Psychosis & Schizophrenia Flashcards
What are the first rank symptoms of Schizophrenia?
- Auditory Hallucinations
- 3rd person
- commentating
- thought echoing (the voices say the person’s thoughts aloud) - Thought
- insertion (recognized as not your own thoughts)
- broadcasting
- withdrawl - Passivity Phenomena
- actions (impulse or volitional)
- thought (they are your own thoughts but you feel someone else made you think them)
- somatic (sensation of probe, microchip etc.) - Delusional Perception. Delusions are often persecutory
- Primary- real perception attached to delusional belief e.g. saw the traffic light turn red and knew that I was Jesus
- Secondary- more elaborate. e.g. hear some voices, think coming from ceiling, Ah! it’s a bug listening to me, oh it must be ISIS listening to me, I must be in MI5
What is a delusion?
A fixed firmly held false belief that is held despite evidence to the contrary which cannot be explained by the person’s educational, cultural or religious background. This is likely to affect the individual’s behaviour and holds personal significance.
What is meant by the term psychosis?
Patients lose touch with reality. They have significantly altered perception, thoughts, mood and behaviour. It includes the following:
- formal thought disorder
- hallucinations
- delusions
Schizophrenia is a type of psychosis. Also includes: schizoaffective disorder, schizophreniform disorder and delusional disorder.
How do typical antipsychotics act? What are common SE of these medications?
Antagonism of D2R
3 common SE: Sedation, Extra-pyramidal, anti-muscarinic (blurred vision, constipation, dry mouth)
Others: Decrease seizure threshold, neuroleptic malignant syndrome, arrythmias, increase PRL, apathy, confusion and depression, hypersensitivity rxns.
What are the organic causes of psychosis?
- Endocrine: Thyroid Dysfunction, Cushing’s
- Drugs: Amphetamines, Cannabis, Black Mamba, Spice
- Meds: DA Agonists (e.g. L-Dopa), Steroids, Thyroxine,
- Brain tumour
- Wilson’s Disease, Huntingdon’s Disease
- SLE, HIV
- Dementia
- Delirium
- Temporal Lobe Epilepsy
What is a hallucination? What are the different types you can experience?
Perceiving something in the absense of a stimulus. These can be auditory, visual, olfactory, visceral, somatic.
What is a delusion of reference?
When you believe that ordinary objects e.g. the tv/ radio/events/other people’s actions have a special meaning or significance to patient. e.g. news reports are telling you to do things, or you see leaflets in a doctor’s clinics that are written about you, objects are arranged as ‘signs’
When is clozapine used? What are it’s common SE? What does the patient need to be informed about?
It is used in tx resistant schizophrenia, i.e. when two different antipsychotics have been used for at least 6w each at the optimum dose without success.
SE= Myocarditis/Cardiomyopathy, orthostatic hypotension, Agranulocytosis, Sedation ++++, Weight gain ++++, Raised triglycerides, Proglycaemic (metabolic syndrome), Hypersalivation, Reduced seizure threshold.
What is the aetiology of Schizophrenia?
- Genetic component- 40% in identical twins, more common if parents/ siblings have been affected
- DA theory- overactivity of DA in mesolimbic pathway (responsible for +ve symptoms) and underactivity of DA mesocortical pathway (responsible for -ve symptoms). Basis for meds, which work better for +ve symptoms.
- Obstetric complications: e.g. maternal malnutrition, viral infections, low birth weight
- More common in certain ethnic groups and even higher in those who have immigrated
- Urban more than rural
- Low SES
- substance misuse can produce psychotic symptoms. Amphetamine/ cocaine are dopaminergic agents.
- Premorbid personality: schizoid personality preceeds 1/4 of cases.
- Trauma/ Abuse: sexual or physical abuse increases risk.
- neurodevelopmental T: people w/ schizophrenia tend to have enlarged ventricles and smaller lighter brains
What are the RF for poor prognosis in patients with schizophrenia?
- Prodrome of symptoms with insidious onset.
- High Expressed emotion of relatives/ friends- critical, over-involved increases the risk of relapse significantly.
- Younger onset
- Late treatment/ Tx delay
What are the positive and negative symptoms of schizophrenia?
+ve:
- hallucinations
- delusions
- bizzare behaviour often purposeless and inappropriate to setting
- ve:
- ahedonism
- apathy
- blunted affect (this is diff to flattened affect. It is a lack of emotional response and a sense of emptiness)
- social withdrawl
- self-neglect
- poverty of thought and speech
What is a depressive delusion?
belief that you are to blame for catastrophes/ accidents etc that you clearly have no link with.
What does a thought disorder describe?
Disordered FORM (ie sequence of thoughts) of thought. Thoughts are unrelated
What is flight of ideas?
ideas are connected by puns, rhymes, words, themes.
What does derailment of thought mean?
thoughts are in no way connected- very hard to make sense of what the person is saying.
e.g. I have supernatural powers, when the light shines on my face I feel cat fur appearing, I hear rice crispy pops on one side of my head, my grandfather got really mad at me this one time. Common to florid psychosis.
What is circumstantial thinking? How does it differ from tangential thought?
irrelevant information provided before Q answered eventually. Ability to focus is lost. Common to Schizophrenia (BB) e.g. Tell me about your childhood? We lived in this 2 storey detached house and I remember the garden it was very green and we lived up the road from blabla and we used to eat blabla and the town was like blabla… I remember swimming with my friends and my parents arguing.
Tangential- They stay “on topic” but never answer the Q. e.g. Tell me about your family. Family it’s so important, you know when you look at the world and the tragedies that happen and how short our lives are, you really realize the importance of family and trusting those you’re related to.
What are flattened and blunted affect? Compare.
Blunted- person is “empty” shell, no emotion is shown whatsoever. Found in schizophrenia.
Flattened- the person is so miserable and the effort to interact is obvious, energy is so depleted. Hallmark of depression.
