Schizophrenia and psychoses Flashcards
Schizophrenic symptoms of short duration are called…
Schizophreniform disorders
Define psychosis
- 4 hallmark symptoms of psychosis
Loss of touch with reality
- Delusions, hallucinations, loss of insight, formal thought disorder
1st rank schizophrenic symptoms
Thought alienation
Passivity phenomena
3rd person AHs
Delusional perception
2nd rank schizophrenic symptoms
Delusions, 2nd person AHs, other hallucinations, thought disorder, catatonia, negative symptoms, (blunting of affect, poverty of speech, amotivation, self-neglect, lack of insight, social withdrawal)
Positive symptoms
Hallucinations, delusions, passivity, thought alienation, mood disturbance
Negative symptoms (LESS)
L Loss of volition, underactivity and social withdrawal
E Emotional flatness, lose normal modulation of mood
S Speech is reduced, monosyllabic if at all
S Slowness in thought and movement, psychomotor retardation may occur, Self-neglect
Typical MSE in schizophrenia
- Appearance and behaviour - withdrawal, suspicion, or (rarely) stereotypies (repetition of purposeless movements) and mannerisms (e.g, saluting).
- Speech - interruptions to the flow of thought (thought blocking), loosening of associations/loss of normal thought structure (knight’s move thinking).
- Mood/affect - flattened, incongruous or ‘odd’.
- Thoughts - delusional perceptions, delusions concerning thought control or broadcasting, passivity experiences.
- Perceptions - hallucinations, especially auditory.
- Cognition - attention, concentration, orientation and memory should be assessed (significant impairment suggests delirium or severe dementia)
Paranoid schizophrenia
- what features are more/less prominent?
Paranoid schizophrenia is characterized by unreasonable suspicion and primarily positive symptoms.
The patient is preoccupied with at least one delusion (usually persecutory in nature) or is experiencing frequent auditory hallucinations.
Meanwhile, disorganized speech, flat affect, catatonic, or disorganized behaviour are not present or are less prominent than these positive symptoms.
Hebephrenic (disorganised)
- Must have what 3 features?
- Disorganized speech (e.g., word salad, incoherence, perseverance)
- Disorganized behaviour (e.g., difficulty starting or finishing a task, difficulty acting appropriately in social situations)
- Flat or inappropriate affect (e.g., poor eye contact, lack of facial expressions)
Catatonic schizophrenia
a) Characterised by what core feature?
b) Plus 2 or more of what other symptoms?
c) May be the result of…?
a) Characterised by substantial increase/decrease in movement with 2 or more of the following:
b) - largely immobile, maintain a rigid posture, and resist all attempts to be moved.
- echolalia (repeating what other people say)
- echopraxia (mimicking the movements of other people).
- bizarre posturing
- grimacing,
- stereotypic movements
c) Untreated schizophrenia
Undifferentiated schizophrenia
- Do not fit into what 3 categories?
a) Don’t fit into predominantly paranoid, disorganised or catatonic subtypes.
b) Individuals do experience significant delusions, hallucinations, disorganized speech, or disorganized or catatonic behaviour, their symptoms are not predominantly positive, disorganized, or movement disordered.
Residual schizophrenia
a) Presentation
b) Usual cause?
NOT presently experiencing prominent ‘positive’ symptoms: delusions, hallucinations, disorganized speech, or disorganized or catatonic behaviours.
However they are experiencing at least two of those symptoms to a lesser extent (e.g., thought distortions or odd beliefs) or they continue to experience the negative symptoms of schizophrenia (e.g., difficulty paying attention, social withdrawal, apathy, a reduction in speech).
b) May be a result of treatment/chronic schizophrenia that has had the positive symptoms treated while the negative symptoms remain
Schizotypal PD
Schizotypal personality disorder develops by early adulthood and is characterized by:
- pervasive deficits in social and interpersonal skills
- eccentric behaviour
- discomfort forming close personal relationships
- cognitive and perceptual distortions
- ideas of reference (these are unlike delusions of reference, in which a person’s behaviour is altered by their belief that something is referential to them personally)
Typical vs atypical antipsychotics:
a) Common side effects for typicals (4 types)
b) Common side effects for atypicals? (3)
a) EPSEs - acute dystonic e.g. oculogyric crisis, muscle spasm, acute torticolis (hours), parkinsonism e.g. BRiT (days), akathisia e.g. motor restlessness, pacing (months), tardive dyskinesia e.g. grimacing, tongue protrusion, lip smacking (years)
b) Metabolic - weight gain, dyslipidaemia, insulin resistance and diabetes
Management of EPSEs:
a) Acute dystonic reaction
b) Parkinsonism
c) Akathisia
d) Tardive dyskinesia
a) Anticholinergic (procyclidine)
b) Anticholinergic (procyclidine)
c) Beta-blockers (e.g. propanolol)
d) Tetrabenazine
