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Psychiatry > Schizophrenia and Psychotic Disorders > Flashcards

Schizophrenia and Psychotic Disorders Flashcards

1
Q

What is thought form?

A

How the though content is organised to form coherent thoughts and sentences

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2
Q

What is thought content?

A

What the person is actually thinking of, when it becomes disordered it results in hallucinations

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3
Q

Features of fluency that indicate abnormal thought form

A

Circumstantiality - talking around the topic

Loosening of associations - moving from one topic to another without apparent connection/association

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4
Q

Features of flow that indicate abnormal thought form

A

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
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5
Q

What is the name for words that don’t otherwise exist but are used by patients to describe things?

A

Neologisms

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6
Q

What is psychosis?

A

Disease of the mind which is severe

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7
Q

What is neurosis?

A

Disease of the nerves which is mild

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8
Q

What does psychosis represent?

A

Psychosis represents an inability to distinguish between symptoms of hallucination, delusion and disordered thinking from reality

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9
Q

Features of hallucinations

A

Have full force and clarity of true perception
Located in external space
No external stimulus
Not willed or controlled

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10
Q

What are the types of hallucinations?

A 
Auditory 
Visual
Tactile
Olfactory 
Gustatory
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11
Q

What is a delusion?

A

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

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12
Q

What are the types of delusion?

A

Grandiose
Paranoid/persecutory
Hypochondriacal
Self-referential

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13
Q

What illnesses might present with psychotic symptoms?

A

Schizophrenia
Delirium
Severe affective disorder - depressive episode with psychotic symptoms, manic episode with psychotic symptoms

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14
Q

What is schizophrenia?

A

A severe mental illness affecting;
Thinking
Emotion
Behaviour

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15
Q

What is the most common cause of psychosis?

A

Schizophrenia

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16
Q

What number of the population are affected by schizophrenia?

A

1 per 100 population

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17
Q

What is the normal age of onset of schizophrenia?

A

15-35 years

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18
Q

What are the positive symptoms of schizophrenia?

A

Classified as positive symptoms as they will be more florid/more easily identified
Hallucinations
Delusions
Disordered thinking

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19
Q

What are the negative symptoms of schizophrenia?

A

Apathy
Lack of interest
Lack of emotions
Pulsity of thought

20
Q

In the ICD 10 diagnostic criteria of schizophrenia at least one of what criteria must be met?

A

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

21
Q

In the ICD 10 diagnostic criteria of schizophrenia at least two of what criteria must be met? (in combination with other criteria)

A
  • 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
22
Q

What do you need to consider in the aetiology of psychosis?

A

Biological factors
Psychological factors
Social factors
Evolutionary theories

Each of these can be considered as;

  • possible predisposing factor
  • precipitating factor
  • perpetuating factor
23
Q

What is the difference between predisposing, precipitating and perpetuating factors?

A

Predisposing puts you at risk
Precipitating causes it to happen
Perpetuating continues into the illness

24
Q

What are the genetic associations with schizophrenia?

A

Cf acknowledged heritability from twin/family studies
Neuregulin
Dysbindin
Di George syndrome

25
Q

What are the neurochemistry associations with schizophrenia?

A 
Dopamine hypothesis 
Glutamate
GABA
GABA and glutamate
Serotoninergic transmission
26
Q

What are the biological factors implicated in schizophrenia?

A 
Obstetric complications 
Maternal influenza
Malnutrition and famine 
Winter birth 
Substance misuse
27
Q

What are the social and psychosocial factors that might influence schizophrenia?

A 
Occupation and social class
Migration 
Social isolation
Life events as precipitants
Cultural factors not implicated
28
Q

What is an important genetic concept and basis for family work in schizophrenia?

A

Expressed critical emotion - high EE families

29
Q

What are the differential diagnoses for schizophrenia?

A

Delirium
Acute organic brain syndrome
Depressive episode with psychotic symptoms
Manic episode with psychotic symptoms

30
Q

Features of delirium/acute organic brain syndrome

A

Consequent upon brain or systemic disease
Prominent visual experience, hallucinations and illusions
Affect of terror
Delusions are persecutory and evanescent
Fluctuating, worse at night

31
Q

Features of depressive episode with psychotic symptoms

A

Delusions of guilt, worthlessness and persecution

Derogatory auditory hallucinations

32
Q

Features of manic episode with psychotic symptoms

A

Delusions of grandeur, special powers or messianic roles

Gross over-activity, irritability and behavioural disturbance - manic excitement

33
Q

Types of schizophrenia

A 
Paranoid schizophrenia 
Hebephrenic schizophrenia 
Catatonic schizophrenia
Undifferentiated schizophrenia 
Post-schizophrenic depression 
Residual schizophrenia 
Simple schizophrenia 
Other schizophrenia 
Schizophrenia, unspecified
34
Q

What information should be provided in schizophrenia management?

A

Service users and families/carers informed and clear information given about diagnosis and what is means

35
Q

What access and engagement should be provided in schizophrenia management?

A

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

36
Q

Principles of management of schizophrenia

A

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

37
Q

How long should individuals with schizophrenia be on treamtaent for?

A

For 2 years after symptoms resolve - at this stage discuss risk of relapse and whether the patient wants to continue with medication

38
Q

What is a depot and when is this beneficial?

A

Injection of antipsychotic medication

Beneficial for those who struggle to take medication consistently

39
Q

Treatment of choice for resistant schizophrenia and those who have not responded to antipsychotics

A

Clozapine

40
Q

What is recovery according to the Scottish Recovery Network?

A

Being able to live a meaningful and satisfying life, as defined by each person, in the presence or absence of symptoms

41
Q

What percentage of people recover after a first episode of psychosis?

A

80%

42
Q

What percentage of people have a moderate recovery from schizophrenia?

A

50%

43
Q

What are good prognostic factors for schizophrenia recovery?

A 
Absence of FH 
Good premorbid function - stable personality, stable relationships 
Clear precipitant 
Acute onset
Mood disturbance
Prompt treatment 
Maintenance of initiative and motivation
44
Q

What are poor prognostic factors for schizophrenia recovery?

A

Slow, insidious onset and prominent negative symptoms
Shorter life expectancy linked to cardiovascular disease, respiratory disease and cancer6%
Starting in childhood

45
Q

How much higher is the suicide risk in people with schizophrenia compared to the general population?

A

9x higher

46
Q

What is the death from violent incidents in people with schizophrenia compared to the general population?

A

Twice as high

47
Q

What percentage of patients with schizophrenia will have a substance misuse problem?

A

3

Psychiatry (21 decks)

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