Schizophrenia and Psychosis Flashcards
What is psychosis
Mental disorder in which thoughts, affective response, ability to recognise reality and the ability to communicate and relate to others, are sufficiently impaired
Cannot work out what is real and not real
Usually has a functional impact and a loss of insight
What are the characteristics of psychosis
Hallucinations Delusions Disorder of the form of thoughts Lack of insight Functional impact
Illicit drugs can lead to psychosis - true or false
True
When they come down from the drug the psychosis often disappears
What is a hallucination
A perception which occurs in the absence of an external stimulus
Experienced as if it were real
Is not subject to conscious manipulation
Can occur in any sensory modality - hearing, seeing, smelling, tasting or feeling things that are not actually there but feel real to the person.
What is thought insertion
When you believe your thoughts are not your own
Being put there by someone else
What is passivity of action
When you believe that someone else is controlling your actions/movements
What is ideas of reference
When a person assigns significance or meaning to an event, speech, objects etc
Feel like specific things are jumping out at you
May believe that messages are being left in newspapers, TV reports are directly communicating to them etc
What is a delusion
A fixed but falsely held belief
Wont be able to convince the person that it is not real despite being contradicted by reality or rational argument
Held outwith the usual social, cultural and educational background of the patient
May be bizarre or impossible
What is paranoia
The belief that external events are related to oneself
It is self-referential - about your own mind
Can be transient or very intrusive
Often think people are talking about them or ‘out to get them’
What are Capgrass delusions
Where you believe people have been replaced by others (e.g. those aren’t nurses they are agents)
What is Capgrass nihilism
Where you believe you have died and are just waiting for your body to stop working
List some common types of delusion
Paranoid
Persecutory
Grandiose
Religious - have met God or are second coming
Misidentification - Capgrass or Fregoli
Guilt
worry that they have committed crimes
Sin – people will believe they have sinned
Nihilistic - believe they have lost everything
What is a Fregoli delusion
Were you think that one person changes their appearance and becomes another (e.g. one nurse leaves and another enters and you think it’s the same person)
What is Othello syndrome
You constantly believe you are being cheated on
Can lead onto violence and even homicide
What are primary delusions
These delusions arrive fully formed in the consciousness without need for explanation
What are secondary delusions
Usually present to try and explain another anomalous phenomenon such as a hallucination
E.g. the voices I’m hearing are being transmitted by the CIA
What is Knight’s move thinking
A type of thought disorder where the person will jump between topics based off previous words or topics
Random content that is hard to follow - no clear link or formal/coherent train of thought
What are the signs of a thought disorder
You can identify it from speech patterns May have: Knight's moving Clanging and punning Going off on tangents Word salad Neologisms Loosening of associations
What is word salad
When the patient uses random words and syllables
Unable to communicate what they mean as they think these words make sense
What is thought withdrawal
When the patient believes that their thoughts are being extracted from their mind
What is thought broadcasting
When someone believes that everyone can tell/hear what they are thinking
Often linked to technology - transmitting them
What is thought blocking
Patients will be unable to finish a thought and stop suddenly
Feel as though they suddenly get blocked
What is meant by loss of insight
The patient cannot tell they are unwell and believe everything that is happening to them is real
List some of the differentials for psychotic symptoms
Unipolar depression
Bipolar - will be associated with mood changes
Schizoaffective disorder
Schizophrenia
Substance use - inlcuding withdrawal
Organic conditions - dementia, delirium, brain injury
What type of hallucinations are common in schizophrenia
3rd person auditory
How does drug induced psychosis present
Psychotic symptoms have an acute onset but are often short lasting (if substance is removed)
Which drug can lead to an insidious onset of psychosis
Heavy cannabis use
Describe depressive psychosis
