Schizophrenia and Psychotic Disorders Flashcards
Describe psychosis
Severe forms of mental illness
Represents an inability to distinguish between symptoms of delusion, hallucinations and disordered thinking from reality
Describe hallucinations
Have the full force and clarity of true perception
Located in external space and no external stimulus
Not willed or controlled
5 special senses
Describe delusional beliefs
Unshakeable idea or belief which is out of keeping with the person’s social and cultural background
Ex. grandiose, paranoid, hypochondriacal and self referential
What illness may experience psychotic symptoms?
Schizophrenia
Delirium
Severe affective disorder - depressive or manic episodes with psychotic symptoms
Describe schizophrenia
Severe mental illness affecting thinking, emotion and behaviour
Most common cause of psychosis
What is the epidemiology for schizophrenia?
Affects 1 per 100 population
Males and females equally
Age of onset is 15-35 years - earlier in men
What are the symptoms of schizophrenia?
Positive - Hallucinations, delusions and disordered thinking
Negative - Apathy, lack of interest and lack of emotions
What is the criteria for schizophrenia in ICD-10?
At least one of - alienation of thought, passivity delusions, hallucinations and persistent delusions
Or at least 2 of - persistent hallucinations, breaks in train of thought, catatonic behaviour and negative symptoms
What is the aetiology of psychosis?
Biological, psychological, social and evolutionary factors
What are some biological factors for schizophrenia?
Genetics, neurochemistry, obstetric complications, maternal influenza, maturation and famine, winter birth and substance misuse
Describe neurochemistry as a biological factor for schizophrenia
Dopamine hypothesis
Glutamate, GABA, noradrenaline and serotoninergic transmission
What are some neurological abnormalities which are a factor for schizophrenia?
Reduced brain volume (3%), ventricular abnormalities, cytoarchitectural abnormalities, reduced frontal lobe performance, eye tracking, soft neurological signs and EEG abnormalities
What are some social and pyschosocial factors for schizophrenia?
Occupation and social class
Migration
Social isolation
Life events
What are the symptoms for delirium or acute organic brain syndrome?
Consequent upon brain or systemic disease
Prominent visual experience, hallucinations and illusions
Affect of terror
Delusions are precursory
Fluctuating and worse at night
What are the symptoms for depressive episode with psychotic symptoms?
Delusions of guilt, worthlessness and persecution
Derogatory auditory hallucination
What are the symptoms for manic episodes with psychotic symptoms?
Delusions of grandeur - special powers and messianic roles
Gross overactivity, irritability and behavioural disturbance
Describe schizoaffective disorder
Mix of affective (depressive, manic or mixed) and schizophrenia features which occur at the same time
All criteria met
Mood disturbance may be present
Lasts at least a month
What are some psychological therapies used in schizophrenia?
CBT
Cognitive remediation
Family intervention
Social skills training
What is the prognosis and recovery for schizophrenia?
80% recovery after first episode of psychosis
50% have a moderate recovery
Early intervention
What are good prognostic factors for schizophrenia?
Absence of family history
Good premorbid function
Clear precipitant
Acute onset
Mood disturbance
Prompt treatment
Maintenance of initiative
What are poor prognostic factors for schizophrenia?
Slow, insidious onset and prominent negative symptoms
Shorter life expectancy is linked to CVD, resp. disease and cancer
Suicide risk is 9 times higher
How are schizophrenic patients functioning at 10 years?
65% had no psychotic symptoms at 10 years
46% had none for more than 2 years
Describe cognition and schizophrenia
Chronic schizophrenic patients show poorer cognition than first onset patients
There is no decline in cognition in follow up studies of first onset
