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Systems: Psychiatry AB > Schizophrenia and Psychotic Disorders > Flashcards

Schizophrenia and Psychotic Disorders Flashcards

1
Q

What is the difference between psychosis and neurosis?

A
  • Psychosis: Disease of the mind (severe)

- Neurosis: Disease of the nerves (mild)

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2
Q

What is psychosis??

A
  • 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.
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3
Q

What are the historical trends of psychotic symptoms?

A
  • 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
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4
Q

How does psychosis present?

A

Hallucinations

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5
Q

What are the features of a hallucination?

A
  • 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
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6
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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7
Q

What types of delusion are there?

A
  • Grandiose
  • Paranoid (Persecutory)
  • Hypochondiracal
  • Self-referential
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8
Q

What mental illness can include psychotic symptoms?

A
  • Schizophrenia
  • Delirium
  • Severe affective disorder
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9
Q

What is the most common cause of psychosis?

A

Schizophrenia

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10
Q

What is schizophrenia?

A

A severe mental illness affecting:

  • Thinking
  • Emotion
  • Behaviour
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11
Q

What is the epidemiology of Schizophrenia?

A
  • Affects 1 per 100 population
  • Males and females equally
  • Age of onset 15-35 years
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12
Q

What are the symptoms of schizophrenia?

A

Positive symptoms

  • Hallucinations
  • Delusions
  • Disorder thinking

Negative symptoms

  • Apathy
  • Lack of interest
  • Lack of emotions
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13
Q

What is the ICD10 criteria for schizophrenia?

A

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
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14
Q

What are the types of schizophrenia?

A
  • Paranoid Schizophrenia
  • Hebephrenic Schizophrenia
  • Catatonic Schizophrenia
  • Undifferentiated Schizophrenia
  • Post-schizophrenic depression
  • Residual schizophrenia
  • Simple schizophrenia
  • Other schizophrenia
  • Schizophrenia, unspecified
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15
Q

What factors need to considered in the aetiology of schizophrenia?

A
  • Biological factors
  • Psychological factors
  • Social factors
  • Evolutionary theories
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16
Q

What are the 3P’s of aetiology for schizophrenia?

A
  • Possible predisposing factor
  • Precipitating factor
  • Perpetuating factor
17
Q

What biological factor may contribute to the aetiology of schizophrenia?

A
  • Genetics
  • Neurochemistry
  • Obstetric complications
  • Maternal influenza
  • Malnutrition and famine
  • Winter birth
  • Substance misuse
18
Q

What genetic components are associated with schizophrenia?

A
  • Acknowledged heritability from twin/family studies
  • Neuregulin implicated
  • Dysbindin implicated
  • Di George Syndrome (22Q deletion)
19
Q

What is the neurochemistry is associated with schizophrenia?

A

Dopamine hypothesis including:

  • Glutamate
  • GABA
  • Seroninergic transmission
20
Q

What psychological theories are associated with the onset of psychosis?

A
  • Jung’s concept of Collective Unconscious
  • Conrad’s psychological theory of psychosis using Gestalt Psychology
  • Hartland’s new model for the aetiology of psychosis
21
Q

What is Jung’s concept of Collective Unconscious?

A
  • 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
22
Q

What is Conrad’s psychological theory of psychosis using Gestalt Psychology?

A

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
23
Q

What is Hartland’s new model for the aetiology of psychosis?

A
  • 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
24
Q

What social and psychosocial factors contribute to the aetiology of schizophrenia?

A
  • Occupation and social class (be aware of drift hypothesis)
  • Migration
  • Social isolation
  • Life events as precipitants
  • CULTURAL FACTORS NOT IMPLICATED
25
Q

What is the connection between psychosis and families?

A
  • 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
26
Q

What are the differentials for schizophrenia?

A
  • Delirium or acute organic brain syndrome

- Affective psychosis

27
Q

How would delirium or acute organic brain syndrome present?

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
28
Q

How would a depressive episode with psychotic symptoms present?

A
  • Delusions of guilt, worthlessness and persecution

- Derogatory auditory hallucinations

29
Q

How would a manic episode with psychotic symptoms present?

A
  • Delusions of grandeur, special powers or messianic roles

- Gross over reactivity, irritability and behavioural disturbance. Manic excitement

30
Q

How is schizophrenia managed?

A
  • Family involvement
  • Antipsychotics
  • Clozapine is used for treatment resistant cases
  • CBTp
  • Cognitive remediation
  • Social skills training
31
Q

How is recovery defined in schizophrenia?

A

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

32
Q

What is the prognosis for schizophrenia?

A
  • 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
33
Q

What are good prognostic factors fro schizophrenia?

A
  • Absence of FH
  • Good premorbid function
  • Clear precipitant
  • Acute onset
  • Mood disturbance
  • Prompt treatment
  • Maintenance of initiative, motivation
34
Q

What are poor prognostic factors for schizophrenia?

A
  • Slow, insidious onset
  • Prominent negative features
  • Starts in childhood
35
Q

How does schizophrenia affect cognition?

A
  • Chronic schizophrenic patients show poorer cognition than first onset patients
  • There is no decline in cognition in follow-up studies of first onset psychosis
36
Q

In what way can prognosis be poor?

A
  • 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

Systems: Psychiatry AB (18 decks)

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