Schizophrenia and Psychotic Disorders Flashcards
what is psychosis?
Psychosis is a severe form of mental illness that patients lack insight into. It represents an inability to
distinguish between symptoms of delusion, hallucination and disordered thinking from reality.
clinical presentation of psychosis
hallucinations
delusions
describe hallucinations in psychosis
Hallucinations have the full force and clarity of true perception. They are located in external space
with no external stimulus. They cannot be willed or controlled. They can affect all 5 senses – auditory
most common in psychosis. Visual hallucinations are more likely to be caused by other disease such
as delirium. Tactile, olfactory and gustatory.
visual hallucinations are mostly associated with what kind of illness
organic
what is a delusion?
A delusion is an unshakable idea or belief which is out of keeping with the person’s social and cultural
background; it is held with extraordinary conviction
give examples of types of delusions
grandioses
paranoid (persecutory)
hypochondriacal
self-referential
what illnesses may produce psychotic symptoms?
schizophrenia delirium severe affective disorder depression with psychosis mania with psychosis
what are the 1st rank symptoms of schizophrenia?
A = auditory hallucinations B = broadcasting C = controlled thought D = delusional perception
what domains does schizophrenia affect?
thinking
emotion
behaviour
what is the most common cause of psychosis?
schizophrenia
what % of the population suffer from schizophrenia?
1%
are females or males more affected by schizophrenia?
equally
what is the mean age of onset of schizophrenia?
15-35
list positive symptoms of schizophrenia
hallucinations
delusions
disordered thinking
list negative symptoms of schizophrenia
apathy lack of interest lack of emotions - different to inability to feel amotivation paucity of thought
for a diagnosis of schizophrenia list the criteria for which only one needs to be present for > 1 month
alienation of thought
delusions of control
hallucinatory voices
persistent delusions
for a diagnosis of schizophrenia list the criteria for which 2 or more needs to be present for > 1 month
persistent hallucinations in any modality
neologisms
catatonic behaviour
negative symptoms
what does alienation of thought include?
thought echo
thought insertion or withdrawal
thought broadcasting
describe hallucinatory voices
running commentary on the patient’s behaviour or discussing him between themselves. or other types of hallucinatory voices coming from some part of the body
describe neologisms
breaks or interpolations in the train of thought resulting in incoherence or irrelevant speech
what term is used for a schizophrenic patient that puts random words together that make no sense?
schizophasia
what is catatonic behaviour?
excitement posturing or waxy flexibility negativism mutism stupor
what biological factors may contribute to schizophrenia?
o Genetics § Acknowledged heritability from twin/family studies § Neuregulin § Dysbindin § Di George Syndrome § Multiple genes with a small effect on development of schizophrenia § DSC genes o Neurochemistry § Dopamine hypothesis § Glutamate § GABA § Serotoninergic transmission o Obstetric complications o Maternal influenza o Malnutrition and famine o Winter birth o Substance misuse – cannabis if someone is at risk of psychotic disorder anyway
4 Ps of mental health
predisposing
precipitating
perpetuating
protective
describe the Jung’s Concept of Collective unconscious
“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.”
Conrad (1958) used the concepts of Gestalt Psychology to Identify Stages in the Development of
Delusions describe
- 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 thought disorder and behavioural symptoms emerge
Phenomenology Science and the Anthropology of the Self: A New Model for the Aetiology of Psychosis describe
This theory recognises gross excess of schizophrenia in migrant population. All individuals construct a
sense of self within a framework of time, morality and cultural symptoms. When individuals migrate,
it is probably 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 factors may contribute to schizophrenia?
- Occupation and social class but be aware of the drift hypothesis
- Migration
- Social isolation
- Life events as precipitants
- Cultural factors are not implicated
what are the psychotic illnesses?
delirium or acute organic brain syndrome
affective psychoses
describe delirium
o Consequent upon brain or systemic disease
o Prominent visual experience, hallucinations and illusions (misperception of real
stimulus)
o Affect of terror
o Delusions are persecutory and evanescent
o Fluctuating, worse at night
describe depression with psychosis
§ Delusions of guilt, worthlessness, and persecution
§ Derogatory auditory hallucinations
describe mania with psychosis
§ Delusions of grandeur, special powers or messianic roles
§ Gross overactivity, irritability and behavioural disturbance: Manic excitement
how does the Scottish Recovery Network define recovery from schizophrenia?
“being able to live a meaningful and satisfying life, as defined by each person, in the
presence or absence of symptoms”.
how many recover after their first episode of psychosis?
80%
good prognostic factors for recovery of psychosis
- Absence of family history
- Good premorbid function – stable personality, stable relationships
- Clear precipitant
- Acute onset
- Mood disturbance
- Prompt treatment
- Maintenance of initiative, motivation
poor prognostic factors for recovery of psychosis
- Slow, insidious onset and prominent negative symptoms
- Mortality is 1.6x higher than the general population
- Shorter life expectancy is linked to CV disease, resp disease and cancer
- Suicide risk is 9 x higher
- Death from violent incidents is twice as high
- 36% of patients have substance misuse problems
- Childhood onset
discuss cognition and schizophrenia
Chronic schizophrenic patients show poorer cognition than first onset patients. There is no decline in
cognition in follow up studies of first onset psychosis. The finding in chronic patients are an artefact
of selective loss of patients – those who recover are not studied.
