Schizophrenia And Delusional Disorders Flashcards
What diagnosis aid may be used when considering schizophrenia in a patient?
Refer to Schneiders first rank symptoms- this is a set of features that are indicative of the condition in the absence of organic cerebral pathology.
What is schizophrenia?
A debilitating psychiatric disorder characterised by changes in thinking, perception, blunted affect and a reduced level of social functioning
List Schneider’s First Rank Symptoms of schizophrenia
Auditory hallucinations- voices repeating thoughts out loud, discussing subject in the first person, running commentary
Thought insertion, withdrawal, broadcasting
Made feelings, impulses, actions
Somatic passivity
Delusional perception
What are the three types of auditory hallucination in schizophrenia?
Gedankenlautwerden- voice heard through ears says thoughts out loud as they are being thought; echo de la pensee- voice repeats thoughts just after thinking them; voice says thoughts in anticipation just before they have been thought
Voices discuss the subject in third person
Voices give a running commentary
What are the three types of thought alienation?
Thought insertion- do you ever feel as though thoughts being forced into your mind by someone or something else?
Thought withdrawal- have you ever experienced the sensation of having your thoughts taken away from you?
Thought broadcasting- do you ever get the feeling that your thoughts can be read by others, as if they’re being broadcast for all to see?
What does made feelings, impulses and actions mean in Schneiders first-rank?
Patient may experience the feeling of free will being removed and that an external agency is controlling his feelings, impulses or actions, may feel under hypnosis
What is somatic passivity?
Feeling that one is a passive recipient of bodily sensations by some other external agency.
Do you ever feel as though someone/thing outside yourself is causing you to have odd bodily sensations that you can’t control?
What is a delusional perception?
A real perception that is misinterpreted to have special significance or meaning e.g door left open—> I am king of Spain!
Green traffic light—> they’re coming for me!
How many types of schizophrenia are there?
9 types Paranoid (most common) Hebephrenic Catatonic (less now) Undifferentiated Residual Post schizophrenic depression? Simple Other Unspecified
Describe other symptoms of schizophrenia not included in first rank?
Other persistent delusions- religious or political identity, superhuman powers
Persistent hallucinations- any modality, esp if occur every day, often accompanied by fleeting/ half formed delusions without clear affective content, persistent overvalued ideas
Breaks or interpolations of thought- result in incoherence or irrelevant speech, may cause neologisms
Catatonic behaviour- alternate between stupor (unresponsive, akinetic, mute and fully conscious) and excitement; bizarre posturing; waxy flexibility - limbs can be moulded into position and will stay for long amounts of time; negativism - motiveless resistance to instructions/ attempts to be moved
Negative symptoms- chronic apathy, poverty of speech, lack of drive, slowness and blunting or incongruity of affect—> social withdrawal and decline in social performance
Change in personal behaviour- loss if interest, aimlessness, idleness, self-preoccupied and isolation
What is a neologism?
A made up word or existing word used in novel, inappropriate way as a result of thought disorder in schizophrenia
What is an overvalued idea?
An unreasonable and sustained intense belief/ preoccupation that is demonstrably false and not normally held by others of the patients subculture. It is maintained with less than delusional intensity but with marked emotional investment.
What other MH issues should be screened for in consideration of negative symptoms in schizophrenia?
Depression and antipsychotic medication side effects
What is the clinical picture of paranoid schizophrenia?
Delusions of persecution - others are plotting/ out to get them
Delusions of reference- believing that strangers/TV/radio or newspapers are referring to the patient
Delusions of exalted birth- having a special mission, the messiah
Delusions of bodily change
Delusions of jealousy
Hallucinatory voices of a threatening nature or issuing commands
Non- verbal auditory hallucinations e.g whistling, laughing, humming
Hallucinations in other modalities- smell, taste, sexual, visual, other somatic
May not look psychiatrically unwell until paranoid symptoms exposed!
What is the clinical picture of hebephrenic schizophrenia?
Irresponsible unpredictable behaviour- exhibiting mannerisms and playing pranks
Rambling and often incoherent speech
Affective changes- incongruous affect, shallow mood, giggling and fatuousness
Poorly organised delusions
Fleeting and fragmentary hallucinations
Onset is normally young 15-25 years And generally has poorer prognosis due to onset of negative symptoms
What is catatonic schizophrenia?
Catatonic symptoms of stupor and excitement are present, bizarre posturing, moulding limbs into position, resistance to being moved/ instructed, echolalia, echopraxia
May stop eating and drinking!
Rule out organic conditions eg encephalitis
What is the clinical picture of simple schizophrenia?
Not often used, lazy. Meant to have insidious onset of negative symptoms, only made confidently in retrospect.
