Psychotic disorders Flashcards
Can psychotic symptoms appear in multiple disorders?
Yes
What are the two categories of psychotic symptoms?
Positive and negative
Name some forms of delusion
- Persecutory
- Referential
- Grandiose
- Erotomania (people in love with them)
- Nihilistic (catastrophe will befall then)
- Somatic (health
When it comes to delusions, what were the two key distinctions that were discussed
Bizarre vs non-bizarre
Primary vs secondary
What is the most common form hallucination?
Auditory
When does an hallucination need to occur to be considered a psychotic hallucination?
While the person is wide awake
What is another, more specific term given to disorganised speech/thinking?
Formal Thought Disorder
What are some examples of Disorganised Speech/Thinking?
- Clanging - speech is phonological rather than semantic or syntactic
- Circumstantiality/Tangentiality – unnecessary or irrelevant detail
- Flight of ideas - loosely associated concepts, rapidly changing topic
- Derailment - speech steers off-topic
- Incoherence - word salad
- Pressure of speech - excessive spontaneous speech production and rapid rate
What are the five negative symptoms for Psychosis?
- Diminished emotional expression: reductions in the expression of emotions in the face, eye contact, intonation of speech (prosody), and body movements that normally give an emotional emphasis to speech.
- Avolition: a decrease in motivated self-initiated purposeful activities
- Alogia: manifested by diminished speech output
- Anhedonia: decreased ability to experience pleasure or degradation of pleasure previously experienced
- Asociality: the apparent lack of interest in social interactions
What proportion of the following populations experience some psychotic symptoms?
- General population
- People with mood/anxiety disorders
- SCZfrenics
In order:
- 5%
- 25%
- 80%
What is Schizotypy?
The theoretical concept that there is a continuum of SCZ still symptoms in community
What are the four dimensions of Schizotypy?
I I C U
I I C U
- Impulsive nonconformity
- Introverted anhedonia
- Cognitive disorganisation
- Unusual experiences
I I C U
What is the OLIFE and what does it measure?
Oxford-Liverpool Inventory of Feeling sand Experiences (Mason (2006))
Measures schizotypy
What is BRIEF PSYCHOTIC EPISODE?
Kinda SCZ-lite
At least one the usual symptoms
Duration of <1 month
What is DELUSIONAL DISORDER?
Pure delusions (no hallucinations)
Duration < 1 month
What is SCHIZOPHRENIFORM disorder?
Same like SCZ but 1-6 months
What proportion of people with SCHIZOPHRENIFORM disorder recover?
About 1/3 (without treatment)
What’s the tricky thing to do with the time periods for SCZ?
It is for 6 months+, but the criteria also mentions 1 month in that is says you have to have XYZ symptoms for a significant portion of the month…?
What is a SCHIZOAFFECTIVE disorder?
This is when you START with psychosis and then get a mood disorder
If you start with the mood stuff, then get psychosis, you get something else
What is the normal age of onset for SCZ?
Early adulthood - 15-25
Is SCZ more common in rich or poor countries?
Poor
Is SCZ more common in the country or city?
City (twice as likely)
Is SCZ more common in natives or migrants
Migrants
What is DEMENCE PRECISE, and who is associated with it?
= SCZ
Benedit Augistine Morel (1860)
What is DEMENTIA PRAECOX, and who is associated with it?
(Senility of the young) = SCZ
Emil Kreapelin (1898)
Differentiated Bipolar and SZC
Who is Bleuler?
Guy who came up wth name SCZ
Believed we could reverse the course
Consider Bipolar and SZC as on a continuum
Who is Kurt Schneider (1959)
Listed the core symptoms… ‘first rank symptoms’
What is the Feighner Criteria?
Criteria established in the late 1970s to standardise the diagnosis of SCZ - set stage for DSM 3
Who is Pat McGorry?
Pushed back against the old school approaches
Pointed out they were dominated by clinical populations who had spent their whole life in institutions
Focused on early intervention
Who is Richard Bentall?
Forget about syndromes, focus on symptoms only
And the person
Author of the book I bought
If your identical twin has SCZ, what’s the chance of you having it?
45-50%
How many genes are involved in SZC?
Early days, but at least 100
What do we know about SCZ and cannabis from a genetics perspective?
Not really sure - something about the ‘COMT gene’
What brain structure changes do we see with SZC?
- Enlarged ventricles (loss of brain tissue?)
- Reduced grey and whiter matter in prefrontal cortex (particularly associated with negative sx)
- Hippcampal size?
What do we know about the neurocognitive deficients associated with SCZ?
- Attention
- Memory
- Attention switching
- IQ deterioration
But SDs are huge, meaning there is not much a SZC finger print in the data
What do we see in relation to social cognition in SCZ?
Some deficits
What are some theoretical models to explain onset/aetiology of SCZ?
- Prenatal damage: result of genetic factors/ environmental influence (maternal viral infection while pregnant, inadequate foetal nutrition)/ birth trauma/complications;
- Neurodevelopmental model (Weinberger): silent damage emerges in prefrontal cortex as the latter develops in adolescence
Brain structure summary for SCZ
Progressive change occurs between Ultra High Risk, First Episode Psychosis, chronic
Changes occur in Hippocampus, Pituitary volume and other regions
Is childhood trauma typically involved in SCZ aetiology?
Def
What did the Swedish conscript study find?
Kids who used cannabis by 18 were 2.4 times more likely to develop SZC than whowho had not
If you’ve used cannabis 1-10 times, 1.5 times for likely to get SZC
if 10+ times, 2. times more likely
What did the 2002 follow up study on the Swedish conscript study find?
13% of SZC cases attributed cannabis use
What are the relapse rates for SCZ?
80% within 5 years
What are the main relapse risk factors for SCZ?
- Substance use
- medication non-adherence
- carer critical comments
- poor premorbid adjustment
What are things that aren’t risk factors for relapse of SCZ?
- DUI (duration of untreated lines),
- DUP
- positive, negative, affective symptoms
- age of onset
- insight
- gender
- marital status
- education and employment
Whats the deal with ‘expressed emotion’?
Brown: 1950’s and 60’s noticed many relapsing patients shared common family environments- conflict, criticism, hostile, over-involved
What is best for SZC, drugs or therapy?
Drugs
What is the best practice approach to dispensing drugs?
Low dose approach
What are some ongoing issues relating to SCZ?
- No biological markers or physiological tests to diagnose schizophrenia
- Aetiology continues to be uncertain
- No clear evidence that the concept of schizophrenia is a valid construct
- Accurate identification and treatment in prodromal or ‘ultra high risk (UHR) phase (Yung, McGorry etc);
What early name for SZC is Benedict Augistine Morel (1860) associated with?
DEMENCE PRECISE
What early name for SCZ is Emil Kraeplin associated with?
DEMENTIA PRAECOX
Who came up with the term Schizophrenia?
Bleuler
