Schizophrenia and psychotic disorders Flashcards
How is psychosis defined?
Inability to distinguish between symptoms of delusion, hallucination, and disordered thinking from reality
What is the eymology of psychosis?
Disease of the psyche
What is a hallucination?
Located in the external space without an external stimulus with the full force and clarity of real perception - can be all 5 senses
What is a delusional belief?
Unshakable idea or belief which is out of keeping with the person’s social and cultural background - held with extreme conviction
What are the 4 types of delusion?
Grandiose
Paranoid
Hypochondrial
Self referential
What illnesses have psychotic symptoms?
Schizophrenia
Delirium
Severe affective disorders
What are effects of schizophrenia?
Severe metal illness affecting thinking, emotion, and behaviour and is the most common cause of psychosis
What are symptoms positively prognostic of schizophrenia?
Hallucinations
Delusions
Disordered thinking
What are symptoms negatively prognostic of schizophrenia?
Apathy
Lack of interest
Lack of emotion
How is schizophrenia diagnosed?
For more than a month in the absence of organic or affective disorder, at least one of the following -
Alienation of thoughts as echo, thought insertion or withdrawal, or thought broadcasting
Delusions of control, influence, or passivity,
Hallucinatory voices giving a running commentary on the patient’s behaviour or speaking between themselves
Persistent delusions that are culturally inappropriate or impossible
And OR at least 2 of -
Persistent hallucinations in any modality
Breaks in the train of thought
Catatonic behaviours
What are the 3 factors required for psychosis?
Possible predisposing factor
Precipitating factor
Perpetuating factor
What are different areas that could cause psychosis?
Biological factors
Psychiatric factors
Social factors
What are biological factors for Psychosis?
Genetics Neurochemistry - Dopamine, glutamate, GABA, serotoninergic transmission Obstetric complications Maternal influenza Malnutrition and famine Winter birth Substance misuse
What are Conrad’s 4 stages in development of delusions?
State of fear
Delusional idea appears
Effort to make sense of the experience by altering view of the world
Final breakdown as thought and behavioural disorders emerge
Why is it thought that migrants are more at risk of psychosis?
Moving from one culture to a completely different one and trying to make sense of it
What are social factors in developing psychosis?
Occupation/social class
Migration
Social isolation
Life events precipitating
How is schizophrenia managed?
Earlier intervention is better
Give the right antipsychotic - clozapine works well against treatment resistant schizophrenia
CBT
Family therapy
What are differentials for psychosis?
Delirium - Prominent visual experience, affect of terror, Delusions are persecutory
Depressive episode with psychotic symptoms
Manic episode with psychotic symptoms
How is recovery defined for schizophrenia?
Being able to live a meaningful and satisfying life as defined by each person, in the presence or absence of symptoms
What are good prognostic factors for schizophrenia?
Absence of family history Good premorbid function Clear precipitating factor Acute onset Mood disturbance Prompt treatment Maintenance of motivation
What are poor prognostic factors for schizophrenia?
Slow insidious onset and prominent negative symptoms
Mortality is 1.6 times higher than general population
Short life expectancy linked to resp/cvs disease
Suicide risk 9 times higher
Violent incident death twice as high
Poorer if childhood psychosis
Many substance misuse
