Schizophrenia Flashcards
What is schizophrenia?
Mental disorder inn which the thoughts, affective response or ability to recognise reality, and ability to communicate and relate to others, are sufficiently impaired to interfere grossly with the capacity to deal with reality
What are the classic characteristics of schizophrenia?
Lack of insight, hallucinations, delusions, disorder of form of thought
What are the types of schizophrenia?
Organic conditions = delirium, dementia, stroke, brain injury
Substance use = acute intoxication, withdrawl, delerium tremens
Manic depressive psychosis = unipolar depression, bipolar disorder
Dementia praecox = schizophrenia and other paranoid illnesses
Schizoaffective disorder
What does schizophrenia involve?
Inability to distinguish between subjective experience and objective reality = qualitatively different from normal experience
What are some examples of psychotic experiences?
Hallucinations, ideas of reference, delusions, thought disorder, thought interference, passivity phenomena, loss of insight
What is a hallucination?
Perception which occurs in absence of an external stimulus
What are some features of a hallucination?
Experienced as originating in real space (not just in thoughts)
Has same qualities as normal perception
Not subject to conscious manipulation
What are the different types of hallucination?
can occur in any sensory modality = auditory, visual, olfactory, gustatory, tactile, haptic
What is idea of reference?
Innocuous or coincidental events will be ascribed significant meaning by the person
What are some examples of idea of reference?
Thinking there are messages in the newspaper about them
Believing objects have been arranged so as to convey a hidden message to them
What are self-referential experiences?
Belief that external events are related to oneself = can vary in intensity from brief though to frequent and intrusive thought to delusional intensity
What are some examples of self-referential experiences?
Feeling that others are speaking about them
Believing they are the second coming of Christ
What are delusions?
Fixed falsely held belief = held with unshakeable conviction, may be bizarre or impossible, impervious to logical arguments or evidence
What are the origins of delusions?
Primary = arrive fully formed in the consciousness without need for explanation Secondary = often attempts to explain anomalous experiences
What are some types of delusion?
Paranoid, sin, persecutory, poverty, grandoise, nihilistic, religious, erotomantic, misidentification, jealousy, guilt
How are though disorders identified?
Must be inferred from patterns of speech = can’t be directly observed
What are some examples of thought disorders?
Neologisms, circumstantiality, clanging and punning, loosening of association, Knight’s move thinking, verbigeration
What are the types of thought interference?
Thought insertion, withdrawl, broadcasting and blocking
How do we process reality?
Reality testing is just another constructed process driven by the brain = involved filtering the info from our senses about the world and interpreting their meaning
Can you tell if the filters we use for processing reality aren’t working?
No = everything still seems real
What is loss of insight?
Patient is unable to attribute their symptoms to being an illness
What are the differentials of psychosis?
Schizophrenia, substance misuse, mania, depression, delirium, dementia
What are some features of drug induced psychosis?
May be very florid symptoms or more insidious and chronic = tend to be short lasting if access to substance is removed, not the same as intoxication or withdrawl effects
What must you beware of in drug induced psychosis?
Comorbidity of substance use with schizophrenia or bipolar disorder
What typifies depressive psychosis and mania with psychosis?
Mood congruent content of psychotic symptoms
What are some features of depressive psychosis?
Delusions of guilt, worthlessness, hypochondriasis or poverty
Hallucinations of accusing, insulting or threatening voices = typically second person
What are some features of mania with psychosis?
Delusions of grandeur, special ability, persecution or religiosity
Hallucinations = tend to be second person and auditory
Flight of ideas
What is delirium?
Acute transient disturbance = clouding of consciousness ranging from subtle drowsiness to unresponsive disorientation, worse at night, may have lucid intervals
What are some causes of delirium?
Alcohol withdrawl, septicaemia, organ failure, hypoglycaemia, encephalitis, space occupying lesions
What are some features of delirium?
Impaired concentration and memory = esp. new info
Visual hallucinations +/- auditory hallucinations
Persecutory delusions, irritability and insomnia
Psychomotor disturbance = agitation or retardation
What are the core symptoms of schizophrenia?
Delusions, auditory hallucinations, thought interference, passivity phenomena
What is the first set of ICD-10 criteria for schizophrenia?
At least 1 of = Thought echo, insertion, withdrawl or boradcasting
Delusions of control/influence clearly referred to body movements or thoughts
Hallucinatory voices
Persistent delusions of other kinds that are culturally inappropriate
What is the second set of ICD-10 criteria for schizophrenia?
At least 2 of = Catatonic behaviour
Persistent hallucinations occurring every day for at least one month when accompanied by delusions
Neologisms, breaks or interpolations in train of thought resulting in incoherent speech
Negative symptom
What are some negative symptoms that occur in schizophrenia?
Marked apathy, paucity of speech, blunting or incongruity of emotional responses
What are the subtypes of schizophrenia?
Paranoid = most common, 80% of all cases, 1st rank symptoms predominate
Hebephrenic
Catatonic = movement disorder predominates
What are some examples of other paranoid psychoses?
Persistent delusional disorder, schizotypal disorder, acute and transient psychotic disorder, schizoaffective disorder
What are some features of persistent delusional disorder?
Systematised = fixed delusions are the major or only feature
What are some features of schizotypal disorder?
Eccentricity and aloofness, social withdrawl, paranoid quasi-delusional ideas, magical thinking, transient auditory hallucinations
What are some features of acute and transient psychotic disorder?
Schizophrenia-like symptoms lasting less than a month
What are some features of schizoaffective disorder?
First rank symptoms with depression or mania
What are some examples of positive syndromes?
Hallucinations, delusions, passivity phenomena, disorder of form of thought
What are some examples of negative syndromes?
Reduced amount of speech, reduced motivation or drive, reduced interest or pleasure, reduced social interaction, blunting of affect
What is schizophrenia considered to be?
A genetically determined neurodevelopmental vulnerability later triggered by environmental stressors
When is the peak incidence of schizophrenia?
Males = age 15-25 Females = age 25-35
What is schizophrenia associated with?
Perinatal complications = prematurity, prolonged labour, foetal distress, hypoxia
What are the risk factors for schizophrenia?
Drug use, urban dwelling, social deprivation, enlarged ventricles and thinner cortices, altered dopamine signalling
What is the link between suicide and schizophrenia?
10-15% completed suicide rate in schizophrenics = may occur following recovery of insight, high risk in first week following discharge from hospital
What are some indicators of poor prognosis for schizophrenia?
Poor premorbid adjustment Insidious onset and childhood/adolescent onset Long duration of untreated psychosis Cognitive impairment Enlarged ventricles
What are some indicators of good prognosis for schizophrenia?
Shorter time of untreated psychosis
Older age of onset and positive family history
Marked mood disturbance
Female gender
