Schizophrenia and Psychotic Disorders Flashcards
What is thought form?
How the though content is organised to form coherent thoughts and sentences
What is thought content?
What the person is actually thinking of, when it becomes disordered it results in hallucinations
Features of fluency that indicate abnormal thought form
Circumstantiality - talking around the topic
Loosening of associations - moving from one topic to another without apparent connection/association
Features of flow that indicate abnormal thought form
Speed - speed up in mania, slow down in depression
Interruptions in flow
- blocking, indicates schizophrenia if persistent
- preservation
Deviations in flow
- derailment
- tangentiality
- flight of ideas
What is the name for words that don’t otherwise exist but are used by patients to describe things?
Neologisms
What is psychosis?
Disease of the mind which is severe
What is neurosis?
Disease of the nerves which is mild
What does psychosis represent?
Psychosis represents an inability to distinguish between symptoms of hallucination, delusion and disordered thinking from reality
Features of hallucinations
Have full force and clarity of true perception
Located in external space
No external stimulus
Not willed or controlled
What are the types of hallucinations?
Auditory Visual Tactile Olfactory Gustatory
What is a delusion?
A 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 are the types of delusion?
Grandiose
Paranoid/persecutory
Hypochondriacal
Self-referential
What illnesses might present with psychotic symptoms?
Schizophrenia
Delirium
Severe affective disorder - depressive episode with psychotic symptoms, manic episode with psychotic symptoms
What is schizophrenia?
A severe mental illness affecting;
Thinking
Emotion
Behaviour
What is the most common cause of psychosis?
Schizophrenia
What number of the population are affected by schizophrenia?
1 per 100 population
What is the normal age of onset of schizophrenia?
15-35 years
What are the positive symptoms of schizophrenia?
Classified as positive symptoms as they will be more florid/more easily identified
Hallucinations
Delusions
Disordered thinking
What are the negative symptoms of schizophrenia?
Apathy
Lack of interest
Lack of emotions
Pulsity of thought
In the ICD 10 diagnostic criteria of schizophrenia at least one of what criteria must be met?
For more than a month in the absence of an organic or affective disorder.
At least one of:
- alienation of thought e.g. thought echo, thought insertion, withdrawal, broadcasting
- delusions of control, influence or passivity, clearly referred to body or limb movements
- hallucinatory voices giving a running commentary on the patient’s behaviour, or discussing the patient 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
In the ICD 10 diagnostic criteria of schizophrenia at least two of what criteria must be met? (in combination with other criteria)
- persistent hallucinations in any modality, when occurring every day for at least one month
- neologisms, breaks or interpolations int he train of thought, resulting in incoherence or irrelevant speech
- catatonic behaviour, such as excitement, posturing or wavy flexibility, negativism, mutism and stupor
- negative symptoms such as marked apathy, paucity of speech and blunting or incongruity of emotional responses
What do you need to consider in the aetiology of psychosis?
Biological factors
Psychological factors
Social factors
Evolutionary theories
Each of these can be considered as;
- possible predisposing factor
- precipitating factor
- perpetuating factor
What is the difference between predisposing, precipitating and perpetuating factors?
Predisposing puts you at risk
Precipitating causes it to happen
Perpetuating continues into the illness
What are the genetic associations with schizophrenia?
Cf acknowledged heritability from twin/family studies
Neuregulin
Dysbindin
Di George syndrome
What are the neurochemistry associations with schizophrenia?
Dopamine hypothesis Glutamate GABA GABA and glutamate Serotoninergic transmission
What are the biological factors implicated in schizophrenia?
Obstetric complications Maternal influenza Malnutrition and famine Winter birth Substance misuse
What are the social and psychosocial factors that might influence schizophrenia?
Occupation and social class Migration Social isolation Life events as precipitants Cultural factors not implicated
What is an important genetic concept and basis for family work in schizophrenia?
Expressed critical emotion - high EE families
What are the differential diagnoses for schizophrenia?
Delirium
Acute organic brain syndrome
Depressive episode with psychotic symptoms
Manic episode with psychotic symptoms
Features of delirium/acute organic brain syndrome
Consequent upon brain or systemic disease
Prominent visual experience, hallucinations and illusions
Affect of terror
Delusions are persecutory and evanescent
Fluctuating, worse at night
Features of depressive episode with psychotic symptoms
Delusions of guilt, worthlessness and persecution
Derogatory auditory hallucinations
Features of manic episode with psychotic symptoms
Delusions of grandeur, special powers or messianic roles
Gross over-activity, irritability and behavioural disturbance - manic excitement
Types of schizophrenia
Paranoid schizophrenia Hebephrenic schizophrenia Catatonic schizophrenia Undifferentiated schizophrenia Post-schizophrenic depression Residual schizophrenia Simple schizophrenia Other schizophrenia Schizophrenia, unspecified
What information should be provided in schizophrenia management?
Service users and families/carers informed and clear information given about diagnosis and what is means
What access and engagement should be provided in schizophrenia management?
Co-morbid substance misuse should not exclude people with schizophrenia from services or intervention, management of severe and complex problems may require a joint consultative approach between mental health and substance misuse services
Principles of management of schizophrenia
Get the patient engaged and provide access to services
Early intervention services - associated with better outcomes
There is some evidence for assertive community treatment being helpful
Make sure that the patient can tolerate an antipsychotic and make sure they are given an antipsychotic early
Antipsychotic given for at least 2 weeks then adjust dose
Minimum effective dose of first generation or second generation antipsychotics
Be aware of relapse and acute exacerbation - consider changing meds or increasing dose and consider adverse effects
In remission - continue antipsychotic mediation
Maintenance treatment
Also evidence for psychological therapies and family intervention in psychosis
How long should individuals with schizophrenia be on treamtaent for?
For 2 years after symptoms resolve - at this stage discuss risk of relapse and whether the patient wants to continue with medication
What is a depot and when is this beneficial?
Injection of antipsychotic medication
Beneficial for those who struggle to take medication consistently
Treatment of choice for resistant schizophrenia and those who have not responded to antipsychotics
Clozapine
What is recovery according to the Scottish Recovery Network?
Being able to live a meaningful and satisfying life, as defined by each person, in the presence or absence of symptoms
What percentage of people recover after a first episode of psychosis?
80%
What percentage of people have a moderate recovery from schizophrenia?
50%
What are good prognostic factors for schizophrenia recovery?
Absence of FH Good premorbid function - stable personality, stable relationships Clear precipitant Acute onset Mood disturbance Prompt treatment Maintenance of initiative and motivation
What are poor prognostic factors for schizophrenia recovery?
Slow, insidious onset and prominent negative symptoms
Shorter life expectancy linked to cardiovascular disease, respiratory disease and cancer6%
Starting in childhood
How much higher is the suicide risk in people with schizophrenia compared to the general population?
9x higher
What is the death from violent incidents in people with schizophrenia compared to the general population?
Twice as high
What percentage of patients with schizophrenia will have a substance misuse problem?
3
