Psychotic Disorders Flashcards
What is psychosis?
A mental state in which reality is greatly distorted (individual is experiencing a reality different to everyone else’s).
What does psychosis present with?
Hallucinations
Delusions
Thought disorder
Fragmentation of the boundaries of the individual
What is a hallucination?
Perception in the absence of an external stimulus
What are delusions?
Fixed false belief, firmly held despite evidence to the contrary and goes against the individuals normal, social and cultural belief system.
What is thought disorder?
Impairment in the ability to form thoughts from logically connected ideas.
What are the different types of delusions and what do they mean?
Persecutory- people are coming after you
Grandiose- you believe you have special skills
Reference- you believe everything is about you
Erotomanic- you believe everyone is in love with you
Hypochondriac- you believe you have a terrible disease
What is formal thought disease?
Problem of speech where each sentence does not follow on from the next, it is different from flight of ideas, flight of ideas is where each sentence although they do not follow on from the next, they are connected.
What are disorders of the self?
This is when the individual can no longer distinguish between theirselves and the world, it involves passitivity phenomena, thought insertion and though broadcast.
What is passivity phenomena?
Phenomena in which individuals feel that some aspect of themselves is under the control of others
You need to determine whether psychosis has an organic or non organic cause, what are the organic causes of psychosis?
Delirium (confusion also state/ electrolyte imbalance) Dementia Infection (syphilis) Endocrine (cushings/thyroid) Temporal lobe epilepsy
What are the non organic causes of psychosis?
Schizophrenia Schizotypal Schizoaffective Acute psychotic episode Mood disorders W/ psychosis Delusional disorder Induced delusional disorder Puerperal psychosis
What is schizotypal disorder?
Also known as Latent schizophrenia, characterised by eccentric behaviour, suspiciousness, unusual speech and deviations of thinking and affect that is similar to those suffering from schizophrenia. There is an increased risk of schizotypal disorder in those who have first degree relatives with schizophrenia.
What is meant by ‘acute and transient psychotic disorders’
A psychotic episode, presenting very similar to schizophrenia but lasting <1month and so not meeting the criteria for schizophrenia.
What is persistent delusional disorder?
The development of a single or set of delusions for a period of at least 3 months, where the delusion is the only or the most prominent symptom. The content of the delusion is often persecutory, grandiose or hypochondrial.
What is the induced delusional disorder?
Uncommon disorder characterised by the presence of similar delusions in two or more individuals.
What is mood disorders with psychosis?
Psychosis occurring secondary to depression or mania (unlike schizophrenia which is usually spontaneous).
What is puerperal psychosis? (Post partum psychosis)
Acute onset of a manic or psychotic episode shortly after childbirth, it usually develops in the first 2 weeks following birth.
What is late paraphrenia?
Late onset schizophrenia
Hallucinations and delusions are prominent (particularly paranoid), while thought disorders and catatonic are rare.
What is schizophrenia?
Most common psychotic condition, characterised by hallucinations, delusions and thought disorders which lead to functional impairment. It occurs in the absence of organic disease, alcohol or drug related disorders and is not secondary to elevation or depression of mood.
What are the biological predisposing risk factors of schizophrenia?
Genetic
Neuro chemical (increase in dopamine, decrease in glutamate, serotonin, GABA)
Age 15-35
Neuro developmental- intrauterine infection, premature birth, fetal brain injury and obstretic complications.
Extremes of parental age
What are the predisposing psychological risk factors for schizophrenia?
Family history
Childhood abuse
What are the social predisposing risk factors of schizophrenia?
Substance misuse
Low socioeconomic status
Migrants
Living in an urban area
What are the precipitating biological risk factors of schizophrenia?
Smoking cannabis or using psychostimulants
What are the precipitating psychological risk factors for schizophrenia?
Adverse life events and poor coping style
What are the precipitating social risk factors of schizophrenia?
Adverse life events
What are the perpetuating biological causes of schizophrenia?
Substance misuse
Poor compliance to medication
What are the perpetuating psychological risk factors of schizophrenia?
Adverse life events
What are the perpetuating social risk factors of schizophrenia?
Decreased social support
Expressed emotion
What are the positive symptoms of schizophrenia?
