special messages left only for them in the newspaper or on TV etc.)
Delusions of infestation (EKBOM’S)
What are some negative symptoms of schizophrenia?
Apathy Poverty of thought or speech Blunting of affect Social isolation Poor self care Cognitive deficits
How should you investigate someone presenting with schizophrenia?
Full interview + collateral hx
Rule out all organic causes
FBC, U&E, LFT, Glucose, TFT, Ca, Syphilis and HIV serology
Urine drug screen
ECG (a/ps prolong the QT interval and so it is a good idea to have baseline ECG before starting a/ps)
What would make you consider admission in a patient with schizophrenia?
If it is first episode of psychosis or there is considerable risk of harm to themselves or others
