Schizophrenia Flashcards
What is Psychosis?
Disease of the mind (severe)
“Psychosis represents an inability to distinguish between symptoms of hallucination, delusion and disordered thinking from reality.”
What is Neurosis?
Disease of the nerves (mild)
What are hallucinations?
Hallucinations
> Have the full force and clarity of true perception
> Located in external space
> No external stimulus
> Not willed or controlled
5 special senses
> auditory or visual
> tactile
> olfactory and gustatory
What are delusions, can you think of examples?
“ a delusion is an unshakeable idea or belief which is out of keeping with the person’s social and cultural background; it is held with extraordinary conviction.”
Examples > grandiose > paranoid (correctly persecutory) > hypochondriacal > self referential
Which illnesses may have Psychotic symptoms?
> Schizophrenia
> Delirium
> Severe affective disorder
- Depressive episode with psychotic symptoms - Manic episode with psychotic symptoms
What percentage of the population have Schizophrenia?
1%
What is the normal age of onset of Schizophrenia?
15-35 years old
What are the positive symptoms within schizophrenia?
Hallucinations
Delusions
Disordered thinking
What are the negative symptoms within schizophrenia?
Apathy
Lack of interest
Lack of emotions
What is used to diagnose Schizophrenia?
The ICD 10
Diagnostic criteria for Schizophrenia by the ICD 10?
For more than a month in the absence of organic or affective disorder:
At least one of the following:
a) Alienation of thought as thought echo, thought insertion or withdrawal, or thought broadcasting.
b) Delusions of control, influence or passivity, clearly referred to body or limb movements actions, or sensations; delusional perception.
c) 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.
d) Persistent delusions of other kinds that are culturally inappropriate and completely impossible (e.g. being able to control the weather).
And OR at least two of the following:
e) Persistent hallucinations in any modality, when occurring every day for at least one month.
f) Neologisms, breaks or interpolations in the train of thought, resulting in incoherence or irrelevant speech.
g) Catatonic behaviour, such as excitement, posturing or waxy flexibility, negativism, mutism and stupor.
h) “Negative” symptoms such as marked apathy, paucity of speech, and blunting or incongruity of emotional responses.
Types of schizophrenia - paranoid?
Dominated by the presence of delusions and hallucinations (positive symptoms).
Negative symptoms, catatonic symptoms as well as thought disorganisation are not prominent.
This prognosis is usually better and the onset of illness later (typically 18-25 years) than the other subtypes.
Types of schizophrenia - Hebephrenic?
Characterised by disorganised thought, disturbed behaviour and inappropriate flat effect.
Delusion and hallucinations (positive symptoms) are fleeting and not prominent.
Onset of the illness is earlier (15-25 years of age) and the prognosis is worse than paranoid.
Types of schizophrenia - catatonic?
A rare form characterised by more catatonic symptoms.
Types of schizophrenia - residual?
1 year of predominantly chronic negative symptoms which must have been preceded by at least one clear-cut psychotic episode in the past
Aetiology of psychosis - Biological factors?
1) Biological:
> Genetics
- Hereditary
- Neuregulin
- Dysbindin
- Di George syndrome
> Neurochemistry
- Dopamine hypothesis
- Glutamate
- GABA
- Serotoninergic transmission
> Obstetric complications
> Maternal influenza
> Malnutrition and famine
> Winter birth
> Substance misuseAetiology of psychosis?
1) Biological factors
2) Psychological factors
3) Social factors
4) Evolutionary theories
Aetiology of psychosis - social factors?
Occupation and social class but be aware of “drift hypothesis”. This states that although often in a lower socioeconomic class this is often a result of the illness.
Migration
Recent meta-analysis of 18 studies confirms the risk in schizophrenia (Cantor-Grae et al BJPsych 2005).
Social Isolation
Life Events as Precipitants
Cultural factors NOT IMPLICATED
Differential diagnosis in psychosis?
1) Schizophrenia
2) Schizophrenia-liek psychotic disorders
3) Schizoaffective disorder
4) Delusional disorder
5) Mood (Affective) disorders:
- Manic episode with psychotic features
- Depressive episode, severe, with psychotic features
6) Personality disorders (Schizotypal, borderline, schizoid, paranoid)
7) Medical causes (Endocrine, space occupying lesion etc)
8) Substance misuse
9) Dementia/delirium
10) Neurodevelopmental (Autistic spectrum)
What is schizoaffective disorder?
Schizoaffective disorder describes the presentation of both schizophrenic and mood (Depressed or manic) symptoms that present in the same episode of illness, either simultaneously or within a few days of each other.
Manic episode with psychotic symptoms?
Manic episode with psychotic symptoms
> Delusions of grandeur; special powers or messianic roles
> Gross overactivity, irritability and behavioural disturbance: Manic excitement
Depressive episode with psychotic symptoms?
Depressive episode with psychotic symptoms
> Delusions of guilt, worthlessness and persecution
> Derogatory auditory hallucinations
Management of schizophrenia - First episode?
First or second generation anti-psychotics e.g. haloperidol or olanzipine
If no response after 4 weeks change antipsychotic
Management of schizophrenia - acute exacerbation or relapse?
1) Amisulpride, olanzapine or risperidone
+
2) Chlorpromaine and other low-potency first generation anti-psychotics
Management of schizophrenia - prophylaxis to precent relapse?
Amisulpride, olanzapine or risperidone
+
2) Chlorpromaine and other low-potency first generation anti-psychotics
Should be continued for two years
Management of schizophrenia - treatment resistant schizophrenia?
Clozapine should be offered.
Lamotrigine or sulpiride can be added for those who have had insufficient response or persistent negative symptoms
Management of schizophrenia with cognitive dysfunction?
Antipyschotics and addition of acetylcholinesterase inhibitors
Management of schizophrenia in remission who have comorbid depressive symptoms?
Second generation antipsychotics
Management of schizophrenia - psychological therapies?
1) Cognitive behavioural therapies
2) Cognitive remediation
3) Family intervention
4) Social skills training
Which antipsychotic should be used in breast feeding?
Clozapine
Good prognostic factors in schizophrenia?
Absence of family history
Good premorbid function - stable personality, stable relationships
Clear precipitant
Acute onset
Mood disturbance
Prompt treatment
Maintenance of initiative, motivation
Poor prognostic factors in schizophrenia?
Slow, insidious onset and prominent negative symptoms are associated with a worse outcome.
Mortality is 1.6 times higher than the general population.
Shorter life expectancy is linked to cardiovascular disease, respiratory disease and cancer.
Suicide risk is 9 times higher.
Death from violent incidents is twice as high.
36% of patients have a substance misuse problem and there are high rates of cigarette smoking.
Poorer if starts in childhood