Delusions Hallucinations Formal thought disorder Thought interference Passivity phenomena
What are the negative symptoms of schizophrenia?
Avolition (decreased motivation)
Asocial behaviour (loss of drive for any social engagements)
Anhedonia
Alogia (poverty of speech)
Affect blunted (absent or diminished capacity to express feelings)
Attention (cognitive) deficits- May experience problems with attention, language, memory and executive function.
What is paranoid schizophrenia?
This is the most common, dominated by positive symptoms (hallucinations and delusions)
What is postschizophrenic depression?
Depression predominants with schizophrenic illness in the past 12 months with some schizophrenia symptoms still present.
What is hebePhrenic schizophrenia?
This is where thought disorganisation predominates. Onset of illness is earlier and has a poorer prognosis.
What is simple schizophrenia?
This is a rare form of schizophrenia where negative symptoms develop with pout psychotic symptoms
What are the blood tests taken in a person with a psychotic disorder on admission?
FBC to check for anaemia and organic cause- infection
TFTS- thyroid dysfunction can present as psychosis
Glucose or HbA1C and cholesterol as atypical antipsychotics can cause metabolic syndrome
Vit B12 and folate deficiencies can cause psychosis
Other than blood tests, what other investigations are ordered for a person with psychosis?
ECG (antipsychotics can cause a prolonged QT interval)
CT scan to rule out organic causes- space occupying lesions
EEG- to rule out temporal lobe epilepsy as a possible cause of psychosis
What are the factors associated with a poor prognosis of schizophrenia?
Strong family history Gradual onset Decreased IQ Premorbid history of social withdrawal No obvious precipitant
What are the biological treatments of schizophrenia?
Atypical antipsychotics are first line eg: risperidone and olanzapine
Clozapine is the most effective anti psychotic and can be used for treatment resistant schizophrenia
What adjuvants May be used with antipsychotics?
Benzodiazepines can provide a short term relief of behavioural disturbance, insomnia, aggression and agitation
Antidepressants and lithium can also be used
What psychological treatment can be used in schizophrenia?
CBT
Family intervention
Art therapy
Social skills training
What are the social treatments for psychotic disorders?
Support groups
Peer support
Supported employment programmes
What are the organic causes of psychosis?
Delirium Dementia Drug induced Iatrogenic (medication- steroids) Complex partial epilepsy Huntingtons SLE Syphilis Endocrine disturbances- cushings Metabolic disorders- vit B12 deficiency and porphyria
What are the non organic causes of psychosis?
Schizophrenia Schizotypal Schizoaffective Acute psychotic episode Mood disorders with psychosis Drug induced psychosis Delusional disorder Induced delusional disorder Puerperal psychosis (psychosis after childbirth)
What is folie imposee?
This is where a dominant person (primary) forms a delusional belief during a psychotic episode and imposes it on another person.
What is folie simultanee?
When two people considered to suffer independently from psychosis influence the content of each other’s delusions so that they become identical or very similar.
What are the Schneider’s first rank symptoms?
This is an alternative tool to ICD-10 in terms of diagnosing schizophrenia
If one or more symptoms are present this is strongly suggestive of schizophrenia
. Delusional perception- a new delusion that forms in response to a real perception
. Third person auditory hallucinations
. Thought interference- thought insertion, withdrawal or broadcast
. Passivity phenomena
What is meant by avolition?
This means a decreased motivation (inability to initiate and persist in goal directed behaviour)
What is avolition?
This is poverty of speech for example if you ask ‘have you got children’ and they reply ‘yes’ without expanding.
What is meant by affect blunted?
A diminished or absent capacity to express feelings.
What are the group A ICD-10 criteria for schizophrenia?
Thought echo/insertion/broadcast (disorders of the self)
Delusions of control, influence or passivity phenomenon
Running commentary auditory hallucinations (3rd person)
Bizarre persistent delusions
What are the group B ICD-10 criteria for schizophrenia?
Hallucinations in other modalities that are persistent
Thought disorganisation (loosening of associations, neologisms, incoherence)
Catatonic symptoms (symptoms which involve a lack of movement and communication)
Negative symptoms
How is ICD-10 used to diagnose schizophrenia in terms of group A and group B?
At least one clear symptom from Group A or two or more from group B for at least a month or more.
