Psychosis and Schizophrenia Flashcards
What is the definition of psychosis
a mismatch between the events in a persons mind and the events in real life
what is the difference between neurosis and psychosis
neurosis is excess contact with reality with hyperexaggerated versions of normal emotions (depression/anxiety)
Psychosis is losing contact with reality with the presence of abnormal perceptions (hallucinations) and thoughts (delusions) (schizophrenia)
What is the definition of a delusion
an unshakable belief outside of the cultural norms of the society the person is in
the person should not be able to be persuaded against their delusion
whats the definiton of ertomania
the deliusion that someone famous is in love with them
what is cotard’s delusion and where is it often seen
the delusion that you are dead/dying/rotting from the inside/have no blood/organs, often with feelings of persecution and guilt - 55% feel they are immortal
seen more commonly in psychotic depression, as opposed to bipolar/schizophrenia
what diseases may cause psychosis
schizophrenia affective disorder neurodegenerative disorders substance use brain injury
what are the +ve and -ve symptoms of schizophrenia
+ve
reality distortion
disorganisation
-ve
psychomotor poverty
anhedonia
avolution (reduced motivation to complete tasks with an end goal - e.g. paying bills)
alogia - malformed speech
affective flattening - very low emotional range
what are the first rank symptoms for schizophrenia 8)
3rd person auditory hallucinations thought echo - person hears their thoughts out loud running commentary passivity (someone is controlling them) somatic hallucination thought broadcast thought insertion/withdrawal delusional perception (real life perception with an attached delusion belie)
what part of the brain are auditory hallucinations associated with
frontotemporal
What is the neuro-pharmacology of psychosis
dopamine exacerbates psychosis, and it is seen as a dopaminergic disease. this makes amphetamines particularly dangerous as they increase dopamine release
however serotonin agonists (LSD) and glutaminergic blockers (ketamine) can cause reality distortion
what are the behavioural and cognitive symptoms of schizophrenia
formal thought disorder
bizarre behaviour - catatonia, mutism, posturing, ticks
inappropriate affect
attention + memory impairments
decreased social cognition - empathy, reading emotion
therefore major interpersonal relationship difficulty
what is the aetiology of schizophrenia
genetics early childhood trauma birth complications maternal complications + infections migration ethnic minority early cannabis use 2.5x (6x in heavy users)
what are some factors that predict poor outcome in psychosis
Male Single Young age at onset family history substance misuse poor premorbid adjustment insidious onset disorganized subtype negative symptoms cognitive impairment lack of affective symptoms poor insight high expressed emotion poor adherence
What is the treatment for schizophrenia
BIO
oral antipsychotic
PSYCHO
family therapy
psychoeducation
CBTp (CBT for psychosis) - only if chronically psychotic
SOCIAL
financial help
accomodation
employment
how do you investigate schizophrenia
full history, MSE, risk assessment
ECG - for antipsychotics
bloods - FBC, U+E, TFT, fasting glucose, lipid profile, CA2+, LFT
urine drug screen
this is to assess suitablility for medication as well as reversible causes for psychosis
collateral history
does schizphrenia affect sleeping pattern
yes - interrupts the circadian rhythm
what are the side effects of clozapine
neutropenia(3%) agranulocytosis (1%) weight gain hyperprolactinemia reduced seizure threshold constipation hypersalivation myocarditis increased risk of stroke/VTE
what does smoking cessation do to clozapine levels in the blood
smoking induces certain cytochrome p450 enzymes, so stopping smoking suddenly causes a reduction in their metabolic rate meaning clozapine is broken down less effectively
Lifetime prevalence of schizophrenia
1%
What happens if clozapine has not been taken for >48 hours
it must be restarted at the 12.5mg starting dose and titrated up again
what medication is used when a schizophrenic patient is resistant to two atypical antipsychotics (the first-line treatments)
clozapine
what is fregoli syndrome
the delusional belief that a single person is impersonating lots of different people
what is capgras syndrome
delusional belief that someone you know has been replaced by an identical imposter
what is ekbom syndrome
delusional belief that a patients body is infested by insects or animals when it isn’t
what is the matchbox sign in ekbom syndrome
a patient will bring a contained filled with pieces of fluff or first that signify that there is an infestation
what is de clerambault syndrome
delusional belief that someone (usually of higher social status) is in love with them, and that they communicate to them through oblique ways
what is othello syndrome
delusional belief that a partner is being unfaithful
what are the subtypes of schizophrenia
Paranoid Simple Hebephrenic Catatonic Cenesthopathic residual persistent delusional disorder undifferentiated
what is the most common subtype of schizophrenia
paranoid
what is hebephrenic schizophrenia
schizophrenia with mainly prominent affective symptoms, such as disordered behaviour and speech, with a shallow affect and inappropriate laughter
what is catatonic schizophrenia
prominent motor symptoms (waxy flexibility ,posturing)
what is residual schizophrenia
chronic stage of schizophrenia where the patient develops prominent negative symptoms after previous episodes of delusions and hallucinations
what is cenesthopathic schizophrenia
form of schizophrenia characterized by bizarre or bothersome bodily sensations (referred to as cenesthopathy), typically without a real, physical cause
what is undifferentiated schizophrenia
subtype of schizophrenia in which the individual exhibits prominent psychotic features, such as delusions, hallucinations, disorganized thinking, or grossly disorganized behavior, but does not meet the criteria for any of the other subtypes of the disorder.
