schizophrenia and psychotic disorders Flashcards
modern use of the term psychosis
severe forms of mental illness and lack of insight
represents an inability to distinguish between symptoms of delusion, hallucination and disordered thinking from reality
define psychosis
represents an inability to distinguish between symptoms of hallucination, delusion and disordered thinking from reality
clinical presentation of psychosis
hallucinations
delusional beliefs
what are hallucinations
have the full force and clarity of true perception
located in external space
no external stimulus to account for them
not willed or controlled
can affect any of the 5 special senses - auditory, visual, tactile, olfactory, gustory
what is a delusion
an unshakable idea/belief which is out of keeping with the person’s social/cultural background
held with extraordinary conviction
e.g. grandiose, paranoid (persecutory), hypochondriacal, self-referential
what illnesses have psychotic symptoms
schizophrenia
delirium
severe affective disorder
- depressive/manic episode w/ psychotic symptoms
what is schizophrenia
a severe mental illness affecting:
- thinking
- emotions
- behaviour
how common is schizophrenia
most common cause of psychosis
affects 1% of population
M=F
what is the age of onset of schizophrenia
15-35y/o
earlier in men than women (28 vs 32 mean age)
symptoms of schizophrenia
+ve
- hallucinations
- delusions
- disordered thinking
- ve
- apathy
- lack of interest
- lack of emotions
-ve symptoms suggest poorer prognosis, +ve suggest a more acute illness and potentially better prognosis
diagnostic criteria for schizophrenia (ICD 10)
- key symptoms (at least one of)
for more than 1mth in the absence of organic or affective disorder:
at least one of:
- alienation of though (though echo, thought insertion or withdrawal, though broadcasting)
- delusions of control, influence of passivity, clearly referred to body or limb movements, actions or sensations; delusional perception
- hallucinatory voices giving a running commentary on the patient’s behaviour, or discussing him between themselves, or other types of hallucinatory voices coming from some part of the body
- persistent delusions of other kinds that are culturally inappropriate and completely impossible
diagnostic criteria for schizophrenia (ICD 10)
- key symptoms (AND/OR at least 2 of)
AND/OR at least 2 of:
- persistent hallucinations in any modality, when occuring every day for at least 1 mth
- neologisms, breaks or interpolations in the train of thought, resulting in incoherence or irrelevant speech
- catatonic behaviour, such as excitement, posturing or waxy flexibility, negativism, mutism and stupor
- -ve symptoms e.g. marked apathy, paucity of speech and blunting or incongruity of emotional repsponses
what are neologisms
making up your own new terminology
considerations re. aetiology of psychosis
biological factors
psychological factors
social factors
evolutionary theories
each of the above can be considered as:
- possible predisposing factor
- precipitating factor - makes it happen now
- perpetuating factor - keeps it going
sz and biological factors - genetics and heritability
- high heritability
- 50% concordance in mz twins
- 10% risk if one parent affected, 40% if 2 parents, 10% on sibling, 10% for dz twins
- also shown in adoption studies that children of sz parents adopted by those w/o illness maintain risk
- children w/o sz parents adopted by sz parents are at no increased risk
sz associated genes
neuregulin - chromosome 8p
dysbindin - chromosome 6p
di george syndrome - 22q
sz and biological factors - neurochemistry
dopamine hypothesis - increased level of dopamine in the brain
revised dopamine hypothesis - mesolimbic and hyperdopaminergia and mesocortical hypodopaminergia
glutamate
GABA
noradrenaline
serotoninergic transmission
sz - biological factors
genetics
neurochemistry
neurological abnormalities
obstetric complications maternal influenza malnutrition and famine winter birth substance misuse
neurological abnormalities found in sz
reduced brain volume - 3% 25% ventricular enlargement - overlaps w/ normal cytoarchitectural abnormalities reduced frontal lobe performance eye tracking abnormalities soft neurological signs EEG abnormalities
stages in the development of delusions
state of fear
delusional idea appears
effort to make sense of the experience by altering one’s view of the world
final breakdown - thought disorder and behavioural symptoms emerge
sz - phenomenology science and the anthropology of the self
there is a gross XS of sz in migrant populations
all individuals construct a sense of self within framework of time, morality and cultural symbols
when individuals migrate, it is probable that change will occur at all these levels
massive alteration in how one perceives oneself - neuronal correlates w/ consequent vulnerability to severe mental illness
sz - social and psychosocial factors
occupation and social class - be aware of drift hypothesis
- as you become unwell you drift down the social classes
migration
social isolation
life events as precipitants
cultural factors don’t seem to be implicated
psychosis and families
schizophrenogenic mother - theory not upheld
double bind theory and ambivalent communication style - not upheld by research
expressed critical emotion and high EE families - important concept and basis for family work and psychosis
differential diagnoses for psychotic illness
delirium or acute organic brain syndrome - whatever cause
depressive episode w/ psychotic symptoms
manic episode w/ psychotic symptoms
schizoaffective disorder
