Psychotic Flashcards
When does schizophrenia typically present?
15-30 years
(Earlier in men than women)
How long must symptoms present for before schizophrenia is diagnosed?
6 months
Define schizoaffective disorder
Schizoaffective disorder = combines symptoms of schizophrenia + bipolar disorder
Patient have:
* Psychosis
* Depression
* Mania
How does schizophreniform disorder present?
Presents like schizophrenia - but lasts less than 6 months
Tom Tip
You might have to explain schizophrenia simply to a relative in your OSCEs. A helpful example may be: “Schizophrenia is a condition that affects how the brain processes information. Normally, the brain is very good at understanding reality, deciding what is important and what is not, and organising thoughts in a structured way. With schizophrenia, the brain struggles to understand the world, makes mistakes in deciding what information is important and organises thoughts in a confused way. This can lead to strong beliefs that do not fit with reality, called delusions. They may also experience voices that are not there, called hallucinations. The disorganised thoughts can lead to unusual speech and behaviours, which is called thought disorder. When these symptoms occur, it is called psychosis.”
Differential diagnosis for schizophrenia
(other causes of psychosis)
- Mania
- Psychotic depression
- Drugs (e.g., hallucinogens and cannabis)
- Stroke
- Brain tumours
- Cushing’s syndrome (e.g., patients taking systemic steroids)
- Hyperthyroidism
- Huntington’s disease
Cause of schizophrenia
- Genetic - having a affected family member is a risk factor
- Environmental
What are the features of the prodrome phase in schizophrenia
Prodome phase = often precedes the full symptoms of psychosis
Patient may experience subtle symptoms:
* Poor memory
* Reduced concentration
* Mood swings
* Suspicion of others
* Loss of appetite
* Difficulty sleeping
* Social withdrawal
* Decreased motivation
What is the central feature of schizophrenia, and its features?
Central feature = psychosis
Key features of psychosis = positive symptoms:
* Delusions (beliefs that are strongly held and clearly untrue)
* Hallucinations (perceiving things that are not real)
* Thought disorder (disorganised thoughts causing abnormal speech and behaviour)
Lack of insight = important feature of psychosis → lack awareness that the delusions and hallucinations are not based in reality
Key positive symptoms of schizophrenia
- Auditory hallucinations (hearing voices, particularly a voice narrating the patient’s actions)
- Somatic passivity (believing that an external entity is controlling their sensations and actions)
- Thought insertion or thought withdrawal (believing that an external entity is inserting or removing their thoughts)
- Thought broadcasting (believing that others are overhearing their thoughts)
- Persecutory delusions (a false belief that a person or group is going to harm them)
- Ideas of reference (a false belief that unconnected events or details in the world directly relate to them)
- Delusional perceptions
A delusional perception occurs when the patient experiences an ordinary and unremarkable perception (e.g., a cat crossing the road) that triggers a sudden, often self-related delusion (e.g., “and I knew I would be meeting the aliens on behalf of humanity”).
Negative symptoms of schizeophrenia
4As
* Affective flattening (minimal emotional reaction to emotive subjects or events)
* Alogia (“poverty of speech” – reduced speech)
* Anhedonia (lack of interest in activities)
* Avolition (lack of motivation in working towards goals or completing tasks)
A reduced level of functioning is an important feature. This involves reduced or impaired:
* Social engagement
* Productivity and achievement at work or school
* Self-care
What are the types of patterns of active symptoms for schizophrenia?
When observed over time (e.g., over at least one year), the active-phase symptoms of psychosis may be:
* Continuous
* Episodic (relapsing and remitting)
* A single episode only
Diagnostic criteria for schizophrenia
Diagnosis based on DSM-5 criteria
* Symptoms (including prodrome phase) = must be at least 6 months
* Active phase symptoms (delusions, hallucinations, thought disorder) = present for at least 1 month (or less if treatment is successful)
Schizophrenia treatment
- Antipsychotics
- CBT
What are the key associated conditions with antipsychotic use?
Metabolic syndrome + cardiovascular disease
Physical health is monitored:
* Weight, BMI, waist circumference
* Metabolic → blood glucose, HbA1c
* Cardiovascular → BP, pulse, ECG (arrhythmias, QTc prolongation)
* LFTs
* Renal function tests
* Prolactin levels (if hyperprolactinemia) develop (e.g. galactorhhea, menstrual disturbances)
- Lithium → serum lithium levels (toxicity); renal and thyroid function due to potential toxicity + S/Es)
- Clozapine → WBC and absolute neutrophil count - due to risk of agranulocytosis
