Schizophrenia Flashcards
a perception in the absence of a
stimulus, i.e. hearing, seeing, smelling, touching or
tasting something that isn’t there - is a ?
Hallucination
a fixed, false belief, held despite rational
argument or evidence to the contrary. It cannot be
explained by the patient’s cultural, religious, or educational background - is a ?
Delusion
list obstetric factors that increase the risk of schizophrenia?
why do they increase risk?
Maternal prenatal malnutrition
viral infections
pre-eclampsia,
low birth weight,
emergency Caesarean section
increase risk because these things may be caused by genetic abnormaliities or hypoxic brain damage
list aetiological factors responsible for schizophrenia?
Genetics - 50% MZ concordance. increased risk in 1st degree relatives
Obstetric complications
Subtance misuse - LSD, amphetamines, cocaine (stimulants) cause psychotic symptoms
Social disadvantage - poorer adults, not kids
Urban living and birth
Migration and ethnicity - afro carribeans
Expressed emotion - critical relatives - increases relapse but not causal
Premorbid schizoid
Bad life experiences - abuse
Neurochemical theories
Neurological structural abnormalities - reduced brain sign, EEG changes
how is cannabis linked to schizophrenia?
doesnt cause it but increases risk the risk factors already in place.
Skunk is a particularly dangerous form for those vulnerable to schizophrenia, since it has higher concentrations of tetrahydrocannabinol, the chemical in cannabis most associated with psychosis.
which cannabis users are at highest schizo risk?
people who are Val–Val allele have the highest risk.
The enzyme catechol-O-methyl transferase (COMT) breaks down dopamine.
There are two alleles coding for the COMT gene: Val and Met.
The Val allele increases the risk of schizophrenia in cannabis users: , those who are Met–Met have the
lowest risk, and heterozygotes have intermediate risk.
what are the theories explaining schizophrenia?
A. Neurodevelopmental
1. enlarged ventricles with overall smaller
and lighter brains
- lower premorbid IQs, deficits inlearning memory and executive function
B. Neurotransmiitter theories
1. dopamine hypothesis states that schizophrenia is a
result of dopamine overactivity in certain areas of the brain
- postive symptoms -> DA overactivty -> increased
mesolimbic system
- negative symptoms -> DA underactivity -> decreased
mesocortical system
- serotonergic overactivity and glutamate dysregulation
C. Psychological theories
- defects in thinking i.e jumping to conclusions lead to delusions
what are the positive symptoms of schizophrenia
cause?
hallucinations and
delusions
are thought to result from excess dopamine
in the mesolimbic tracts.
what are the negative symptoms of schizophrenia
cause?
apathy—the opposite of enthusiasm; loss of motivation
• blunted affect—decreased reactivity of mood
• anhedonia—the inability to enjoy interests/activities
• social withdrawal
• poverty of thought and speech.
marked decrease in selfcare,
-> thought block/ paucity of thought
->Ideas don’t connect - loose associatoin
May result from dopamine underactivity in the mesocortical tracts.
what is the at-risk mental state (ARM) ?
consists of low-grade symptoms such as
social withdrawal and loss of interest in work, study, and
relationships, without any frank psychotic symptoms.
Typically, the picture is of someone in their late teens or
early twenties who has dropped out of college or work
after a period of increasing absences. seem distant. may deny psychotic symptoms
MAY lead to schizo. used to be called prodrome
how does the acute phase of schizophrenia present?
PSYCHOTIC and POSITIVE symptoms
The acute phase has the most striking and florid psychotic features:
delusions - any type
hallucinations - auditory
Thinking is disturbed, resulting in muddled speech, and behaviour may be withdrawn, overactive, or bizarre.
Negative symptoms such as a marked decrease in selfcare, social withdrawal, can also present
which are The most diagnostically significant delusions in schizophrenia?
- Delusional perception
- Passivity - being controlled
- Delusional thought interference
Delusional perception - This is a two-stage process
whereby a real perception is then interpreted in a
delusional way, e.g.
– ‘The traffic lights changed to green and I knew I
was Queen of Ireland!’
Passivity - belief that movement, sensation, emotion,
or impulse are controlled by an outside force, e.g.
– ‘He makes my eyes go round and round and I can’t
keep them still.’
DTI - their thoughts are under the control of something
List the type of auditory hallucinations in schizo?
thought echo
third person - discussing about the patient
runnin comentary - of patients life
what is a formal thought disorder?
Formal thought disorder is when thoughts become
disconnected (loosening of associations).
Vagueness may
progress to very disjointed speech that is hard to follow
and apparently senseless.
as part of Delusional thought interference explain Thought withdrawal
Thought withdrawal—thoughts are removed from the
patient’s mind, e.g. ‘The old man uses an invisible
fishing line to pluck the thoughts from my head!’
as part of Delusional thought interference explain thought insertion
– Thought insertion—thoughts are placed directly
into the patient’s mind, e.g. ‘She uses magnets to
push her thoughts in.
as part of Delusional thought interference explain thought broadcasting
– Thought broadcasting: thoughts are broadcast to others
so that people can know what they are thinking,
characterise the chronic phase of schizo?
negative symptoms which may last
indefinitely and be immensely disabling
what are the subtypes of schizophrenia?
how do they present? most common?
Paranoid
- most common. delusions and hallucinations
Catatonic
- psychomotor disturbance; stupor, excitement
- rigidity, automatic obedience
- absent or non prominent delusions and hallucinations
Hebephrenic
prominent sx:
- disorganized and chaotic mood/behaviour/speech
- loosened associations and schizophasia (“word
salad”), and flat or inappropriate affect.
- hebephrenia, named after the Greek term for
“adolescence”
- Ages affected ; adolescnce 15-25
- non prominent: delusions and hallucinations
Simple
- negative sx only
Residual
- negative sx after delusion and hallucinations stop
may overlap
list schneiders first rank symptoms?
Delusional perception
Passivity
Delusions of thought interference
• Thought insertion
• Thought withdrawal
• Thought broadcasting
Auditory hallucinations • Thought echo • ‘Third person’ (voices discussing or arguing about the patient) • Running commentary
importnace of in schneiders first rank symptoms in diagnosing schizo?
they are neither necessary nor sufficient to make
the diagnosis, as they can occur in mania and delirium,
and may be absent in schizophrenia.
sx presnt for 1 month at least.
list ddx for schizophrenia?
- Organic causes - i.e. medications, delirium & dementia
- Acute and transient psychotic episode
- self resolves in months - Mood disorder: psychotic sx indepression+ mania
- Schizoaffective disorder - schizo + affective sx present
- Persistent delusional disorder - no hallucinations
- Schizotypal disorder - abnormal thoughts and personality disorder
what is the importance of the duration of untreated psychosis (DUP)?
the longer the DUP, the greater the damage to the
person’s cognitive abilities, insight, and social situation (e.g. dropping out of school, work, relationships).
what is the rx of schizo?
Antipsychotics
- typical
- atypical
Psychological management
- CBT: should all be offered this (NICE)
- Family therapy ; to reduce EXPRESSED EMOTION -
reduces relapse
- Concordance therapy
Social approaches
- ward admission
- education, housing, training, support foe employment
- social skills development
