Schizophrenia and Psychosis Flashcards
branches of psychosis?
dementia praecox (schizophrenia and other paranoid illnesses)
manic depressive psychosis (bipolar and unipolar depression)
- schizoaffetive disorder lies somehwere between dementia praecox and manic depressive
organic conditions (delirium, dementia, brain injury etc)
substance use (intoxication, withdrawal etc)
what is psychosis?
mental disorder in which the thoughts, affective response or ability to recognise reality and ability to communicate and relate to others are impaired causing poor capacity to deal with reality
inability to distinguish between subjective internal experience and reality
characterised by lack of insight
how does the brain interpret reality in a normal person?
no direct interface, all experiences are filtered by the brain and presented as perceptions of the world
sensory organs aren’t perfect and brain is limited in processing ability
examples of psychotic experiences?
hallucinations ideas of reference delusions formal thought disorder thought interference passivity phenomena loss of insight
describe a hallucination
experienced as originating in real space, not just in thoughts (not like inner speech)
has same qualities as a normal perception
not subject to conscious manipulation
when are hallucinations significant?
only when in the context of other relevant symptoms
- can be induced in most people (e.g by sensory deprivation)
what are ideas of reference?
innocuous or coincidental events will ascribed meaning by the person
- e.g thinking there are messages in newspaper/news show about them
- news reader is talking directly to them
- seeing objects arranged in a way to convey a message
- seeing meaning in other people’s gestures
- etc
what are self-referential experiences?
the belief that external events are related to oneself
what makes a belief delusion?
must be fixed and falsely held with unshakeable conviction
impervious to logical argument or evidence to the contrary
held outwith the usual social cultural and educational background of the patient
may be bizarre or impossible
what is a primary delusion?
arrives fully formed in the consciousness without need for explanation
what are secondary delusions?
are often attempts to explain anamalous experiences (e.g hallucinations, passivity, depression etc)
- e.g my thoughts are being inserted by the CIA/aliens etc
content of delusions?
specific content is culturally defined
persecutor is often culturally recognisable to society/culture as a danger/threat (IRA, FBI, mafia, devil, spirits etc)
types of thinking in though disorder?
neologisms - where people have their own vocabulary (drop made up words into conversation)
clanging and punning (“Dr Pell, ding dong bell, go to hell”)
knights move thinking (jumping from thought to thought via some linking word or connection)
circumstantiality/tangentiality
loosening of associations
verbigeration/word salad
types of thought interference?
thought insertion
thought withdrawal
thought broadcasting
thought blocking
what is passivity?
feeling as though you are being controlled
passivity of
- volition = movement
- affect = feelings
- impulse = urges (e.g walk into traffic)
- somatic passivity = influence on body
what can cause loss of insight?
filter which, in most people, filters information from senses and interprets meaning, relevance and connectedness is impaired
therefore to you, everything seems real, things make sense, everything has meaning and you know whats going on
features of drug induced psychosis?
may be florid symptoms or chronic symptoms
tend to be short lasting if access to the psychoactive substance is removed
features of depressive psychosis?
typified by mood congruent content of psychotic symptoms
hallucinations are typically 2nd person threatening, insulting, accusing voices
delusions of worthlessness/guilt/hypochondriasis/poverty
features of mania with psychosis?
typified by mood congruent content of psychotic symptoms
delusions of grandeur/special ability/persecution/religiosity
hallucinations (often 2nd person auditory - e.g Gods voice talking to you)
flight of ideas
first rank symptoms in schizophrenia?
suggest schizophrenia in the absence of drug use or organic impairment but are not pathopneumonic
core psychotic symptoms of schizophrenia?
delusions
hallucinations
thought interference
passivity
at least 1 out of which symptoms must be present for ICD criteria for schizophrenia diagnosis?
either one of:
- thought echo/insertion/withdrawal/broadcasting
- delusions of control, influence or passivity
- hallucinatory voices giving running commentary, or discussing patient
- persistent delusions of other kinds that inappropriate and impossible
3 subtypes of schizophrenia?
paranoid - typical, most common, 1st rank syndromes predominate
hebephrenic - immaturity/silliness, do immature or inappropriate things, lots of animation and giggliness etc
catatonic - movement disorder predominated, not really seen any more as it responds so well to treatment
other paranoid psychoses?
persistent delusional disorder
- systematised, fixed delusions the major or only feature
schizotypal disorder
- eccentricity and aloofness, social withdrawal, paranoid quasi-delusional ideas, magical thinking and transient auditory hallucinations
- acute/transient psychotic disorder- symptoms lasting <1 month
schizoaffective disorder
- bipolar and schizophrenia either at same time or within 2 weeks of each other
positive symptoms?
hallucinations
delusions
passivity
disorder in form of thought
negative symptoms?
reduced speech, motivation/drive, interest/pleasure and social interaction
what is schizophrenia?
diagnosis based on cluster of symptoms
considered a genetically determined neurodevelopmental vulnerability later triggered by environmental stressors
who gets schizophrenia?
slightly more common in males
peak incidence in men = 15-25
peak incidence i females = 25-35
more common in lower socioeconomic class
risk factors fro schizophrenia?
genetics (higher chance if MZ twin, both parents or one parent affected, some mutations)
birth complications/perinatal complications
prenatal exposure to viral infections
drug use (cannabis)
urban dwelling
social adversity/deprivation
neurodevelopmental changes (enlarged ventricles, thinner cortices)
neurochemical changes (altered dopamine signalling)
Premorbid/prodromal features of people who may go on to develop schizophrenia?
subtle motor,cognitive and social deficits in childhood that become greater as time goes on (e.g delay in speech, walking etc)
can also have odd ideas and experiences, eccentricity, altered affect and odd behaviours
bad prognostic indicators in schizophrenia?
poor pre-morbid adjustment insidious onset early onset (child/adolescent) long duration untreated cognitive impairment enlarged ventricles
good prognostic indicators in schizophrenia?
older age at onset
female
marked mood disturbance especially elation
family history of mood disorder
3 general patterns of schizophrenia progression?
dips, the returns to normal level and stays there for long time
dips and returns to normal level several times over time
dips several times but never fully returns to normal so is basically worsening over time
possible end outcomes in schizophrenia?
suicide
homicide by schizophrenia patient is rare but take not of anyone with command hallucinations or delusions of jealousy
at least 2 out of which symptoms must be present for ICD diagnosis of schizophrenia?
persistent hallucinations in any modality occurring every day for at leas 1 month when accompanied by delusions
neologisms, breaks or interpolations in the train of thought
catatonic behaviour such as excitement, posturing or waxy flexibility, negativism, mutism and stupor
negative symptoms
