Schizophrenia and psychotic disorders Flashcards
Personality disorders
Psychosis definition [2]
Represents an inability to distinguish between symptoms of delusion, hallucination and disordered thinking from reality
Lack of insight
When is auditory hallucination classically seen
Classical psychosis
When is visual hallucination classically seen
Organic illness
4 eg of psychotic delusions
Grandiose
Persecutory
Hypochondriacal
Self-referential
Positive symptoms [3]
Negative symptoms [3]
Positive - hallucinations, delusions, disordered thinking
Negative - apathy, lack of interest, lack of emotions
Dx schizophrenia
Duration [2]
At least one of [4] or at least two of [4]
More than a month in absence of organic/affective disorder
At least one of:
- Alienation of thought
- Delusions of control
- Hallucinatory voices
- Persistent delusions
OR
- Persistent hallucinations in any modality occurring everyday for at least 1 month
- Schizotalk
- Catatonic behavior
- Negative symptoms
Catatonic behavior [5]
4 negative symptoms
- Posturing
- Waxy flexibility
- Negativism
- Mutism
- Stupor
Negative symptoms
- Marked apathy
- Paucity of speech
- Blunt affect
- Incongruity of emotional responses
Aetiology of psychosis:
Biological factors
- 4 genetic disorders
- 4 neurochemistry factors
- 5 other factors
Genetic disorders
- CF
- Neuregulin
- Dysbindin
- Di George syndrome
Neurochemistry
- Dopamine hypothesis
- Glutamate
- GABA
- Serotoninergic transmission - negative symtoms
Others
- Obstetric complications
- Maternal influenza
- Malnutrition, famine
- Winter birth
- Substance misuse (if predisposed to..)
What is serotonergic symptoms responsible for? In terms of schizophrenia etiology
negative symptoms in schizophrenia
Psychological factors [2]
Jung’s concept of collective unconscious Gestalt psychology
Social factors [5] with regards to schizophrenia etiology
Mirgant populations - gross excess of schizophrenia
Drift hypothesis - drifting to an unfamiliar environment
Social isolation
Life events precipitate
Familial factors
- Schizophrenogenic mother - but not evidenced
- High EE families
3 differentials of psychosis (illnesses with psychotic sx)
Delirium
Affective psychoses
Schizophrenia
Features of delirium [4]
Visual experience - hallucinations, illusions
Affect of terror
Delusions: persecutory, evanescent (disappearing, not consistent)
Fluctuating but worse at night
Affective psychoses types[2] and name 2 features
Depressive episode with psychotic symptoms
- Delusions of guilt, worthlessness, persecution
- Derogatory auditory hallucinations
Manic episode with psychotic symptoms
- Grandiose delusions - messianic roles
- Gross overactivity, irritability, behavioural disturbance, manic excitement
Good prognostic factors of psychosis [7]
Good prognosis factors
- Absence of FMH
- Good premorbid function - stable personality and relationships
- Clear precipitant
- Acute onset
- Mood disturbance
- Prompt treatment
- Maintenance of initiative and motivation
Poor prognostic factors of psychosis [7]
Slow, insidious onset and prominent negative sx
- Lack of obvious precipitant
Higher mortality in those with CVD, resp disease, ca - due to shorter life expectancy
- Suicide risk higher
Low IQ
Substance misuse problems
Cigarette smoking
Onset in childhood
Specific personality disorders:
Name 3 cluster A
Prominent problems are…?
All cluster A disorders have same onset?
Paranoid personality disorder
Schizoid personality disorder
Schizotypal personality disorder
Prominent problems are with perceived safety of interpersonal relationships
Onset: early adulthood
Specific personality disorders: Name 3 cluster B
Prominent problems are
Antisocial personality disorder
Narcissistic personality disorder
Borderline personality disorder
Histrionic personality disorder
Prominent problems are with keeping feelings tolerable without acting
Specific personality disorders: Name 3 cluster C Prominent problems are
OCD Personality disorder
Avoidant personality disorder
Dependent personality disorder
Prominent problems relate to anxiety and how it is managed in relationships
Paranoid personality disorder [1]
A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent
Schizoid personality disorder [2]
Pervasive pattern of detachment from social relationships
Restricted range of expression of emotions in interpersonal settings
COLD
Schizotypal personality disorder [3]
Pervasive pattern of social and interpersonal deficits
Marked by acute discomfort of/for close relationships
Marked by cognitive/perceptual distortions and behavioural eccentricities
ODD
Antisocial personality disorder
Define in 1 sentence
Features [3]
Criteria [2] - includes age
Failure to conform social norms with respect to lawful behaviours Features: Deceitfulness Impulsivity Irritability and aggressiveness Lack of remorse
At least 18 yo AND evidence of conduct disorder before 15 yo
Narcissistic personality disorder Onset 3 defining features
Onset: early adulthood Features:
- Pervasive pattern of grandiosity
- Need for admiration
- Lack of empathy
Borderline personality disorder
Onset
Features [2]
Pervasive pattern of instability of interpersonal relationships, self-image and affects
Marked impulsivity
Histrionic personality disorder definition [1]
Onset
§ Pervasive pattern of excessive emotionality and attention seeking Onset: early adulthood
OCD personality disorders
Onset
Definition
Pervasive pattern of pre-occupation with orderliness, perfectionism and mental/interpersonal control
Onset: early adulthood
Avoidant personality disorder
Onset
Pervasive pattern of social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation
Onset: early adulthood
Dependent personality disorder
Onset
Pervasive and excessive need to be taken care of that leads to submissive and clinging behaviour, fears of separation
Onset: early adulthood
Management of schizophrenia
Acute psychotic episode
First line
Second line
Third line
Anti-psychotics
IM or inhaled
IM lorazepam
ECT
Chronic mx schizophrenia
Atypical anti-psychotics
Full trial of 2 different anti-psychotics and it doesn’t work
- Try 2 months each
- Maintenance tx at least 18m
Psychosocial interventions eg psychotherapy (CBTp)
Schizophrenia mx: treatment resistant forms
First line, second line, third line
Not responsive to 2 antipsychotics (incl SGA) > clozapine
Clozapine + second SGA
Clozapine + lamotrigine
