Schizophrenia and psychotic disorders Flashcards
1
Q
Definition of psychosis
A
- Severe form of mental illness
- Lack of insight into illness
- Difficulty distinguishing between symptoms of delusion, hallucination and disordered thinking from reality
2
Q
Presentation of psychosis
A
- Hallucination
- All aspects of true perception: clarity
- Externallyl located
- No external stimulus
- Not willed or controlled
- 5 special senses → auditory, visual, olfactory, gustatory, tactile
- Delusional beliefs
- Unshakeable idea or belief outwit personal social and cultural background
- Grandiose, paranoid, hypochondriacal, self-referential
3
Q
How is psychosis classified
A
- Rarely a disorder on its own, most commonly classified by diseases accompanied by psychotic features
- Schizophrenia
- Delirium
- Severe affective disorder (depression with psychosis, mania with psychosis)
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4
Q
Definition of schizophrenia
A
- Severe mental illness affecting, thoughts, behaviours and emotions
- Most common cause of psychosis → 1/100 population
- F=M
- Onset 15-35 years, earlier in men
5
Q
Presentation of schizophrenia
A
- Positive symptoms
- Hallucinations
- Delusions
- Disordered thinking
- Negative symptoms
- Apathy
- Lack of interest
- Lack of emotions
- Positive symptoms are sign of acute illness whereas negative symptoms are a sign of poorer prognosis
6
Q
Diagnostic criteria for schizophrenia diagnosis (ICD 10)
A
- Occurring for more than a month and in absence of organic or affective disorder
- One or more of:
- Alienation of thought → thought echo, thought insertion/ withdrawal/ broadcasting
- Delusions of control → influence or passivity in reference to body, limb movements, sensations or delusional perceptions
- Hallucinatory voices → third party, running commentary of patients behaviours, discussing amongst themselves, voices coming from specific parts of body
- Persistent delusion → inappropriate to patient and completely impossible (ie. ability to control weather)
- Or two of:
- Persistence hallucinations → any modality
- Neologisms → break or interpolation of train of thought (causes gibberish)
- Catatonic behaviours → eccentricity, posturing, flexibility, negativism, mutism, stupor
- Negative symptoms → apathy, poverty of speech, blunting/ incongruity of emotions
7
Q
Aetiology of schizophrenia
A
- Biological
- Psychological
- Social
- Evolutionary theory
- Above can be classified into possible predisposing, precipitating or perpetuating factors
8
Q
Biological factors of schizophrenia
A
- Genetics
- Monozygotic twins → 50%
- One parent → 10%
- Dizygotic twins → 10%
- Specific genes → neuregulin, dysbindin, Di George syndrome
- Neurochemistry
- ‘Dopamine hypothesis’ → increases levels of dopamine in key dopaminergic pathways
- Glutamate
- GABA
- Noradrenaline
- Serotonin
9
Q
Neurological abnormalities in schizophrenia
A
- Reduced brain volume → 3%
- Ventricular enlargement → 25%
- Cytoarchitectural abnormalities
- Reduce frontal lobe functioning
- Eye tracking disorder → saccadic
- Soft neurological signs
- EEC abnormalities
10
Q
Other etiological factors of schizophrenia
A
- Migrant population → caused by social isolation from individuals identity, culture and morals
- Drift hypothesis → occupation and social class changes
- Social isolation
- Major life events → precipitant
11
Q
Differentials fo psychotic disorder
A
- Delirium or acute organic brain syndrome
- Brain or systemic disease
- Particular visual experience, hallucination, illusion
- Delusions of persecutory and transient
- Fluctuates but worst at night
- Depressive episode with psychotic symptoms
- Delusions of guilt, worthlessness, persecution
- Derogatory auditory hallucination
- Inherently severe depression
- Manic episode with psychotic symptoms
- Delusions of grandeur → special powers, god-complex
- Gross overactivity → irritability, behavioural abnormalities, manic excitement
- Inherently severe mania
12
Q
Schizoaffective disorder
A
- Mix of affective and schizophrenic features
13
Q
Management of schizophrenia ?
A
- Provision of information → education of patient and career
- Access and engagement of care → involves treatment of comorbid conditions (substance-misuse)
- Early intervention services
- Family-based interventions
- Psychological interventions
- Educational intervention
- Access to antipsychotic medication
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14
Q
Prognosis and recovery of schizophrenia
A
- Aim is to live a meaningful and functional life with the absence of symptoms
- 80% recover after first psychotic episode
- 50% have moderate recovery
- Small group with chronic condition and little recovery
- Early intervention → effective treatment and better outlook
15
Q
Good prognostic factors
A
- Absence of family history
- Good premorbid function → stable personality, stable relationships
- Clear cause of precipitation
- Acute onset
- Presence of mood disturbances
- Prompt and effective treatment
- Maintenance of initiative and motivation
