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Psychiatry (Brian) > Schizophrenia and Psychiatric Disorders > Flashcards

Schizophrenia and Psychiatric Disorders Flashcards

1
Q

What is psychosis?

A

Psychosis = disease of the mind, an inability to distinguish between symptoms of delusion, hallucination and disordered thinking from reality

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2
Q

What are delusions?

A

Delusion = unshakable idea or belief which is out of keeping with person’s social and cultural background, it is held with extraordinary conviction

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3
Q

What are examples of delusional beliefs?

A
  • Granidiose
  • Paranoid
  • Hypochondriacal
  • Self-referential
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4
Q

Psychosis - presentation

A
  • Hallucinations
    • Have full force and clarity of true perception
    • Located in external space
    • No external stimulus
    • Uses all 5 special senses
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5
Q

Describe the hallucinations in psychosis?

A
  • Hallucinations
    • Have full force and clarity of true perception
    • Located in external space
    • No external stimulus
    • Uses all 5 special senses
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6
Q

What are some illnesses that can have psychosis?

A
  • Schizophrenia
  • Delirium
  • Severe affective disorder
    • Depressive episode
    • Manic episode
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7
Q

Schizophrenia - pathology

A
  • Thinking
  • Emotion
  • Behaviour
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8
Q

Schizophrenia - aetiology

A
  • 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
  • Psychological factors
  • Social factors
    • Occupation and social class, “drift hypothesis”
    • Migration
    • Social isolation
    • Life events as precipitants
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9
Q

What are some genetic causes of schizophrenia?

A
  • Nruegulin (chromosome 8p)
  • Dysbindin (chromosome 6p)
  • Di George syndrome
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10
Q

What are some neurological abnormalities linked to schizophrenia?

A
  • Ventricular enlargement
  • Reduced frontal lobe performance
  • Eye tracking abnormalities
  • EEG abnormalities
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11
Q

What are some social factors linked to schizophrenia?

A
  • Occupation and social class, “drift hypothesis”
  • Migration
  • Social isolation
  • Life events as precipitants
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12
Q

Schizophrenia - epidemiology

(how common as cause of psychosis, prevalence, sex)

A
  • Most common cause of psychosis
  • 1/100 prevalence
  • M:F equally
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13
Q

Presentation - schizophrenia

A
  • Positive symptoms
    • Hallucinations
    • Delusions
    • Disordered thinking
  • Negative symptoms (presence of these suggests poorer prognosis)
    • Apathy
    • Lack of interest
    • Lack of emotion
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14
Q

What are the positive and negative symptoms for schizophrenia?

A
  • Positive symptoms
    • Hallucinations
    • Delusions
    • Disordered thinking
  • Negative symptoms (presence of these suggests poorer prognosis)
    • Apathy
    • Lack of interest
    • Lack of emotion
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15
Q

Differential diagnosis - schizophrenia

A
  • 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
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16
Q

What is the diagnostic criteria for schizophrenia?

A
  • 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
  • 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
17
Q

Management - schizophrenia

A
  • 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
  • Psychological therapies
    • CBT
    • Family intervention
18
Q

Prognosis - schizophrenia

A
  • 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
19
Q

What are some good and poor prognostic factors for schizophrenia?

A
  • 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
20
Q

Complications - schizophrenia

A
  • 9x risk of suicide
  • 2x risk of death in violence
  • Chronic schizophrenic patients should poorer cognition than first onset patients
21
Q

If you have psychosis, do you have schizophrenia?

A

If you have psychosis does not mean you have schizophrenia, however it is the most common cause

Psychiatry (Brian) (16 decks)

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