Schizophrenia Flashcards
What is schizophrenia? how is it diagnosed? is there pathognomonic symptom?
-group of brain disorders
-characteristic distortions of thought/perception/emotion/behavior
-no pathognomonic symptom
-neurodevelopmental
-genetic
currently diagnosed according to clinical features
what are the three positive symptoms of schizophrenia?
- hallucinations
- thought disorder
- delusions
Do positive or negative symptoms respond better to treatment in schizophrenia?
positive
what the four negative symptoms of schizophrenia?
- apathy
- lack of volition (lose drive)
- social withdrawal
- cognitive impairment
what is the ICD10 criteria for schizophrenia: 1 of 4 or 2 of 4 for how many months?
one of: -thought interference -passivity phenomena -hallucinatory voices giving running commentary, discussing pt., or coming from part of body -impossible persistent delusions OR two of: -formal thought disorder -catatonic behavior --ve symptoms -loss interest/idleness/self absorbed attitude/social withdrawal for one month or more
What is passivity phenomenon?
The core feature is the belief that one is no longer in control of one’s own body, feelings or thoughts. The individual feels that some external agent is controlling them to feel emotions, to desire to do things, to perform actions or to experience bodily sensations. Respectively, these are termed passivity of affect, passivity of impulse, passivity of volition and somatic passivity.
What are schneider’s 1st rank symptoms? list them (6)
symptomes strongly suggestive of schizophrenia but not pathognomonic (can get in other disorders and can not have them in schizophrenia)
- thoughts spoken aloud
- third person voices
- running commentary
- delusional perception
- passivity phenomena: made acts, impulses, volition, feelings
What is a delusion?
- A fixed belief, not amenable to logical thought or argument
- Did not come about through logical means
- Not a cultural or subcultural belief
Can get any type of delusion in schizophrenia- tends to be bizarre (things that are not possible). Can be paranoid, grandiose, nihilistic. Tend not to be mood-congruent.
Often related to current affairs or other things often thought about by the patient.
What is a hallucination?
- Perceptual experience not based on an actual object (as opposed to illusion which is distortion perception of an object)
- As vivid as a real perception
- Exists in external space
- Believed to be public (other people can perceive it too- realisation that others do not perceive it may be explained by further delusional elaboration- e.g. Patient who believed I must be protected by a “force field” as I could not hear his voices)
What is disruption of associations in schizophrenia?
in normal healthy thinking one thought provokes another one in a logical manner
In schizophrenia- may have lack of association between thoughts- so what they are saying may not make sense
What is thought blocking - thought disorder?
when the chain of thought unexpectedly breaks off- not caused by distraction by other thoughts though!
What is crowding of thought -thought disorder?
thoughts feel passively concentrated and compressed- some characteristics of flight of ideas but also has quality of passivity ie being controlled from outside
what is thought interference?
disturbance of the experience of thought: thought insertion/thought withdrawal/thought broadcasting
What is thought insertion?
thoughts being put into mind by an external agency
what is thought withdrawal?
thoughts being taken out of mind by an external agency - can be delusional explanation for thought blocking
what is thought broadcasting?
-thoughts being broadcasr to other people/shared with others
What emotional disorders can occur in shizophrenia? (6)
• Blunting of affect- limited range of emotion, lack of emotional sensitivity/connection to surroundings
o Reactivity affect – change of affect according to situations
• Incongruent affect- affect incongruent with circumstances- e.g. Laughing at sad story
• Apathy- lack of feelings/care about things
• Lack of motivation/volition
• Anhedonia
• Lack of interest in relationships/being sociable, lack of social skills
what motor and behavioral disorders can occur in schizophrenia? (6)
• Catatonia-State of increased tone in muscles at rest, abolished by voluntary activities.
Other abnormalities of motor activity and posture- may have-
• Stupor (unresponsiveness)
• Hyperactivity- non-goal directed
• Mutism (no speech)
• Stereotypies- non-goal directed movements (can involve unusual postures which can be held for a long time), or mannerisms
in extreme cases waxy flexibility
What is the nature of the delusions in schizophrenia?
- can get any type that tend to be impossible
- can be paranoid/nihilistic/grandiose
- tends not to be mood congruent
- often related to current affairs or other things the patient thinks about
What is the nature of the hallucinations in schizophrenia?
-auditory is most common, 3rd person most common
what is the: -cultural presence -lifetime risk -suicide risk -peak incidence in males/females -incidence -affect of socioeconomic class of shizophrenia?
- present in all cultures
- lifetime risk 1%
- peak incidence males: 15-25yrs
- peak incidence females: 25-35yrs
- incidence 15/100’000
- increased incidence in lower socioeconomic class
What are good prognostic markers for schizophrenia (4)
- older age of onset
- female gender
- marked mood disturbance esp. elation
- family history of mood disorder
What are bad prognostic markers for schizophrenia? (6)
- longer duration of untreated psychosis
- poor pre-morbid adjustment
- insidious onset
- early onset: childhood/adolescence
- cognitive impairment
- enlarged ventricles
Do positive or negative symptoms have more impact on functioning and QOL?
negative
Are positive or negative symptoms assoc. with poor adjustment prior to illness starting?
negative
What is a functional hallucination?
a hallucination that happens when something else occurs
What is an illusion?
distortion of the perception of an object e.g. seeing the outline of a bush as an attacker in the dark
What is a neologism?
made up word
what is delusional perception?
delusional belief arising from normal perception
What is a self-referential experience?
belief that external events are related to one’s self
-can vary in intensity from brief thought to frequent and intrusive thoughts to delusional intensity
What is self-referential delusions/delusions/ideas of reference?
some events in environement have special meaning/directed at me
What is flight of ideas?
- words associated together inappropriately e.g. meaning/rhyme
- pt jumps from topic to topic but with recognisable links
What is tangential thinking?
wanders from topic and never returns
What is circumstantiality?
gives excessive/unnecessary detail but returns to topic
What is knights move thinking?
patient moves from one idea to another with strage illogical associations between the ideas.
