Schizophrenia and Psychiatric Disorders Flashcards
What is psychosis?
Psychosis = disease of the mind, an inability to distinguish between symptoms of delusion, hallucination and disordered thinking from reality
What are delusions?
Delusion = unshakable idea or belief which is out of keeping with person’s social and cultural background, it is held with extraordinary conviction
What are examples of delusional beliefs?
- Granidiose
- Paranoid
- Hypochondriacal
- Self-referential
Psychosis - presentation
- Hallucinations
- Have full force and clarity of true perception
- Located in external space
- No external stimulus
- Uses all 5 special senses
Describe the hallucinations in psychosis?
- Hallucinations
- Have full force and clarity of true perception
- Located in external space
- No external stimulus
- Uses all 5 special senses
What are some illnesses that can have psychosis?
- Schizophrenia
- Delirium
- Severe affective disorder
- Depressive episode
- Manic episode
Schizophrenia - pathology
- Thinking
- Emotion
- Behaviour
Schizophrenia - aetiology
- Biological factors
- Genetics
- Nruegulin (chromosome 8p)
- Dysbindin (chromosome 6p)
- Di George syndrome
- Neurochemistry
- Dopamine hypothesis – increased level of dopamine in brain
- Revised dopamine hypothesis – mesolimbic hyperdopaminergia and mesocortical hypodopaminergia
- Glutamate
- GABA
- Noradrenaline
- Serotoninergic transmission
- Neurological abnormalities
- Ventricular enlargement
- Reduced frontal lobe performance
- Eye tracking abnormalities
- EEG abnormalities
- Obstetric complications
- Maternal influenza
- Malnutrition and famine
- Substance misuse
- Genetics
- Psychological factors
- Social factors
- Occupation and social class, “drift hypothesis”
- Migration
- Social isolation
- Life events as precipitants
What are some genetic causes of schizophrenia?
- Nruegulin (chromosome 8p)
- Dysbindin (chromosome 6p)
- Di George syndrome
What are some neurological abnormalities linked to schizophrenia?
- Ventricular enlargement
- Reduced frontal lobe performance
- Eye tracking abnormalities
- EEG abnormalities
What are some social factors linked to schizophrenia?
- Occupation and social class, “drift hypothesis”
- Migration
- Social isolation
- Life events as precipitants
Schizophrenia - epidemiology
(how common as cause of psychosis, prevalence, sex)
- Most common cause of psychosis
- 1/100 prevalence
- M:F equally
Presentation - schizophrenia
- Positive symptoms
- Hallucinations
- Delusions
- Disordered thinking
- Negative symptoms (presence of these suggests poorer prognosis)
- Apathy
- Lack of interest
- Lack of emotion
What are the positive and negative symptoms for schizophrenia?
- Positive symptoms
- Hallucinations
- Delusions
- Disordered thinking
- Negative symptoms (presence of these suggests poorer prognosis)
- Apathy
- Lack of interest
- Lack of emotion
Differential diagnosis - schizophrenia
- Delirium or acute organic brain syndrome
- Depressive episode with psychotic symptoms
- Must be categorised as severe
- Mani episode with psychotic symptoms
- Schizoaffective disorder
- Mix of affective and schizophrenia like features
What is the diagnostic criteria for schizophrenia?
- More than a month in the absence of organic or affective disorder
- At least one of following
- Alienation of thought
- As thought echo, though insertion or withdrawal, or thought broadcasting
- Delusions of control, influence or passivity
- Referred to body or limb movements actions, or sensations, delusional perception
- Hallucinatory voices
- Typically giving running commentary on patients behaviour, or discussing them between themselves
- Persistent delusions
- Culturally inappropriate and completely impossible
- Alienation of thought
- Or at least 2 of the following
- Persistent hallucinations in any modality, when occurring every day for at least a month
- Neologisms, breaks or interpolations in the train of through resulting in incoherence of irrelevant speech
- Catatonic behaviour, such as excitement, posturing or waxy flexibility, negativism, mutism and stupor
- “Negative” symptoms
Management - schizophrenia
- Provision of information
- Pharmacological
- Anti-psychotics – on first episode
- Following remission continue maintenance treatment for at least 18 months
- On acute exacerbation
- Amisulpride, olanzapine or risperidone
- To prevent relapse
- Amisulpide, olanzapine or riperidone
- Treatment resistant schizophrenia
- Clozapine
- Anti-psychotics – on first episode
- Psychological therapies
- CBT
- Family intervention
Prognosis - schizophrenia
- 80% recover after first episode
- 50% have a moderate recovery
- Some relapse
- Small group with chronic symptoms with little recovery
- Good prognostic factors
- Absence FH
- Good premorbid function – stable personality, stable relationships
- Clear precipitant
- Acute onset
- Mood disturbance
- Prompt treatment
- Maintenance of initiative and motivation
- Poor prognostic factors
- Slow, insidious onset and prominent negative symptoms
- If starts in childhood
What are some good and poor prognostic factors for schizophrenia?
- Good prognostic factors
- Absence FH
- Good premorbid function – stable personality, stable relationships
- Clear precipitant
- Acute onset
- Mood disturbance
- Prompt treatment
- Maintenance of initiative and motivation
- Poor prognostic factors
- Slow, insidious onset and prominent negative symptoms
- If starts in childhood
Complications - schizophrenia
- 9x risk of suicide
- 2x risk of death in violence
- Chronic schizophrenic patients should poorer cognition than first onset patients
If you have psychosis, do you have schizophrenia?
If you have psychosis does not mean you have schizophrenia, however it is the most common cause
