Schizophrenia and Psychosis Flashcards
Define psychosis
An inability to distinguish between symptoms of delusion, hallucination and disordered thinking from reality
What are hallucinations?
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
What are the types of hallucination?
Visual - tends to be organic dx Auditory - tends to be more schizophrenia Tactile Gustatory Olfactory
Define delusion
Unshakeable idea/belief out of keeping with the person’s social or cultural background that is held with extraordinary conviction
What are different types of delusion?
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)
What illnesses may present with psychotic symptoms?
Schizophrenia
Delirium
Manic episode with psychotic symptoms
Depressive episode with psychotic symptoms
What is schizophrenia?
A severe mental illness affecting thinking, emotions and behaviour
How common is schizophrenia?
Affects 1% of males and females equally
Tends to have onset between 15-35yo
What are the three types of symptoms of schizophrenia and how are they caused?
Positive - linked to excess dopamine in the brain
Negative - linked to prefrontal pathologies
Cognitive symptoms e.g. memory/concentration problems
Give examples of positive symptoms of schizophrenia
Hallucinations
Delusions
Disordered thought
Catatonia
Give examples of negative symptoms of schizophrenia
Apathy Lack of interest Emotional incongruity Blunted response Avolition (lack of motivation) Paucity of thought
How do most antipsychotics work?
D2 receptor antagonists
What is the ICD-10 for schizophrenia?
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)
What is the most common type of schizophrenia?
Paranoid
What are the three sections to consider in the aetiology of schizophrenia?
Biological
Psychological
Social
What are the biological aetiologies of schizophrenia?
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
What are the psychological theories of schizophrenia?
Jungs Conrad (fear --> delusions and effort to make sense of experience by altering view of the world --> breakdown of thought/behaviours)
What are the psychosocial aetiologies of schizophrenia?
Occupation (drift hypothesis)
Migration
Social isolation
Life events as precipitants
What is the concept of the schizophrenogenic mother?
Overinvolved and hypercritical mother may be aetiological factor
What are the differentials for schizophrenia?
Delirium Affective disorders (mania and depressive with psychotic symptoms)
What is classical in the presentation of delirium?
Worse at night!!
Visual hallucinations
Terror affect
Delusions persecutory and effervescent
What may cause delirium?
Elderly UTI, encephalitis, cancer (paraneoplastic) etc. etc.
What is classical in the presentation of depressive episode with psychosis?
Delusions of worthlessness, guilt, nihilism
Derogatory auditory hallucinations
What is classical in the presentation of mania episode with psychosis?
Delusions of grandeur, special powers, messianic roles
Gross overactivity, irritation, behavioural disturbance, manic excitement
What is involved in the management of schizophrenia?
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
What is the risk of clozapine?
Blood dyscarsia (esp. neutropenia)
What is considered schizophrenia that is treatment resistant?
Not responding to two atypical antipsychotics
What are the extrapyramidal side effects?
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
Define recovery in schizophrenia
As viewed by the patient
Up to 50% have moderate recovery
What are the good prognostic factors in schizophrenia?
No FH Acute onset Clear precipitant Good premorbid function Prompt treatment Maintenance of motivation and initative Mood disturbance
What are poor prognostic factors for schizophrenia?
Slow, insidious onset
Negative symptoms predominate
What is the prognosis for schizophrenia?
9x more likely to commit suicide
1.6x higher mortality (due to CV and respiratory disease and cancer)
Higher rates of cigarette smoking
What is tardive dyskinesia?
Purposeless, involuntary, repetitive movements, e.g. lipsmacking
Typically from many years use of typical antipsychotics
