Psychotic disorders Flashcards
What is psychosis
Mental state in which reality is greatly distorted
Psychotic presentation
- Delusions
- Hallucinations
- Thought disorders
Higher in black and ethnic minority populations
What are the non-organic causes of psychosis
Schizophrenia
Schizotypal disorders
Schizoaffective disorder
Acute psychotic episode
Mood disorder with psychosis
Drug-induced
Delusional disorder
Puerperal psychosis
What are the organic causes of psychosis
Drug-induced psychosis
Medication-induced psychosis
Complex partial epilepsy
Delirium
Dementia
Huntington’s disease
SLE
Syphilis
Endocrine disturbances (Cushing’s, B12 deficiency)
What is schizotypal disorder
Latent schizophrenia
Eccentric behaviour, suspiciousness, unusual speech, deviation of thinking
No hallucinations or delusions
What is acute psychotic disorder
Psychotic episode similar to schizophrenia
Lasts < 1 month
What is schizoaffective disorder
Symptoms of schizophrenia and mood disorders in the same episode
What is persistent delusional disorder
A set of delusions for >3 months
No other symptoms
What is induced delusional disorder
AKA shared paranoid disorder
Similar delusion in 2+ individuals
One person’s delusion believed by another
What are the characteristic features of schizophrenia
Hallucinations
Delusions
Thought disorders
Leading to functional impairment
M=F
What is the dopamine hypothesis for schizophrenia
Possible link to over-activity of mesolimbic pathway in brain
What are the predisposing factors for schizophrenia
Biological
- Genetics, high dopamine, low glutamate/serotonin/GABA, intrauterine infection, premature birth, fetal brain injury, age 15-35, extremes of parental age
Psychological
- Family history, childhood abuse
Social
- Substance abuse, low socioeconomic status, migrants, living in urban areas
What are the precipitating factors for schizophrenia
Biological
- Cannabis use, psychostimulant use
Psychological
- Adverse life event, poor coping skills
Social
- Adverse life event
What ate the perpetuating factors for schizophrenia
Biological
- Substance misuse, poor compliance
Psychological
- Adverse life event
Social
- Low social support, expressed emotion
What are the positive symptoms of schizophrenia
Delusions
Hallucinations
Formal thought disorder
Thought interference
Passivity phenomenon
What are the negative symptoms of schizophrenia
Lack of motivation
Antisocial behaviour
Anhedonia
Poverty of speech
Affect blunted
Cognitive deficits
What is post-schizophrenic depression
Depression within 12 months of schizophrenic illness
Some schizophrenia symptoms still present
What is simple schizophrenia
Negative symptoms without psychotic symptoms
What is undifferentiated schizophrenia
Meets diagnostic criteria for schizophrenia, but does not fit into a subtype
What is the criteria for group A schizophrenia
Thought echo/insertion/withdrawal/broadcast
Delusions
Running commentary auditory hallucinations
Bizarre persistent delusions
Need 1 for >1 month
What is the criteria for group B schizophrenia
Non-auditory hallucinations
Thought disorganisation
Catatonic symptoms
Negative symptoms
Need 2 for > 1 month
What investigations are needed for schizophrenia
Bloods
- FBC, TFTs, glucose, HbA1c, calcium, LFTs, cholesterol, B12, folate
Urine drug screen
ECG (before antipsychotic use)
Consider CT
Consider EEG
What are the poor prognostic factors for schizophrenia
Strong family history
Gradual onset
Low IQ
Premorbid history of social withdrawal
No obvious precipitant
What is the biological management for schizophrenia
Antipsychotics
- Typical
- Atypical (risperidone, olanzapine)
- Consider depot
- Clozapine if treatment-resistant (2 failed)
Adjuvants
- Benzodiazepines
- Antidepressants
- Lithium
ECT
- If treatment-resistant
What is the psychological management for schizophrenia
CBT
Family intervention
Art therapy
Social skills training
What is the social management for schizophrenia
Support groups
Peer groups
Supported employment programmes