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
What is the difference between a hallucination and a delusion?
A hallucination is the belief in the occurrence of a perception that objectively never occurred
Whereas a delusions stems from a warped interpretation of a perception that objectively occurred
What are some types of delusions?
Persecutory - someone/something is out to get you
Referential - interrupting real events in a deluded way, usually sinister
Grandiose - belief in grandiose ego
Passivity - belief in being controlled, eg like puppet on string
Ego boundary intrusion - insertion, withdrawal, shared
Delusion perception - belief you’ve become someone else
What is catatonic behaviour?
A marked decrease in reactivity to the environment
- Mutisim or negativity
- Excitement or inappropriate movement/posture
- Purposeless, overactive behaviour
What is brief psychotic disorder?
Psychosis that last >1day but remits by 1 month
What is Delusional disorder?
A least 1 month of delusions with no other psychotic symptoms
What are some other causes, apart from Schizophrenia, that can cause psychosis?
Substance use A toxin A medication Withdrawal from a medication Organic disease eg toxoplasmosis
What is Schizotypal personality?
A personality disorder characterised by;
- Reduced capacity to form close relationships
- Cognitive or perceptive disorder
- Eccentric behaviour
What are elemental hallucinations? What do they reflect?
Simple, unformed auditory hallucination eg banging, beeping, shouting
Can be early Schizophrenia or organic causes
What is the most common type of delusion?
Paranoid and referential
What characterises a bizarre delusion?
A delusion that really has no plausibility
Eg implanting meatballs in the shin
Bizarre delusions are very characteristic of Schizophrenia
Why ask about the details of psychosis?
Diagnosis
Treatment options
Treatment response
Safety
What are the negative symptoms of Schizophrenia?
Avolition Social Withdrawal Anhedonia Paucity of thought Paucity of affect
What are the cognitive symptoms of Schizophrenia?
Frontal: Executive function
- Organisation/Planning
- Short term memory
What are the DDx for “negative symptoms” in Schizophrenia?
The pathology of the disease
Comorbid depression
Medication SE
Drug and alcohol
What are the treatment options for the negative symptoms of Schizophrenia?
Clozapine can work (sometimes augmented with low dose aripiprazole)
Anti-depressants don’t work
What are the DDx for psychosis?
Organic - Delirium - Endo - Brain - bleed, tumour, infection Non-Organic - Affective vs Non-affective - Delusional disorder - Personality Substance
