Schizophrenia and Psychotic Disorders Flashcards
What is psychosis?
Severe forms of mental illness
Lack of insight
Inability to distinguish between symptoms of delusion, hallucination and disordered thinking from reality
What is the clinical presentation of psychosis?
Hallucinations - full clarity with no external stimulus
Delusional beliefs
5 senses
What is a delusion?
Unshakeable idea or belief which doesn’t match the person’s social and cultural background; it is held with EXTRAORDINARY conviction
Give 2 examples of delusions?
Paranoid (persecutory)
Grandiose
Hypochondriacal
Self referential
What psychiatric conditions may present with psychotic symptoms?
Schizophrenia
Delirium
Severe affective disorder
What is schizophrenia?
Mental illness affecting thinking, emotion and behaviour
How common is schizophrenia?
1:100
M=F
15-35y/o
How does schizophrenia present?
Positive symptoms: - Hallucinations - Delusions - Disordered thinking Negative symptoms: - Apathy - Lack of interest, emotions
How is schizophrenia diagnosed?
>1 month, in absence of organic/affective disease: At least 1 of: a) Alienation of thought b) Delusions of control or passivity c) Hallucinations d) Persistent delusions and/or 2 of: e) Persistent hallucinations f) Neologisms g) Catatonic behaviour h) Negative symptoms
What is alienation of thought in reference to schizophrenia?
Thought echo Insertions Withdrawal Blocking Broadcasting (thoughts not in their own control) Knight's Move
What is passivity in reference to schizophrenia?
The belief that something else is controlling ones actions/sensations
What are hallucinations in reference to schizophrenia?
Voices giving running commentary
Discussing patient
What are persistent delusions in reference to schizophrenia?
Delusions that are culturally inappropriate or completely impossible
What are persistent hallucinations in reference to schizophrenia?
Any modality
Every day for at least 1 month
What are neologisms in reference to schizophrenia?
Breaks/interpolations in train of thought leading to incoherent speech
What is catatonic behaviour in reference to schizophrenia?
Excitement Posturing Waxy flexibility Negativism Mutism Stupor
What are negative symptoms in reference to schizophrenia?
Apathy
Paucity of speech
Blunting/incongruity of emotional responses
What are the causes of psychosis?
Factors among:
- Biological
- Psychological
- Social
- Evolutionary theories
(could be predisposing, precipitating or perpetuating)
What are the biological factors of schizophrenia?
Genetics (Twin studies, neuregulin, dysbinding, Di George Syndrome) Neurochemistry (Glutamate, Gaba) Obstetric complications Maternal Flu Malnutrition Winter birth Substance misuse
What are the social/psychosocial factors of schizophrenia?
Occupation and social class
Migration
Social isolation
Life events
What is the differential diagnosis of schizophrenia?
Delirium
Acute organic brain syndrome
Affective psychoses
How does delirium/acute organic brain syndrome psychoses differ from schizophrenia?
Caused by organic disease Prominent visual hallucinations/illusions Terror effect Persecutory delusions Worse at night - fluctuates
How does a Depressive episode with psychosic symptoms differ from schizophrenia?
Delusions of guilt, worthlessness, persecution
Derogatory auditory hallucinations
How does a Manic episode with psychosic symptoms differ from schizophrenia?
Delusions of grandeur, special powers
Messianic roles
Overactivity, irritability
What therapy is indicated in treatment resistant schizophrenia with aggression/hostility?
Clozapine
How is schizophrenia managed?
Early intervention
Assertive community treatment
Antipsychotics
Psychotherapy
How are psychotherapies used for schizophrenia?
Psychosis - CBT
Cognitive remediations
Family intervention
Social skills training
How is a Schizophrenia “recovery” diagnosed?
Being able to live a meaningful and satisfying life, with or without symptoms
What is the prognosis of schizoophrenia?
80% after first episode
Up to 50% have moderate recovery
What are the good prognostic factors for schizophrenia?
Absense of +ve FH Good premorbid function Clear precipitant Acute onset Mood disturbance Prompt treatment Maintenance of initiative
What are the poor prognostic factors for schizophrenia?
Slow, insidious onset
Severe negative symptoms
Systemic disease
Starting in childhood
Outline Conrad’s stages of development of delusions?
State of fear
Delusional idea appears
Make sense of experience by altering view of the world
Breakdown leading to disorder
