Schizophrenia Flashcards
What is schizophrenia?
The most common form a psychosis
A mental disorder in which the thoughts, affective response or ability to recognise reality, and the ability to communicate and
relate to others, are sufficiently impaired to interfere grossly with the capacity to deal with reality
What are some causes of psychosis?
Dementia praecox - Schizophrenia and paranoid illnesses
Manic depressive psychosis - Depression and bipolar disorder
Organic conditions - Delirium, dementias and strokes
Substance use - Acute intoxication, withdrawal, delirium tremens
What is schizoaffective disorder?
Schizoaffective disordercombines the symptoms of schizophrenia withbipolar disorder. Patients havepsychosisand symptoms ofdepressionandmania.
What is schizophreniform disorder?
Schizophreniform disorderpresents with the same features as schizophrenia but lastsless than six months.
What is “ideas (Delusions) of reference”
Innocuous or coincidental events will be ascribed significant meaning by the person
What are some examples of “Ideas of reference”
- Thinking that there are really messages in the newspaper about them
- Believing that the news report on the TV is commenting on their life or talking directly to them
- Seeing that objects or events have been arranged so as to specifically convey a hidden meaning to them
- Knowing that people’s conversations or social media postings are about them
- Believing that a radio station is broadcasting songs in such a way as to tell you something
- Seeing meaning in other peoples gestures
What are some factors that increase risk of schizophrenia?
Genetic factors (78% heritability) - Polygenic
Environmental factors
What are some gene alterations thought to be involved in schizophrenia?
- Neuregulin - a sigalling protein that mediates cell-cell interactions and plays critial roles in the growth and development of multiple organ systems
- Dysbindin - essential for adaptive neural plasticity
- DISC-1 - involved in neurite outgrowth and cortical development through its interaction with other proteins
What are some environmental risk factors for schizophrenia?
- 2nd trimester viral illness
- Obstetric problems
- Childhood CNS infection
- Substance misuse
- Urban dwelling
- Social adversity or deprivation
- Neurodevelopmental changes
- Neurochemical signalling changes
What are some obstetric problems that can increase risk of schizophrenia?
Pre-eclampsia
Foetal hypoxia
Emergency Caesarian section
What are some substances that increase risk of psychosis?
- Amphetamines
- Cocaine
- Cannabis
- Novel psychoactive substances (‘legal highs’)
What is the ICD-11 criteria for schizophrenia diagnosis?
At least 2 of the following symptoms must be present (By the individuals report or through observation) most of the time for a period of 1 month or more
1 of these must be a major symptom
What are the 4 major criteria for schizophrenia diagnosis?
- Persistent delusions
- Persistent hallucinations
- Formal thought disorder
- Experiences of influence, passivity or control
What are the 3 minor criteria for schizophrenia diagnosis?
- Negative symptoms (E.g. asociality, anhedonia, amotivation, anergia)
- Grossly disorganised behaviour that impedes goal-directed activity
- Psychomotor disturbance such as catatonic restlessness, agitation, posturing, waxy flexibility, negativism, mutism or stupor
What is catatonia?
This is a state in which a person is awake, but does not respond to their environment
What is a diagnosis of schizophrenia with the presence of a full syndrome of catatonia?
Catatonia associated with another mental disorder
Catatonic schizophrenia
How may schizophrenia symptoms be clustered?
Positive symptoms
Negative symptoms
What are some of the positive symptoms of schizophrenia?
Hallucinations
Delusions
Passivity phenomena
Disorder of the form of thought
What are some negative symptoms of schizophrenia?
Affective blunting
Alogia (Paucity of speech)
Avolition (Lack of motivation)
Asociality (Loss of social interest)
Anhedonia (Loss of enjoyment)
What are some of the subtypes of schizophrenia?
Hebephrenic
Catatonic
What are the characteristics of hebephrenic schizophrenia?
- Prominent affective changes
- Fragmentary feeling
- irresponsible behaviour
- Shallow mood
- Incoherent speech
- Social isolation
What is 1st line management of schizophrenia?
2nd generation antipsychotic (DA antagonist) e.g. risperidone or olanzapine - titrate up over 6-8 weeks
What is 2nd line management of schizophrenia?
1st (e.g. haloperidol) or different 2nd generation antipsychotic - titrate up over 6-8 weeks
What is 3rd line management of schizophrenia?
Check diagnosis, consider psychological input, optimise social supports, check compliance (consider depot?), consider combining two antipsychotics, consider clozapine
Drug-induced psychosis vs schizophrenia
Drug-induced is usually short-lasting after the substance is removed
Depressive psychosis vs schizophrenia
Depressive psychosis has delusions of worthlessness, guilt, hypochondriasis, poverty, sin and nihilism
Depressive hallucinations tend to be 2nd person auditory, accusatory or insulting in character
Mania with psychosis vs schizophrenia
Manic delusions are often of grandeur, special ability, persecution and religiosity
Manic hallucinations tend to be 2n person auditory and positive (E.g. hearing God telling you you’re great)
What is persistent delusional disorder?
Systematised, fixed delusions are the major or only feature
What is schizotypal disorder?
A disorder chracterised by eccentric behaviour and anomalies of thinking and affect which resemble those seen in SZ, though no definate and characteristic SZ anomalies occur at any stage
What are the main symptoms of schizotypal disorder?
cold or inappropriate affect, anhedonia, odd or eccentric bhaviour, a tendency to social withdrawal, paranoid or bizarre ideas not amounting to true delisions, obsessive episodes which intense illusios, auditory or other hallucinaions and delusion-like ideas, usually occuring without external provocation
What is induced delusional disorder
Psychoses that occur in one person due to contact with another with psychoses
What are the french terms for induced delusional disorder?
Folie a deux, Folie a plusieurs
