Schizophrenia and Psychotic Disorders Flashcards
what is psychosis?
inability to distinguish symptoms of delusion, hallucination and disordered thinking form reality
how may psychosis present?
> hallucinations
> delusional belief
describe hallucinations seen in psychosis
> full clarity of true perception > no external stimulus > located in the external space > not willed or controlled > tactile/visual/auditory/gustatory/olfactory
what is a delusional belief?
unshakable idea/belief out of keeping with a persons social and cultural background held with extraordinary conviction
what are the symptoms of schizophrenia?
positive
> hallucinations
> delusions
> disordered thinking
negative
> apathy
> lack of emotion
> lack of interest
what is the ICD-10 classification of schizophrenia?
one for 1 month with absence of organic or affective disorder
> persistent delusion
> delusion of control/influence/passivity (clearly referred to limb and body movement
> alienation of thought
> hallucinatory voices
or at least 2 of the following for 1 month
> negative symptoms
> catatonic behaviour
> persistent hallucination in any modality occurring every day for a month
> neologisms breaks or interpolations in train of though
what different thought alienation may occur in schizophrenia?
> echo
insertion
withdrawal
broadcasting
what different types of hallucinatory voices can occur in schizophrenia?
> from body part
talking about them
running commentary
what negative symptoms can be seen in schizophrenia?
> blunting
paucity of speech
marked apathy
describe catatonic behaviour seen in schizophrenia
> mutism > wavy flexibility > posturing > excitement > stupor
what psychological factors are associated with schizophrenia?
> social isolation (chicken and egg)
> migrant
what biological factors are associated with schizophrenia?
> genetic > neurochemistry (serotininergic transmission) > maternal influenza > obstetric complications > malnutrition > substance misuse
what is the differential diagnosis for psychosis?
> delirium > schizophrenia > manic episode > depressive episode > (dementia)
what presentation might point to delirium as the cause of psychosis?
> persecutory delusions > fluctuating (worse at night) > affect of terror > visual experience > acute
what are the management options?
> psychological therapies (CBT and family intervention)
antipsychotics
clozapine if resistant
what monitoring is put in place if clozapine is commenced?
full blood monitoring regularly for neutropenia
what are bad prognostic factors?
> starting in childhood
substance misuse
slow insidious onset and prominent negative symptoms
what are good prognostic factors?
> absence of family history > good premorbid function > acute onset > clear precipitant > mood disturbance > prompt treatment > maintenance of motivation
how much higher is the mortality rate for people with schizophrenia?
1.6 times higher
how much more likely are people with schizophrenia likely to commit suicide?
9 times
what is recovery from schizophrenia?
being able to live a full and meaningful and satisfying life defined by each person in the presence or absence of symptoms
