Schizophrenia Flashcards
What is the definition of psychosis?
An acute and severe episode of a mental condition
- Being out of touch w reality – disordered thoughts, beliefs, perceptions
- Lack of insight
What is the definition of schizophrenia?
Heterogeneous syndrome of disorganised and bizarre thoughts – delusions, hallucinations, prolonged impaired psychosocial functioning
What are the possible causes of psychotic symptoms?
Organic Disorders
- Epilepsy
- Cerebral lesions e.g. tumours, stroke, trauma – CAT/MRI scans important to diagnosis
- Nervous system illness – infections, congenital
- Endocrine disorders – esp hyperthyroidism
- Metabolic disorders or physiological disturbances affecting nervous system
- Iatrogenic causes
- Psychosis related to alcohol and
psychoactive substance misuse
- Parkinson’s disease
- Dementia
Affective Disorders – present with psychotic symptoms
- Mania
- Psychotic depression – i.e. depression + psychosis
- Post-partum psychosis – e.g. mother throwing baby out of the window after giving birth
Schizophrenia
- Psychosis related to disorders of psychological development and/or to stress-related reactions
- Psychotic Sx in context of adult personality disorder
- Psychosis in childhood or adolescence
What are the theorised causes of schizophrenia?
- Dopaminergic theory – too little no good
- Serotoninergic theory –too little = become withdrawn, too much = become psychotic
- Glutamine theory (not as popular) – too little = become withdrawn, too much = develop neurotoxicity
What are the factors implicated in schizophrenia?
Predisposing: factors from early life determining a person’s vulnerability to precipitating factors
→ Genetics, environment in utero, neurodevelopmental effects, personality, physical/psychological/social factors in infancy & early childhood
\Precipitating: events occurring shortly before onset of disorder
→ Cerebral tumours or injury, drug/substance-induced psychosis, personal misfortune, environment of high expressed emotion
Perpetuating: factors that prolong the course of the disorder
→ Secondary demoralisation, social withdrawal, lack of support/poor SES or environment
→ Poor adherence w antipsychotic medications – a lot will not understand the need to take the medication as they cannot think straight, so frequently non-adherent, resulting in relapse
What are the DSM-5 criteria for schizophrenia?
A. Two or more of the following, each persisting for a significant portion of at least a 1-month period
Positive symptoms – normal people have, are out of control in the patient
→ Delusions
→ Hallucinations
→ Disorganized speech
→ Grossly disorganised or catatonic behaviour (Impaired communication, unusual/no movement)
Negative symptoms – normal people have, patients don’t
→ Affective flattening, avolition etc
B. Social/occupational dysfunction – for a significant portion of the time since onset of the disorder, one or more major areas of functioning such as work, interpersonal relations, or self-care are significantly lower
C. Duration – continuous signs for at least 6 months (may include prodromal or residual symptoms)
- Inclusive of at least 1 month of symptoms fulfilling criterion A
D. Schizoaffective or mood disorder has been EXCLUDED
E. Disorder is NOT due to a medical disorder or substance use – reversible causes
F. If a history of a pervasive developmental disorder is present, there must be symptoms of hallucinations or delusions present for at least 1 month
What are the treatment goals for schizophrenia?
(3 stages)
Acute stabilization
→ Minimize threat to self and others
→ Minimize acute symptoms
→ Improve role functioning
→ Identify appropriate psychological interventions
→ Collaborate w family and caregivers – support for caregivers
Stabilization
→ Minimize/prevent relapse
→ Promote medication adherence
→ Optimize dose and manage adverse effects
Stable/Maintenance Phase
→ Improve functioning and quality of life
→ Maintain baseline functioning
→ Optimize dose vs Adverse effects
→ Monitor for prodromal Sx of relapse
→ Monitor and manage adverse effects
