Schizophrenia and Psychosis Flashcards
What are the DSMV criteria for Schizophrenia?
A) Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1 ), (2), or (3):
1. Delusions. 2. Hallucinations. 3. Disorganized speech (e.g., frequent derailment or incoherence). 4. Grossly disorganized or catatonic behavior. 5. Negative symptoms (i.e., diminished emotional expression or avolition).
B) Symptoms are intrusive to a point of affecting the ability to function in work, socially, or in carrying out self care, and is markedly below the pre-morbid level
C) Symptoms must be present for at least 6 months, this is at least 1 month of symptoms meeting criteria A plus residual or prodromal periods. These can be predominantly negative symptoms
D) Schizoaffective disorder and depression or bipolar with psychotic features have been ruled out because
1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.
E) The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
F) If there is a history of autism spectrum disorder or a communication disorder of child hood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1 month (or less if successfully treated).
What is the Gaussian curse?
Curve that stratifies the population by their susceptibility to psychosis
What are referential beliefs?
Interrupting things around you in a certain way, usually sinister
What structural abnormality can be found in the brains of schizophrenics?
Decreased brain volume
Increased ventricular volume
Decreased medial temporal structures, eg hippocampus
What are the negative symptoms of schizophrenia?
DIMINISHED EMOTIONAL EXPRESSION Anhedronia Nihilism AVOLITION Social withdrawal Paucity of thought/affect Cognitive disturbance
What are some risk factors for the development of Schizophrenia?
In utero - Maternal starvation - Influenza in 2nd trimester - Maternal anaemia Post partum - Cannabis exposure - Head injury Male gender
What are the natural histories of Schizophrenia?
Group 1 - One episode, no ongoing impairment: 22%
Group 2 - Multiple episodes, return to normal inbetween: 35%
Group 3 - Multiple episodes, impairment after the first but return to baseline subsequently - 8%
Group 4 - Multiple episodes, ongoing decline: 35%
What are some predictors of severe disease?
Male Early onset Insidious onset Soft neurological signs Poor premorbid functioning Significant neurocognitive dysfunction Structural brain abnormalities
What are some good psychosocial predictive factors?
Intensive case management Psychoeducation Family education CBT Compliance therapy Social skills training
What is the treatment algorithm for Schizophrenia?
Exclude organic cause
Start atypical anti-psychotic eg Risperidone, Olanzapine
> if good response > continue for 12 months then wean
> if poor response > increase dose
> if not working > augment with sodium valproate or lithium
or use alternative atypical anti-psychotic
> if not working > clozapine
How does circumlocution thought form present?
Long laboured thought process, often circulating around the subject without addressing it directly
How does tangential thought form present?
Thought the of speaker trails off the and shows a lack of focus, never returning the original subject
How does thought derailment present?
Sudden change to an unrelated subject, lack of logical connection
How does paucity of thought present?
Delays before answering questions
Slow delivery
Brief or monosyllabic answers
How does “flood of ideas” present?
Excessively garrulous
Hard to interrupt
Disjointed flow with only loose connections