Physctic symptoms have mood congruent (depressive) content
Delusions of worthlessness or guilt
Hallucinations which are persecutory, threatening or insulting (usually 2nd person)
Describe mania with psychosis
Symptoms are mood congruent
In mania delusions are often of grandeur, special ability, religious etc
Hallucinations are usually auditory (God talking to them)
People may believe that everyone is jealous of them
Hallucinations are usually 2nd person and encouraging them that their ideas are great
M
What can cause delirium
Infection or sepsis Organ failure Hypoglycaemia Alcohol withdrawal Drug intoxication or withdrawal ETC
How does delirium present
Acute and transient Fluctuating course - worse at night Clouding of consciousness Impaired concentration and memory Can be drowsy and quiet or very agitated Visual and auditory hallucinations
What are the first rank symptoms of Schizophrenia
Delusion
Auditory hallucinations - often persecutory
Thought disorders - withdrawal, insertion, broadcasting etc
Passivity experiences - impulse, affect etc
List the subtypes of schizophrenia
Paranoid - most common and predominately the frist rank symptoms
Hebephrenic - younger onset, immaturity and silliness to them, playing pranks and giggling
Catatonic – characterised by movement disorder, will go rigid and hold a strange position for hours on end
What is schizoaffective disorder
The patient will have the first rank symptoms of schizophrenia and mania or depression
What is persistent delusional disorder
Fixed delusions are the major or only feature
What are the positive symptoms
Hallucinations Delusions Passivity Phenomena Disorder of the Form of Thought Thought insertion, withdrawal, broadcasting Breaks in train of thought Neologisms
What are examples of negative symptoms
Reduced speech Reduce motivation Reduced interest or pleasure Reduced social interaction Blunting of affect Catatonia
What causes schizophrenia
A genetically determined neurodevelopmental vulnerability later triggered by environmental stressors
When does schizophrenia present
Onset is usually in young adults
Peak incidence 15-25 years for men
Peak incidence 25-35 year for women
There is a higher incidence of schizophrenia in lower socioeconomic classes - true or false
True
What are the risk factors for schizophrenia
Genetics - strong component Birth complications - labour issues, prem birth or infection exposure Winter/spring birth Drug use - cannabis Urban dwelling Social deprivation Neurodevelopmental changes Altered dopamine signalling
What are the bad prognostic indicators for schizophrenia
Poor pre-morbid adjustment Insidious onset Early onset Long duration of untreated psychosis Cognitive impairment Enlarged ventricles
What are the good prognostic indicators for schizophrenia
Older age of onset
Female gender
Marked mood disturbance especially elation
Family history of mood disorder
What is the suicide risk for schizophrenia
10-15% completed suicide rate
May occur following recovery of insight
High risk time in first week of discharge from hospital
Do genetics have an influence on schizophrenia
Yes
There is a 78% heritability
High incidence in MZ twins or if parents have it
No single gene involved though - it is a multifactorial
What signs could be seen on a brain scan in someone with schizophrenia
Reduced frontal lobe volume
Reduced frontal lobe grey matter
Widely distributed grey matter abnormalities
Enlarged lateral ventricle volume
How is dopamine associated with schizophrenia
Drugs which release dopamine in the brain can produce a psychotic state
Amphetamines do this and can make the symptoms of schizophrenia worse
What class of drugs can be used to treat schizophrenia
Dopamine receptor antagonists
Reduce the amount of dopamine in the brain
Which neurotransmitters may contribute to schizophrenia
Dopamine - excess
Serotonin
Glutamine
List some of the typical antipsychotics
Chlorpromazine
Haloperidol
List some of the atypical anti-psychotics
Olanzapine
Risperidone
Clozapine
What are the benefits of the atypical anti-psychotics
Less likely to induce Extra-Pyramidal side-effects
Better efficacy against negative symptoms
Effective in patients unresponsive to typical drugs
What are the side effects of blocking dopamine in order to treat schizophrenia
Acute dystonia (muscle spasms) - takes hours to days
Parkinsonism
Tardive dyskinesia- repetitive involuntary purposeless movements-
What happens if you block histamine receptors
Sedation
Increased appetite
What happens if you block alpha-adrenergic receptors
May cause hypotension and interrupts baroreflex response
