Psychosis and Schizophrenia Flashcards
define psychosis
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 reality
what are the classic characteristics of psychosis
hallucinations
delusions
disorder of the form of thought
lack of insight
inability to distinguish between subjective experience and reality
is harmful to individuals functioning and interpersonal relationships
what can psychosis occur in
organic conditions: delirium, dementia, brain injury, stroke
substance use: acute intoxication, withdrawal, delirium tremens
manic depressive psychosis: unipolar depression, bipolar depression
(schizoaffective disorder)
dementia praecox: shizophrenia
what is schizoaffective disorder
when someone has symptoms of both schizophrenia and mood disorder (BPAD, depression)
what are types of psychotic experiences
hallucinations
ideas of reference (thinking things have strong personal significance)
delusions
formal thought disorder (disorganised thoughts as evidenced by disorganised speech)
thought interference
passivity phenomena
loss of insight
what causes hallucinations
aberrent brain processing making you perceive things without stimulus
what is a hallucinations
a perception which occurs in the absence of an external stimulus
what are the qualities of a hallucination
is experienced as originating in real space (not in thoughts)
has same qualities as normal perception (vivid, solid, compelling)
not subject to conscious manipulation
can occur in any sensory modality: visual, auditory, olfactory, gustatory, tactile, hapatic
when only are hallucinations significant
only when in the context of other relevant symptoms
what are ideas of reference
innocuous or coincidental events will be ascribed significant meaning by the person:
messages in newspaper about them, news reports commenting on their life/ talking directly to them, knowing peoples conversations/ social media postings are about them, believing a radio station is broadcasting songs in a way to tell you something, seeing meaning in other peoples gestures
what are self referential experiences
the belief that external events are related to oneself
what are the qualities of self referential experiences
can vary in intensity from a brief thought to frequent and intrusive thoughts to delusional intensity
e.g.
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 (grandiosity)
persecutory - other people to blame
paranoia- self referential
what is a delusion
a fixed, falsely held belief
what are the qualities of a delusion
held with unshakable conviction
impervious to logical argument/ evidence to the contrary
held outwith the usual social, cultural, religious and educational background of the patient
may be bizarre or imposisble
what is a primary delusion
arrives fully formed in the consciousness without need for explanation
what are the types of delusion
Paranoid
Persecutory
Grandiose
Religious
Misidentification- people replaced by imposters (e.g. FBI agents)/ thinking different people are the same person
Guilt
Sin
Poverty
Nihilistic (that you have lost everything are bankrupt is no point. Capgrass- think you are dead)
Of Love/ erotomanic/ De cleramabult- thinking you are in love/ someone in public eye has fallen in love with you
Jealousy- Othello syndrome. This can lead to homicide so red flag
Of reference
what are secondary delusions
often attempts to explain anomalous experiences e.g. hallucinations, passivity experiences, depression
what determines the content of a delusion
is culturally defined- persecutor is often recognisable to society/ culture as a danger/ threat
how must thought disorders be inferred
from patterns in speech-cannot be directly observed
what are types of thought disorder
neologisms- make up new words and expect you to know what they mean
circumstantiality (talk around question then make point)/ tangentiality (will talk around point then go off on tangent and not make point)
clanging and punning
loosening of associations/ knights move thinking (sequence of unrelated/ loosely related ideas)
verbigeration/ word salad
what are the types of thought interference
thought insertion (thoughts put into head) thought withdrawal (thoughts taken out) thought broadcasting (everyone can see them) thought blocking (cant think for a while)
what are the types of passivity
volition- made action
affect- made feelings
impulse- made urges
somatic- influence on the body
what questions can you use to carefully challenge someones beliefs
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?”
“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 condition does 3rd person auditory hallucinations suggest
schizophrenia
what conditions can you get formal thought disorder
schizophrenia
mania
dementia/ delirium
what conditions can you get poverty of thought in
schizophrenia (sometimes)
depression
dementia/ delirium (sometimes)
what conditions can you get self referential delusions in
schizophrenia substance misuse mania depression dementia/ delirium
what conditions can you get grandiose delusions in
schizophrenia
substance misuse
mania
delirium/ dementia
what conditions can you get persecutory delusions in
schizophrenia substance misuse mania depression delirium/ dementia
what conditions can you get passivity phenomenon in
schizophrenia
substance misuse
delirium/ dementia
what conditions can you get 2nd person auditory hallucinations in
schizophrenia (sometimes) substance misuse mania depression delirium/ dementia
what conditions can you get 3rd person auditory hallucinations in
schizophrenia
substance misuse
delirium/ dementia
what conditions can you get visual hallucinations in
schizophrenia (sometimes)
substance misuse
delirium/ dementia
what conditions do you get fluctuant and variable symptoms
substance misuse
delirium/ dementia
what conditions can you get impaired conscious level
substance misuse (sometimes) delirium/ dementia
what is drug induced psychosis
psychotic episode related to substance misuse
not due to intoxication or withdrawal effects
what do you need to differentiate drug induced psychosis from
intoxication
withdrawal
co-morbidities of substance use (schizophrenia and BPAD)- pychotic symptoms in the context of substance misuse does not necessarily mean drug induced pyschosis
what are symptoms like in drug induced psychosis
may be florid/ insidious and chronic
tend to be short lasting if access to psychoactive substance is removed
what are the features of depressive psychosis
typified by mood congruent content of psychotic symptoms
delusions of worthlessness / guilt / hypochondriasis / poverty
hallucinations of accusing / insulting / threatening voices - typically 2nd person
what are the features of mania with psychosis
mood congruent content of psychotic symptoms
delusions of grandeur / special ability / persecution / religiosity
hallucinations- auditory, tend to be 2nd person
flight of ideas
what is delirium
acute transient disturbance caused by e.g. withdrawal, infection, medial/ surgical inpatients…
what are the features of delirium
clouding of consciousness - subtle drowsiness to unresponsive, disorientation in time, pace and person, fluctuating severity (lucid intervals), worse at night
impaired concentration/ memory (esp for new information)
visual hallucination/ illusions / auditory hallucinations (often threatening)
persecutory delusions
psychomotor disturbance (agitation/ retardation)
irritability
insomnia
what does ‘first rank’ symptoms of schizophrenia mean
symptoms that are suggestive of schizophrenia, in the absence of drug use or organic impairment, but are NOT pathognomic e.g. can occur in 20% of manic episodes
what are the core psychotic symptoms of schizophrenia (first rank symptoms)
delusion delusional percept auditory hallucinations audible thoughts voices arguing/ discussing voices commenting on patients action thought disorder: passivity thought interference (withdrawal, insertion, broadcasting) passivity experiences (delusion of control): affect, impulse, volition, somatic
what person are auditory hallucinations in schizophrenia commonly in
3rd person
what is the diagnostic criteria for schizophrenia
(1) At least one of the following:
Thought echo, thought insertion or withdrawal, or thought broadcasting.
