Schizophrenia Flashcards
What is Schizophrenia?
- Schizophrenia is the group of severe mental illnesses affecting your thinking, emotion and behaviour.
- It is characterised by continuous or relapsing episodes of psychosis and is in fact the most common cause of psychosis.
- It affects 1 in 100 people (1% - quite common), M=F and age of onset = 15-35.
- No single cause has been identified
Which illnesses have psychotic symptoms? (3)
- Schizophrenia
- Delirium
- Severe affective disorder - depressive or manic episode with psychotic symptoms
What are the positive symptoms of Schizophrenia?
Having these symptoms suggests acute illness and is more treatable.
- Hallucinations – mainly auditory (in the third person and/or voices commenting on the patient’s behaviour)
- Delusions
- Ideas of reference
- Thought disorder (thought withdrawal, insertion, broadcast or Knight’s move thinking i.e thought derailment)
- Paranoia
Delusional beliefs:
- What makes something a delusional belief?
- What types are there?
- These ideas have no logical perception in the real world – they are a complete jump and the connection is un-understandable meaning you cannot see the reasoning behind the idea i.e ‘I saw a bike today and that told me I am now the King of Spain’ or ‘My mum blinked 3 times and that means the end of the world is in 2 days’
- Grandiose, paranoid, hypochondriacal or self-referential
What are self-referential ideas / ideas of reference?
This is where the person thinks irrelevant occurrences or details in the world relate directly to oneself – these ideas kind of make sense - you can sort of follow their line of thought, however, they are still false i.e a person might see News of when the Capitol was stormed in the U.S and think ‘they’re doing that to send me a message’
Hallucinations vs pseudohallucinations
True Hallucination:
- Perception in the absence of real stimulus.
- Have the full force and clarity of true perception with no external stimulus.
- Not willed or controlled.
- Involve 5 special senses - auditory, visual, tactile, olfactory and gustatory.
- Behaviour changes because of their hallucination i.e ripped up the carpets because a voice told them to.
Psuedo-hallucination:
- These ‘hallucinations’ or images do not exist in external space and don’t have the same characteristic of a real perception (i.e if you look at a laptop screen but you can see through the screen or it’s shimmering, or wavy etc then this is not the usual characteristics of a laptop screen and this would be a pseudo-hallucination).
- If the patient can conjure it up or control it then that is another sign that it is a pseudo-hallucination and not a hallucination.
What are the negative symptoms of Schizophrenia?
Negative symptoms/2nd rank – suggests long term illness and a poorer prognosis and are also seen in other conditions i.e they are more vague
- Marked Apathy
- Lack of interest
- Blunted affect
- Poverty of speech
What is Knight’s move thinking?
A thought disorder that comes across in the person’s speech. The usual logical sequence of ideas is lost and the person jumps from one idea to another with no apparent connection.
What is ‘blunted affect’?
A lack of emotion
You would be unable to read the person as their facial expressions are not what you would expect. For example if you told someone they won the lottery and they did not react then this would be blunted affect.
Can a schizophrenic patient have both positive and negative symptoms?
- Yes, a schizophrenic patient can have both positive and negative symptoms, they are just descriptive terms.
- Positive symptoms tend to be present in early disease.
- And chronic Schizophrenia is charecterised by its long duration and by the ‘negative’ symptoms of underactivity, lack of drive, social withdrawal and emotional emptiness.
Diagnostic criteria for Schizophrenia
At least one of the following must have been going on for more than a month in the absence of organic or affective disorder:
a) Alienation of thought / thought disorder as thought echo (echo of your thoughts as you thinking), 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 (think their body is being controlled by someone else)
c) Hallucinatory voices typically 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).
ADHP - ‘A Dangerous Hallucination Persists’
AND/OR at least 2 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, poverty of speech, and blunting or incongruity of emotional responses.
What is the most common type of Schizophrenia?
Paranoid Schizophrenia
What are the 3 main factors that cause Schizophrenia?
- Biological factors
- Psychological factors
- Social factors
How do genetics play a role in Schizophrenia?
- 50% concordance in MZ twins – if you are a twin and your twin has schizophrenia your risk is 50%
- 10% risk if one parent is affected
- 40% if two parents affected
- 10 % sibling
- 10% DZ twins
- Neuregulin (chromosome 8p)
- Dysbindin (chromosome 6p)
- Di George Syndrome (22q)
What is the ‘dopamine hypothesis’ in relation to psychotic symptoms?
The idea that increased/excess levels of dopamine in the brain cause psychotic symptoms – the oldest and most accepted hypothesis
