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?
Age of onset?
Who is it more common in?
It is the most common psychotic disorder
- 1% prevalence
- Peak onset is twenties for men, women have later age of onset generally (26-32 years)
- M>F but only slight
What are some risk factors for developing schizophrenia?
- VERY STRONG family history link
- urban areas
- low SES
- migrant (literally moving around increases risk)
- long term cannibis use
- Afro-Caribbean
- Winter babies (? second trimester flu vaccine)
What is the neurological aetiology in schizophrenia?
OVERACTIVITY OF DOPAMINE
Mesolimbic pathway- affects positive symptoms (more common)
Mesocortical pathway-affects negative symptoms
SEROTONIN
Clozapine blocks 5-HT pathway
Acetyl chlorine may be responsible for cognitive impairments (GABA)
What are Schneider’s first rank symptom of schizophrenia
ABCD
AUDITORY HALLUCINATIONS
· Talking about you 3rd person (she/ he)
· Commenting on things you do (running commentary)
THOUGHT DISORDER
-Feel as if others can hear your thoughts (thought broadcast)
-Your own thoughts being repeated over and over again in your head (thought echo)
-Feel as if thoughts are being added/removed from your brain (thought withdrawl/insertion)
-Not able to think clearly/thoughts suddenly stopping (thought block)
Do you feel able to think clearly?
Do you ever experience your thoughts suddenly stopping as though there were no thoughts left?
What is it like?How do you explain it?
DELUSIONS OF CONTROL (feel like your being controlled by an outside force (passivity)
○ Controlling thoughts and mood
○ Controlling things you do
DELLUSIONAL PERCEPTION (autochthonous delusion) (a normal thing being interpreted abnormally) · For example, green traffic light=I'm Jesus
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)
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
What is the management of schizophrenia
BIO-PSYCHO-SOCIAL APPROACH
BIOLOGICAL: Anti-psychotic either typical or atypical depending on desired effects (e.g. sedation?) and/or tolerance of side effect profile - more info in pharmacology pack
PSYCHOLOGICAL:
CBT has been shown to reduce relapse rate
Family interventions also useful
Support groups
Art therapy is also suggested by NICE
