Schizophrenia and Psychotic Disorders Flashcards

1
Q

What is psychosis?

A

Severe forms of mental illness
Lack of insight
Inability to distinguish between symptoms of delusion, hallucination and disordered thinking from reality

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2
Q

What is the clinical presentation of psychosis?

A

Hallucinations - full clarity with no external stimulus
Delusional beliefs
5 senses

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3
Q

What is a delusion?

A

Unshakeable idea or belief which doesn’t match the person’s social and cultural background; it is held with EXTRAORDINARY conviction

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4
Q

Give 2 examples of delusions?

A

Paranoid (persecutory)
Grandiose
Hypochondriacal
Self referential

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5
Q

What psychiatric conditions may present with psychotic symptoms?

A

Schizophrenia
Delirium
Severe affective disorder

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6
Q

What is schizophrenia?

A

Mental illness affecting thinking, emotion and behaviour

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7
Q

How common is schizophrenia?

A

1:100
M=F
15-35y/o

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8
Q

How does schizophrenia present?

A
Positive symptoms:
- Hallucinations
- Delusions
- Disordered thinking
Negative symptoms:
- Apathy
- Lack of interest, emotions
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9
Q

How is schizophrenia diagnosed?

A
>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
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10
Q

What is alienation of thought in reference to schizophrenia?

A
Thought echo
Insertions
Withdrawal 
Blocking
Broadcasting (thoughts not in their own control)
Knight's Move
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11
Q

What is passivity in reference to schizophrenia?

A

The belief that something else is controlling ones actions/sensations

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12
Q

What are hallucinations in reference to schizophrenia?

A

Voices giving running commentary

Discussing patient

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13
Q

What are persistent delusions in reference to schizophrenia?

A

Delusions that are culturally inappropriate or completely impossible

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14
Q

What are persistent hallucinations in reference to schizophrenia?

A

Any modality

Every day for at least 1 month

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15
Q

What are neologisms in reference to schizophrenia?

A

Breaks/interpolations in train of thought leading to incoherent speech

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16
Q

What is catatonic behaviour in reference to schizophrenia?

A
Excitement
Posturing
Waxy flexibility
Negativism
Mutism
Stupor
17
Q

What are negative symptoms in reference to schizophrenia?

A

Apathy
Paucity of speech
Blunting/incongruity of emotional responses

18
Q

What are the causes of psychosis?

A

Factors among:

  • Biological
  • Psychological
  • Social
  • Evolutionary theories

(could be predisposing, precipitating or perpetuating)

19
Q

What are the biological factors of schizophrenia?

A
Genetics (Twin studies, neuregulin, dysbinding, Di George Syndrome)
Neurochemistry (Glutamate, Gaba)
Obstetric complications
Maternal Flu
Malnutrition
Winter birth
Substance misuse
20
Q

What are the social/psychosocial factors of schizophrenia?

A

Occupation and social class
Migration
Social isolation
Life events

21
Q

What is the differential diagnosis of schizophrenia?

A

Delirium
Acute organic brain syndrome
Affective psychoses

22
Q

How does delirium/acute organic brain syndrome psychoses differ from schizophrenia?

A
Caused by organic disease 
Prominent visual hallucinations/illusions
Terror effect
Persecutory delusions
Worse at night - fluctuates
23
Q

How does a Depressive episode with psychosic symptoms differ from schizophrenia?

A

Delusions of guilt, worthlessness, persecution

Derogatory auditory hallucinations

24
Q

How does a Manic episode with psychosic symptoms differ from schizophrenia?

A

Delusions of grandeur, special powers
Messianic roles
Overactivity, irritability

25
What therapy is indicated in treatment resistant schizophrenia with aggression/hostility?
Clozapine
26
How is schizophrenia managed?
Early intervention Assertive community treatment Antipsychotics Psychotherapy
27
How are psychotherapies used for schizophrenia?
Psychosis - CBT Cognitive remediations Family intervention Social skills training
28
How is a Schizophrenia "recovery" diagnosed?
Being able to live a meaningful and satisfying life, with or without symptoms
29
What is the prognosis of schizoophrenia?
80% after first episode | Up to 50% have moderate recovery
30
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 ```
31
What are the poor prognostic factors for schizophrenia?
Slow, insidious onset Severe negative symptoms Systemic disease Starting in childhood
32
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