Schizophrenia and psychotic disorders Flashcards
define psychosis
inability to distinguish between symptoms of hallucination, delusion and disordered thinking from reality
Clinical presentation of psychosis
hallucinations and 5 special senses
delusions
delusion is an unshakeable idea or belief which is out of keeping with the person’s social and cultural background; it is held with extraordinary conviction
what is schizophrenia
A severe mental illness affecting:
Thinking
Emotion
Behaviour
most common cause of psychosis
positive symptoms of schizophrenia (more characteristic of acute episodes)
Hallucinations
Delusions
Disordered thinking
negative symptoms of schizophrenia (chronic)
Apathy
Lack of interest
Lack of emotions
age of onset for schizophrenia
15 - 35 Y old
diagnostic criteria for schizophrenia
criteria for schizophrenia
For more than a month in the absence of organic or affective disorder:
At least one of the following:
a) Alienation of thought as thought echo, thought insertion or withdrawal, or thought broadcasting.
b) Delusions of control, influence or passivity, clearly referred to body or limb movements actions, or sensations; delusional perception.
c) 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.
d) Persistent delusions of other kinds that are culturally inappropriate and completely impossible (e.g. being able to control the weather).
And OR at least two of the following:
e) Persistent hallucinations in any modality, when occurring every day for at least one month.
f) Neologisms, breaks or interpolations in the train of thought, resulting in incoherence or irrelevant speech.
g) Catatonic behaviour, such as excitement, posturing or waxy flexibility, negativism, mutism and stupor.
h) “Negative” symptoms such as marked apathy, paucity of speech, and blunting or incongruity of emotional responses.
aetiology of psychosis
- predisposing factor
- precipitating factor
- perpetuating factor
Considerations
Biological factors
Psychological factors
Social factors
Evolutionary Theories
possible genetic links to schizophrenia
Neuregulin (chromosome 8p)
Dysbindin (chromosome 6p)
Di George Syndrome
Inherited CNV’s
[Roughly 10% risk if one parent affected; 40% if two parents]
neurochemistry link to schizophrenia
“Dopamine hypothesis” -increased levels in parts of the brain
Glutamate
GABA
Noradrenaline
Serotoninergic transmission
neurological abnormalities in schizophrenia
Reduced brain volume 3%
Ventricular enlargement 25% (but overlaps with normal)
Cytoarchitectural abnormalities
Reduced frontal lobe performance
Eye tracking (saccadic) abnormalities
Soft neurological signs
EEG abnormalities
obstetric complications associated with schizophrenia
Maternal influenza
Malnutrition and famine
Winter birth
Substance misuse
Delirium or Acute Organic Brain Syndrome (however caused)
Consequent upon brain or systemic disease
Prominent visual experience, hallucinations and illusions
Affect of terror
Delusions are persecutory and evanescent
Fluctuating, worse at night
depressive episode - with psychotic symptoms
Delusions of guilt, worthlessness and persecution
Derogatory auditory hallucinations
manic episode with psychotic symptoms
Delusions of grandeur; special powers or messianic roles
Gross overactivity, irritability and behavioural disturbance: Manic excitement
what is schitzoaffective disorder
Mix of affective and schizophrenia features which occur at the same time (or within a few days)
All criteria met
Mood disturbance must be present (not other symptoms eg lost of pleasure without mood)
Last at least a month
management guidelines for schizophrenia
SIGN 131 – Management of Schizophrenia – 2013
NICE – Psychosis and schizophrenia in adults: prevention and management – clinical guideline [CG178 - 2014]
NICE – Psychosis and schizophrenia in children: recognition and management [CG155 – 2016]
pharmacological treatment
antipsychotic medicine - at lowest reommended dose
recovery with schizophrenia
Scottish Recovery Network defines recovery as “being able to live a meaningful and satisfying life, as defined by each person, in the presence or absence of symptoms”.
80% for recovery after a first episode of psychosis
early intervention more effective
good prognostic factors
Absence of family history
Good premorbid function - stable personality, stable relationships
Clear precipitant
Acute onset
Mood disturbance
Prompt treatment
Maintenance of initiative, motivation
negative prognostic factors
Shorter life expectancy is linked to cardiovascular disease, respiratory disease and cancer.
Suicide risk is 9 times higher.
Death from violent incidents is twice as high.
how is cognition in schizophrenic patients
Chronic schizophrenic patients show poorer cognition than first onset patients
