Schizophrenia and Psychotic Disorders Flashcards
What is the difference between psychosis and neurosis?
- Psychosis: Disease of the mind (severe)
- Neurosis: Disease of the nerves (mild)
What is psychosis??
- Severe form of mental illness where there is lack of insight
- Represents an inability to distinguish between symptoms of delusion, hallucination and disordered thinking from reality.
What are the historical trends of psychotic symptoms?
- Demonic possession and witchcraft
- Conflict of good and evil
- Influences by gassing or poisoning
- Scrutiny via TV, wireless or radar
- Persecution by Russians, FBI/CIA and Religious organizations
- Interference from aliens /spaceships
- Effects of computers and internet
How does psychosis present?
Hallucinations
What are the features of a hallucination?
- Have the full force and clarity of true perception
- Located in external space
- No external stimulus
- Not willed or controlled
- Can affect any of the 5 senses
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 types of delusion are there?
- Grandiose
- Paranoid (Persecutory)
- Hypochondiracal
- Self-referential
What mental illness can include psychotic symptoms?
- Schizophrenia
- Delirium
- Severe affective disorder
What is the most common cause of psychosis?
Schizophrenia
What is schizophrenia?
A severe mental illness affecting:
- Thinking
- Emotion
- Behaviour
What is the epidemiology of Schizophrenia?
- Affects 1 per 100 population
- Males and females equally
- Age of onset 15-35 years
What are the symptoms of schizophrenia?
Positive symptoms
- Hallucinations
- Delusions
- Disorder thinking
Negative symptoms
- Apathy
- Lack of interest
- Lack of emotions
What is the ICD10 criteria for schizophrenia?
For more than a month in absence or organic or affective disorder
At least 1 of:
-Alienation of though
-Delusions of control (referred to limb movements)
-Hallucinatory voices
-Persistent delusions
And OR at least 2 of the following:
- Persistent hallucinations
- Neologisms, breaks or interpolations in the train of thought; incoherent speech
- Catatonic behaviour
- Negative symptoms
What are the types of schizophrenia?
- Paranoid Schizophrenia
- Hebephrenic Schizophrenia
- Catatonic Schizophrenia
- Undifferentiated Schizophrenia
- Post-schizophrenic depression
- Residual schizophrenia
- Simple schizophrenia
- Other schizophrenia
- Schizophrenia, unspecified
What factors need to considered in the aetiology of schizophrenia?
- Biological factors
- Psychological factors
- Social factors
- Evolutionary theories
What are the 3P’s of aetiology for schizophrenia?
- Possible predisposing factor
- Precipitating factor
- Perpetuating factor
What biological factor may contribute to the aetiology of schizophrenia?
- Genetics
- Neurochemistry
- Obstetric complications
- Maternal influenza
- Malnutrition and famine
- Winter birth
- Substance misuse
What genetic components are associated with schizophrenia?
- Acknowledged heritability from twin/family studies
- Neuregulin implicated
- Dysbindin implicated
- Di George Syndrome (22Q deletion)
What is the neurochemistry is associated with schizophrenia?
Dopamine hypothesis including:
- Glutamate
- GABA
- Seroninergic transmission
What psychological theories are associated with the onset of psychosis?
- Jung’s concept of Collective Unconscious
- Conrad’s psychological theory of psychosis using Gestalt Psychology
- Hartland’s new model for the aetiology of psychosis
What is Jung’s concept of Collective Unconscious?
- There is a storehouse of latent memory traces from man’s ancestral past
- These typical symbols of myth, fable and fairy stories are not accessible other than through altered consciousness, dreams or perhaps psychosis
What is Conrad’s psychological theory of psychosis using Gestalt Psychology?
Identification of stages in the development of delusions
- A state of fear
- The delusional idea appears
- An effort to make sense of the experience by altering one’s view of the world
- Final breakdown, as though disorder and behavioural symptoms emerge
What is Hartland’s new model for the aetiology of psychosis?
- Recognises gross excess of schizophrenia in migrant populations
- All individuals construct a sense of self within framework of time, morality and cultural symbols
- When individuals migrate it is probable that change will occur at all these levels
- This massive alteration in how one perceives oneself will have neuronal correlates with consequent vulnerability to severe mental illness
What social and psychosocial factors contribute to the aetiology of schizophrenia?
- Occupation and social class (be aware of drift hypothesis)
- Migration
- Social isolation
- Life events as precipitants
- CULTURAL FACTORS NOT IMPLICATED
What is the connection between psychosis and families?
- Schizophrenogenic mother: when someone is overly involved and overly emotional but it confers no benefit to the patient
- ‘Double bind’ ambivalent communication style
- High EE families is an important concept for the basis of family work
What are the differentials for schizophrenia?
- Delirium or acute organic brain syndrome
- Affective psychosis
How would delirium or acute organic brain syndrome present?
- Consequent upon brain or systemic disease
- Prominent visual experience, hallucinations and illusions
- Affect of terror
- Delusions are persecutory and evanescent
- Fluctuating, worse at night
How would a depressive episode with psychotic symptoms present?
- Delusions of guilt, worthlessness and persecution
- Derogatory auditory hallucinations
How would a manic episode with psychotic symptoms present?
- Delusions of grandeur, special powers or messianic roles
- Gross over reactivity, irritability and behavioural disturbance. Manic excitement
How is schizophrenia managed?
- Family involvement
- Antipsychotics
- Clozapine is used for treatment resistant cases
- CBTp
- Cognitive remediation
- Social skills training
How is recovery defined in schizophrenia?
Being able to live a meaningful and satisfying life as defined by each person, in the presence or absence of symptoms
What is the prognosis for schizophrenia?
- 80% for recovery after a first episode of psychosis
- Early intervention and more effective treatment mean that the outlook is not as bleak as it once was.
- Up to 50% have a moderate recovery
- Small group with chronic symptoms and little recovery
What are good prognostic factors fro schizophrenia?
- Absence of FH
- Good premorbid function
- Clear precipitant
- Acute onset
- Mood disturbance
- Prompt treatment
- Maintenance of initiative, motivation
What are poor prognostic factors for schizophrenia?
- Slow, insidious onset
- Prominent negative features
- Starts in childhood
How does schizophrenia affect cognition?
- Chronic schizophrenic patients show poorer cognition than first onset patients
- There is no decline in cognition in follow-up studies of first onset psychosis
In what way can prognosis be poor?
- Mortality is 1.6 times higher than the general population.
- 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.
- 36% of patients have a substance misuse problem and there are high rates of cigarette smoking