Leads to dizziness, light-headedness and fainting
What happens if you use drugs to cause a muscarinic blockade
Blurred vision Dry mouth Constipation Urinary retention Sedation and confusion Affects the parasympathetic
Which antipsychotic can cause agranulocytosis
Clozapine
If the patient presents with a sore throat you must get a FBC
What is clanging and punning
When the speech flows from one rhyming word to another or with pun associations
“Are you well, Adele, I like Adele”
What are the diagnostic criteria for Schizophrenia
At least one of the first rank symptoms, lasting for over a month, 2 of the positive/negative and no evidence of influence of drugs, alcohol, mood disorder or any other organic cause (e.g. dementia)
What type of hallucinations are common in withdrawal
Tactile and visual hallucinations
often bugs crawling on them
Flight of ideas is characteristic of which disorder
Mania
What is the most common type of hallucination seen in schizophrenia
third person auditory hallucinations
What are the two main classes of drugs used to treat psychosis
Typical anti-psychotics - first generation
Atypical anti-psychotics - second generation
Is there a genetic basis to schizophrenia
Yes
Increased risk in children of affected parents
Likely multiple genes and additional environmental effects
Dopamine may be involved in the pathophysiology of schizophrenia - true or false
True Central (mesolimbic) dopamine systems of the brain are considered to be overactive in schizophrenia Studies have shown that dopamine agonists may induce schizophrenic symptoms
What is posturing
The spontaneous adoption of fixed positions which are held for an abnormal length of time.
Seen in schizophrenia and catatonia.
What is verbigeration
The obsessive repetition of random words and phrases without a stimulus.
Most commonly seen in schizophrenia.
What is a made action
When the person feels as thought their actions are being controlled by an external agent.
Their bodies are performing the action but they are not in control of it.
Seen in schizophrenia.
What is gedankenlautwerden
A type of hallucination where patients hear their own thoughts aloud at the same time they think them.
This is seen in schizophrenia.
What is folie a deux
An identical or similar mental disorder affecting two or more individuals, usually the members of a close family.
They will share the same delusional beliefs and sometimes the same hallucinations
What is psychomotor retardation
The slowing down or hampering of mental or physical activities, typically seen in the form of slow thinking or slow body movements.
Seen in depressive disorders.
What is a flashback
Psychological phenomena during which a person relives a past event or fragments of a past experience.
This usually occurs involuntarily without a conscious attempt to remember the event.
What is denationalization
When a person feels detached from their thoughts, feelings and body.
People may feel as though they are detached and observing themselves from outside their body.
What is hyperkinesis
A state of excessive restlessness.
Seen in ADHD.
What is mitgehen
Seen in catatonia.
Even the slightest touch or pressure will move the patient but the body part immediately returns to the original position.
Describe flight of ideas
A manner of speaking where a person talks rapidly and jumps from topic to topic. It will be hard to keep up with them.
What is loosening of associations
A thought disturbance demonstrated by speech that is disconnected and fragmented, with the individual jumping from one idea to another unrelated or indirectly related idea
What is a nihilistic delusion
Persistent belief that the person is dead, decomposing or may have lost internal organs.
They may also believe they do not exist entirely as a human being.
What is psychomotor agitation
Characterized by unintentional and purposeless motions and restlessness, often but not always accompanied by emotional distress.
May include, pacing, tapping feet, wringing hands etc.
List signs and symptoms of catatonia
Immobility and stupor
Mutism
Staring and reduced blinking
Posturing and cataplexy
Grimacing - maintaining odd facial expressions
Echopraxia - mimicking examiner’s movement
Echolalia - mimicking examiner’s speech
Stereotypy - repetitive, non-goal-directed activity (playing with fingers etc.)
Repeating words and phrases - verbigeration
Rigidity
Waxy flexibility - initial resistance then allows repositioning
Doing the opposite of instructions
Withdrawal
Excitement
Passive obedience - mitgehen
Automatic obedience
