Schizophrenia Flashcards
What is schizophrenia
Schizophrenia and the related psychotic illnesses belong to a group of disorders traditionally called?
What does that term mean?
aetiology of schizophrenia is currently unknown and there is no definitive diagnostic test available. True or false
Schizophrenia is a brain disorder that affects how people think, feel and perceive.
Functional psychoses
Functional’ in this context means a disorder of brain function with no corresponding structural abnormality.
•
True
What is the cardinal feature of schizophrenia
They could arise from?
The cardinal feature is the presence of psychotic symptoms – hallucinations and/or delusions.
- A reaction to drugs
- Severe anxiety
- Acute confusion
- Early signs of dementia
Schizophrenia affects about 1 in 100 individuals
• Usually begins in late adolescence or early adulthood
• Untreated, it runs a chronic deteriorating course
True or false
Symptoms of schizophrenia are divided into?
True
The symptoms of schizophrenia are conventionally divided into positive symptoms (an excess or distortion of normal functioning) and negative symptoms (a decrease or loss of functioning)
What are the positive symptoms and negative symptoms of schizophrenia
POSITIVE SYMPTOMS
• Delusions – commonly persecutory, thought interference, or
passivity delusions
• Hallucinations – usually running commentary, 3rd person
• Formal thought disorder – a loss of the normal flow of thinking usually shown in the subject’s speech or writing
SCHIZOPHRENIA • NEGATIVE SYMPTOMS • Impairment or loss of volition, motivation, and spontaneous behaviour • Loss of awareness of socially appropriate behaviour and social withdrawal • Flattening of mood • Blunting of affect and anhedonia • Poverty of thought and speech
What are the aetiological theories of schizophrenia
NEUROCHEMICAL ABNORMALITY HYPOTHESIS • Dopaminergic overactivity
• Serotonergic (5-HT) overactivity • Alpha adrenergic overactivity
• GABA hypoactivity
• Glutaminergic hypoactivity
• THE NEURODEVELOPMENTAL HYPOTHESIS
THE DISCONNECTION HYPOTHESIS
What does the disconnection hypothesis state
Widespread reductions in grey matter (particularly temporal lobe)
• Disorders of memory and frontal lobe function occurring in a background of widespread cognitive abnormalities
• Reduced correlation between frontal and temporal blood flow on specific cognitive tasks
• A reduction in white matter integrity in tracts connecting the frontal and temporal lobes
Incidence around 15 new cases per 100 000 population
• M=F, although males tend to have an earlier onset than females
(23yrs VS 26yrs) and develop more severe illness
• Heritability estimates range between 60 – 80%
• The diagnosis of schizophrenia carries around a 20% reduction in life expectancy.
• Suicide is the most common cause of premature deaths in schizophrenia.
True or false
True
Name some environmental factors that have been associated with the increased risk of schizophrenia
ENVIRONMENTAL FACTORS – The following have been associated with an increased risk of schizophrenia:
• Complications of pregnancy, delivery, and the neonatal period • Delayed walking and neurodevelopmental difficulties
• Early social services contact and disturbed childhood behaviour • Severe maternal malnutrition
• Maternal influenza in pregnancy and winter births • Degree of urbanization at birth
• Use of cannabis especially during adolescence
How is schizophrenia diagnosed What is the General criteria for Paranoid, Hebephrenic, Catatonic and Undifferentiated type of Schizophrenia:
• Either at least one of the syndromes, symptoms and signs listed below under (1), or at least two of the symptoms and signs listed under (2), should be present for most of the time during an episode of psychotic illness lasting for at least one month (or at some time during most of the days).
What are the symptoms under 1
1) At least one of the following:
• Thought echo, thought insertion or withdrawal, or thought broadcasting.
• Delusions of control, influence or passivity, clearly referred to body or limb movements or specific thoughts, actions, or sensations; delusional perception.
• Hallucinatory voices giving a running commentary on the patient’s behaviour, or discussing him between themselves, or other types of hallucinatory voices coming from some part of the body.
• Persistent delusions of other kinds that are culturally inappropriate and completely impossible (e.g. being able to control the weather, or being in communication with aliens from another world).
What’s re the symptoms under 2
2) or at least two of the following:
• Persistent hallucinations in any modality, when occurring every day for at least one month, when accompanied by delusions (which may be fleeting or half- formed) without clear affective content, or when accompanied by persistent over- valued ideas.
• Neologisms, breaks or interpolations in the train of thought, resulting in incoherence or irrelevant speech.
• Catatonic behaviour, such as excitement, posturing or waxy flexibility, negativism, mutism and stupor.
• “Negative” symptoms such as marked apathy, paucity of speech, and blunting or incongruity of emotional responses (it must be clear that these are not due to depression or to neuroleptic medication).
What is the most commonly used Exclusion criteria for diagnosing schizophrenia
The disorder is not attributable to organic brain disease, or to alcohol- or drug-related intoxication, dependence or withdrawal.
• Continuous signs of the disturbance must persist for at least 6months, during which the patient must experience at least 1 month of active symptoms (or less if successfully treated).
True or false
If the patient also meets criteria for manic episode or depressive episode , the criteria listed under (1) and (2) above must have been met before the disturbance of mood developed.
How is catatonic schizophrenia diagnosed
A. The general criteria for Schizophrenia must eventually be met, though this may not be possible initially if the patient is uncommunicative.
• B. For a period of at least two weeks one or more of the following catatonic behaviours must be prominent:
• Stupor (marked decrease in reactivity to the environment and reduction of spontaneous movements and activity) or mutism;
• Excitement (apparently purposeless motor activity, not influenced by external stimuli);
• Posturing (voluntary assumption and maintenance of inappropriate or bizarre
postures);
• Negativism (an apparently motiveless resistance to all instructions or attempts to be moved, or movement in the opposite direction);
• Rigidity (maintenance of a rigid posture against efforts to be moved);
• Waxy flexibility (maintenance of limbs and body in externally imposed positions);
• Command automatism (automatic compliance with instructions).
C. Other possible precipitants of catatonic behaviour, including brain disease and metabolic disturbances, have been excluded.
Name some schizophrenia related disorders
SCHIZOPHRENIA RELATED DISORDERS
• Schizoaffective Disorder
• Schizotypal Disorder
• Schizophreniform Disorder
What is schizoaffective disorder
How is schizoaffective disorder diagnosed and treated
•
This disorder has features of both an affective disorder and schizophrenia which are present in approximately equal proportions.
• Lifetime prevalence is 0.5-0.8% with limited data on gender and age differences.
ICD-10 Criteria
• Schizophrenic and affective symptoms simultaneously present and both
are equally prominent
• Excludes patients with separate episodes of schizophrenia and affective disorders and when episodes are in the context of substance use or other medical disorder
• Treatment
• As for schizophrenia but treat associated manic or depressive symptoms
