Schizophrenia Flashcards
What is formal thought disorder?
A pattern of disordered language use that reflects disordered thought form
E.g. loosening of association (derailment), flight of ideas, circumstantial thoughts, tangential thoughts, thought block
What are the positive symptoms?
Delusions
Hallucinations
Thought disorder
Disorganised behaviour
What are the negative symptoms?
Poverty of speech Social withdrawal Reduced attention Avolition Blunted affect
What are Schneiders First Rank Symptoms?
Auditory hallucinations, Broadcasting of thought, Controlled thought (delusions of control), Delusional perception.
What is delusional perception?
The patient who takes a precept and ascribes an delusional idiosyncratic value to it, e.g. “I heard the church bells and knew I would win Wimbledon”
What is made volition?
The patient reports his will to be under the control of an external force.
What is somatic passivity?
Patient reports experiencing sensations on their body and believed being controlled by an external force
What are organic causes of psychosis?
Delirium - is another syndrome and there are many causes of delirium (e.g. sepsis) Medication-induced (e.g. corticosteroids, stimulants, dopamine agonists) Endocrine disorders (e.g. Cushings, hypothyroidism, hyperthyroidism) Neurological disorder (e.g. temporal lobe epilepsy, multiple sclerosis, movement disorders, Wilson's disease, Huntington's disease) Other systemic diseases (e.g porphyria, SLE)
How is schizophrenia diagnosed?
Symptoms present for longer than 28 days (some classification system needs longer duration)
No “organic” cause
First rank symptoms present or persistent hallucinations and delusions
May also have negative and cognitive symptoms
What are other psychiatric disorders?
Schizoaffective disorder (a mixture of first rank symptoms and mood symptoms)
Delusional disorder (the main symptom is non-first rank delusional belief with minimal hallucination)
Schizotypal Disorder
Acute and transient psychotic disorder (symptoms less than 28 days)
Mood disorder (Mania, Severe depression)
Substance misuse - e.g. alcohol withdrawal, intoxication with stimulants, cannabis
What us the epidemiology of schizophrenia?
Lifetime risk roughly one in a hundred M=F Very rare below age 14 Rare 16-18 Peak incidence 23 yrs male 26 yrs female (second peak between 30-40) Urban > rural Lower social class
What is the aetiology of schizophrenia?
Biological:
Genetic - Family history (possible multiple genes)
Obstetric complication - increased risk
Dopamine theory - how antipsychotic medication works
Neurodevelopmental theory
Psychological:
Cognitive errors - jumping to conclusions (especially in delusions and paranoia)
Premorbid personality - schizotypal disorder
Social:
Urban living (x2 to x3 - consistent research finding)
Migration (x3)
Life events (including physical and sexual abuse)
Ethnicity (x4 in Afro-Caribbeans in the UK; higher incidence also in South Asians)
What are the prodrome symptoms in schizophrenia?
on-specific negative symptoms
emotion distress/ agitation without reason
Transient psychotic symptoms
longer the DUP (duration of untreated psychosis) the worst the outcome.
Average DUP is over a year.
What are good prognostic factors in schizophrenia?
Female Married Family history of affective disorder Acute onset Good Premobid personality Early treatment Prominent mood symptoms Good response to treatment
What are poor prognostic factors in schizophrenia?
Family history of schizophrenia High expressed emotion (more later) Substance misuse Prominent negative symptoms Early onset Lack of insight/non-compliance