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Psychiatry > Schizophrenia and Psychosis > Flashcards

Schizophrenia and Psychosis Flashcards

1
Q

Define psychosis

A

An inability to distinguish between symptoms of delusion, hallucination and disordered thinking from reality

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2
Q

What are hallucinations?

A

Perceiving something with the full force and clarity of true perception where there is no external stimulus

Hallucinations are perceived to be in the external space and are not willed or controlled

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3
Q

What are the types of hallucination?

A 
Visual - tends to be organic dx 
Auditory - tends to be more schizophrenia 
Tactile 
Gustatory 
Olfactory
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4
Q

Define delusion

A

Unshakeable idea/belief out of keeping with the person’s social or cultural background that is held with extraordinary conviction

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5
Q

What are different types of delusion?

A

Grandiose (believing you are superior, a God, a celebrity etc.)
Paranoid/persecutory
Hypochondrial
Self-referential (misinterpreting remarks, gestures etc. as intentional slights/signs of ridicule/contempt)

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6
Q

What illnesses may present with psychotic symptoms?

A

Schizophrenia
Delirium
Manic episode with psychotic symptoms
Depressive episode with psychotic symptoms

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7
Q

What is schizophrenia?

A

A severe mental illness affecting thinking, emotions and behaviour

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8
Q

How common is schizophrenia?

A

Affects 1% of males and females equally

Tends to have onset between 15-35yo

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9
Q

What are the three types of symptoms of schizophrenia and how are they caused?

A

Positive - linked to excess dopamine in the brain

Negative - linked to prefrontal pathologies

Cognitive symptoms e.g. memory/concentration problems

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10
Q

Give examples of positive symptoms of schizophrenia

A

Hallucinations
Delusions
Disordered thought
Catatonia

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11
Q

Give examples of negative symptoms of schizophrenia

A 
Apathy 
Lack of interest
Emotional incongruity 
Blunted response 
Avolition (lack of motivation) 
Paucity of thought
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12
Q

How do most antipsychotics work?

A

D2 receptor antagonists

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13
Q

What is the ICD-10 for schizophrenia?

A

1 month of symptoms and NOT due to organic disease (e.g. delirium) or affective disorder

1 of:

  • Alienation of thought (broadcasting, withdrawal, insertion)
  • Delusions of control, passivity or influence
  • Hallucinatory voices (running commentary, from body part, discussing patient)
  • Delusion that is impossible

+2 of:

  • Hallucinations every day for a month
  • Neologisms, interpolations in train of thought, word salad, incoherent or irrelevant speech
  • Catatonia (waxy flexibility, posturing, stupor, excitment, negativism, mutism
  • Negative symptoms (apathy, lack of emotions, lack of interest, blunting, paucity of speech)
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14
Q

What is the most common type of schizophrenia?

A

Paranoid

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15
Q

What are the three sections to consider in the aetiology of schizophrenia?

A

Biological
Psychological
Social

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16
Q

What are the biological aetiologies of schizophrenia?

A

Genetic (as evidenced by twin studies), e.g. neurgulin, dysbindin, Di George syndrome - multiple contributes from different genes

Neurochemistry - dopamine theory (too much), GABA, glutamate (NDMAr hypofunctioning), serotonergic transmission (responsible for negative symptoms?)

Others - maternal obstetric complications, maternal influenza, malnutrition, famine, substance misuse, winter birth

17
Q

What are the psychological theories of schizophrenia?

A 
Jungs 
Conrad (fear --> delusions and effort to make sense of experience by altering view of the world --> breakdown of thought/behaviours)
18
Q

What are the psychosocial aetiologies of schizophrenia?

A

Occupation (drift hypothesis)
Migration
Social isolation
Life events as precipitants

19
Q

What is the concept of the schizophrenogenic mother?

A

Overinvolved and hypercritical mother may be aetiological factor

20
Q

What are the differentials for schizophrenia?

A 
Delirium
Affective disorders (mania and depressive with psychotic symptoms)
21
Q

What is classical in the presentation of delirium?

A

Worse at night!!
Visual hallucinations
Terror affect
Delusions persecutory and effervescent

22
Q

What may cause delirium?

A

Elderly UTI, encephalitis, cancer (paraneoplastic) etc. etc.

23
Q

What is classical in the presentation of depressive episode with psychosis?

A

Delusions of worthlessness, guilt, nihilism

Derogatory auditory hallucinations

24
Q

What is classical in the presentation of mania episode with psychosis?

A

Delusions of grandeur, special powers, messianic roles

Gross overactivity, irritation, behavioural disturbance, manic excitement

25
Q

What is involved in the management of schizophrenia?

A

Atypical antipsychotics (amisulfiride, onlanzopine, risperidone)
If first episode continue for 18 months
Treatment resistant - offer clozapine with blood monitoring
Family therapy
Cognitive remediation (if cognitive problems)
CBTp - 16 sessions minimum
Social skills training

26
Q

What is the risk of clozapine?

A

Blood dyscarsia (esp. neutropenia)

27
Q

What is considered schizophrenia that is treatment resistant?

A

Not responding to two atypical antipsychotics

28
Q

What are the extrapyramidal side effects?

A

Due to treatment with generally the typical antipsychotics

Due to decreased dopamine in the nigrostriatal pathway –> Parkinson like symptoms

Symptoms: tardive dyskinesia, dystonia, bradykinesia, Parkinsonism, akathisia

29
Q

Define recovery in schizophrenia

A

As viewed by the patient

Up to 50% have moderate recovery

30
Q

What are the good prognostic factors in schizophrenia?

A 
No FH 
Acute onset 
Clear precipitant 
Good premorbid function 
Prompt treatment 
Maintenance of motivation and initative
Mood disturbance
31
Q

What are poor prognostic factors for schizophrenia?

A

Slow, insidious onset

Negative symptoms predominate

32
Q

What is the prognosis for schizophrenia?

A

9x more likely to commit suicide
1.6x higher mortality (due to CV and respiratory disease and cancer)
Higher rates of cigarette smoking

33
Q

What is tardive dyskinesia?

A

Purposeless, involuntary, repetitive movements, e.g. lipsmacking

Typically from many years use of typical antipsychotics

Psychiatry (26 decks)

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