Psychosis - Schizophrenia Flashcards
What are symptoms of first rank?
Symptoms which are indicative of schizophrenia in the absence of other pathology or organic impairment
Are first rank symptoms pathognomonic?
No, because they can be present in other psychoses
What are the main 4 first rank symptoms?
Hallucinations, delusions, thought interference, passivity
What type of delusions are usually seen in schizophrenia?
Primary delusions
What are some questions worth asking about auditory hallucinations in schizophrenia?
“Do you hear voices when there is no-one else around?” (- this is because hallucinations in schizo seem to come from outside the head like a normal voice) and “are the hallucinations your own thoughts?”
Describe the hallucinations which occur in schizophrenia?
Auditory: 2nd or 3rd person or commentating
What are some symptoms that are unlikely to occur in schizophrenia and so might be helpful in excluding it as a diagnosis?
Altered consciousness, disorientation and disturbances of memory as well as visual hallucinations
The first time someone presents with an episode that meets the ICD-10 criteria for schizophrenia, this is diagnosed as what? Why?
Acute psychotic episode - because a diagnosis of schizophrenia is fairly life-altering
What is the ICD criteria for schizophrenia?
At least one thing from criteria 1, or 2 things from criteria 2 present for most of the time for at least 1 month
Essentially, what are the criteria (1) in the ICD-10 diagnosis of schizophrenia?
Delusions, auditory hallucinations and thought interference
Essentially, what are the criteria (2) in the ICD-10 diagnosis of schizophrenia?
Hallucinations in any modality when occurring every day for a month, disorganised speech, catatonic behaviour, negative symptoms
What are some examples of catatonic behaviour in ICD-10 criteria?
Excitement, posturing/waxy flexibility, negativism, mutism, stupor
What is catatonia?
A state of psycho-motor immobility
What is posturing/waxy flexibility?
Being nearly completely unresponsive to stimuli and immobile for long periods of time
What are some examples of negative symptoms in ICD-10 criteria?
Marked apathy, paucity of speech, blunting/incongruity of emotional responses
What is the most common subtype of schizophrenia?
Paranoid
Describe paranoid schizophrenia?
The typical picture of schizophrenia, first rank symptoms predominate
Describe hebephrenic schizophrenia?
Younger onset, emotionally immature, disorganised, do silly things
Describe catatonic schizophrenia?
Movement disorder predominates
What are some positive symptoms of schizophrenia?
Delusions, hallucinations, passivity, disorders of the form of thought, thought interference
What are some negative symptoms of schizophrenia?
Reduced speech, reduced motivation, reduced interest/pleasure, reduced social interaction, blunting of affect
What is the onset of a) positive schizophrenia? b) negative schizophrenia?
a) acute onset b) slow, insidious onset
Describe the brain structure in a) positive schizophrenia? b) negative schizophrenia?
a) normal brain structure b) underlying brain structural abnormality
Positive schizophrenia is a biochemical disorder involving what?
Dopamine transmission
Describe the response to anti-psychotic treatment in a) positive schizophrenia? b) negative schizophrenia?
a) good response to anti-psychotics and better outcomes b) poor response to anti-psychotics, may actually make symptoms worse
What characterises chronic schizophrenia?
Long duration and negative symptoms
What is schizoaffective psychosis?
A clinical presentation in which clear cut affective and schizophrenic symptoms occur in the same episode
What is the lifetime risk of schizophrenia? Which gender is it more common in?
1% lifetime risk, slightly more common in males
What is the peak age of onset of schizophrenia in a) men? b) women?
a) 15-25 b) 25-35
What is the relationship between schizophrenia and socioeconomic status?
Schizophrenia is more common in people of a lower socioeconomic status
What is the risk of schizophrenia if the following family members are affected a) monozygotic twin? b) both parents? c) one parent?
a) 40-60% b) 50% c) 15%
There is a higher rate of schizophrenia in which ethnic group in the UK?
Afro-Caribbean
‘The proportion of observable differences in a trait between individuals in a population that is due to genetic differences’ is known as what? What % of this is seen in schizophrenia?
Heritability - 78% in schizophrenia
What are the three main risk factors for the development of schizophrenia?
Birth complications, winter/spring birth, drug use
What drug is the most likely to cause schizophrenia? What are some others that may increase risk?
Cannabis / amphetamines, ivory wave and cocaine
As well as being a risk factor for its development, what else is important to note about cannabis in schizophrenia?
Very common for people diagnosed with schizophrenia to use this, though it exacerbates paranoia and can make hallucinations more troublesome
What happens if people with schizophrenia take amphetamines/cocaine?
Can make them very unwell and will worsen symptoms to the point that it can take weeks to recover
Apart from the main three, what are some other factors which increase the risk of development of schizophrenia?
Urban dwelling, childhood viral CNS infection, social deprivation
What neurodevelopmental changes might predispose to schizophrenia development?
Enlarged ventricles, thinner cortices
What neurochemical change may predispose to schizophrenia development?
Altered dopamine signalling
What are some pre-morbid features of schizophrenia?
Subtle motor, cognitive and social deficits in childhood that become greater as time goes on
Describe the prodromal period of schizophrenia?
Gradual onset of non-specific symptoms like odd ideas and experiences, eccentricity, altered affect, odd behaviours
What are some good prognostic indicators for schizophrenia?
Older age of onset, female sex, marked mood disturbance (especially elation), family history of mood disorders
What are some bad prognostic indicators for schizophrenia?
Poor pre-morbid adjustment, insidious onset, early onset, long duration of untreated psychosis, cognitive impairment, enlarged ventricles, negative symptoms
What % of people with schizophrenia complete suicide? When is this most likely to occur?
10-15% / once they regain insight, i.e. the first week following discharge from hospital
What is the relationship between schizophrenia and homicide? What are some features to look out for that may increase the risk of homicide in someone with schizophrenia?
Homicide by people with schizophrenia is rare / command hallucinations and delusions of jealousy