Delusions of control, influence or passivity, clearly referred to body or limb movements or specific thoughts, actions, or sensations; delusional perception.
Hallucinatory voices giving a running commentary on the patient’s behaviour, or discussing him between themselves, or other types of hallucinatory voices coming from some part of the body.
Persistent delusions of other kinds that are culturally inappropriate and completely impossible (e.g. being able to control the weather, or being in communication with aliens from another world).
(2) or at least two of the following:
Persistent hallucinations in any modality, when occurring every day for at least one month, when accompanied by delusions (which may be fleeting or half-formed) without clear affective content, or when accompanied by persistent over-valued ideas.
Neologisms, breaks or interpolations in the train of thought, resulting in incoherence or irrelevant speech.
Catatonic behaviour, such as excitement, posturing or waxy flexibility, negativism, mutism and stupor.
“Negative” symptoms such as marked apathy, paucity of speech, and blunting or incongruity of emotional responses (it must be clear that these are not due to depression or to neuroleptic medication).
what are three subtypes of schizophrenia
paranoid (most common)
hebephrenic (immature/ innapropriate/ silly)
catatonic (movement disorder predominates, responds well to treatment- will hold posture for longer than you voluntarily could, will hold pose you put them in, wont respond to speech)
what are 4 other form of paranoid psychosis
Persistent Delusional Disorder
Systematised, fixed delusions the majority/ only feature
Schizotypal disorder
Eccentricity and aloofness, social withdrawal, paranoid quasi-delusional ideas, magical thinking, and transient auditory hallucinations
Acute and Transient Psychotic Disorder
Schizophernia-like symptoms, lasting < one months
Schizoaffective Disorder (bipolar + SZP)
First rank symptoms + depression/ mania
what are the positive syndromes in schizophrenia
hallucinations
delusions
passivity
disorder of form of thought
what are the negative syndromes in schizophrenia
reduced speech reduced motivation/ drive reduced interest/ pleasure reduced social interaction blunting of affect
who gets schizophrenia
lifetime risk 1%
more common in males
onset in young adults (15-25 males, 25-35 women)
higher incidence in lower socioeconomic class
what are the risk factors for schizophrenia
genetics
UK african-caribbean
birth complications (prematurity, prolonged labour, fetal distress, hypoxia)
prenatal exposure to viral infections, maternal stress, malnutrition
winter/ spring birth
drug use (cannabis)
urban dwelling
social adversity/ deprivation
neurodevelopmental changes (enlarged ventricles, thinner cortices)
neurochemical changes (excess dopamine signalling)
what are the premorbid features of schizophrenia
subtle motor, cognitive and social deficits in childhood
become greater as time goes on
what are the prodromal features of schizophrenia
gradual onset of non specific symptoms
odd ideas and experiences
eccentricity, altered affect, odd behaviours
what is the prognosis of schizophrenia
1/3rd only have one episode, are treated and return to wellness
1/3rd have repeated episodes returning to wellness inbetween
1/3rd have recurrent episodes but residual symptoms, dont return to wellness, decline over time
what are poor prognostic indicators for schizophrenia
poor pre morbid adjustment insidious onset early onset - childhood/ adolescence long duration of psychosis cognitive impairment enlarged ventricles
what are good prognostic indicators for schizophrenia
older age of onset female marked mood disturbance especially elation family history of mood disorder shorter time of untreated psychosis
how common is suicide in schizophrenia
10-15% completed suicide rate
high risk in first week after discharge
how common is homicide in schizophrenia
rare
take notice of command hallucination and delusions of jealousy
what causes schizophrenia
genetically disposed
mediated or exacerbated by environmental factors
what is the heritability of schizophrenia
79%
do opiates cause psychosis
no
what drugs increase the risk of schizophrenia
amphetamines
cocaine
cannabis
novel psychoactive substances
