Schizophrenia and psychotic disorders Flashcards
Define psychosis.
Represents an inability to distinguish between symptoms of delusion, hallucination and disordered thinking from reality.
Define hallucinations.
Perception without stimulation.
Define a delusion.
A delusion is an unshakeable idea or belief which is out of keeping with the person’s social and cultural background; it is held with extraordinary conviction.
Examples of delusional beliefs
- grandiose
- paranoid (correctly persecutory)
- hypochondriacal
- self referential
Illness that may have psychotic symptoms.
- Schizophrenia
- Delirium
- Severe affective disorder
- Depressive episode with psychotic symptoms
- Manic episode with psychotic symptoms
Epidemiology of schizophrenia.
- Affects 1 per 100 population
- Males and females equally
- Age of onset 15-35 years
Symptoms of Schizophrenia
Positive Symptoms
- Hallucinations
- Delusions
- Disordered thinking
Negative Symptoms
- Apathy
- Lack of interest
- Lack of emotions
Schizophrenia ICD10 criteria
For at least one month:
- one of the following symptoms
- alienation of thought as thought echo, thought insertion or withdrawal, or thought broadcasting
- passivity
- auditory hallucinations
- persistent delusions of other kinds that are culturally inappropriate and completely impossible
- or at least two of the following symtoms:
- persistent hallucinations in any modality, when occurring every day for at least one month
- neologisms, breaks in the train of thought, resulting in incoherent or irrelevant speech
- catatonic behaviour
- “negative symptoms”
Give examples of auditory hallucinations.
- Third person hallucinations
- Voices talking about the person in a derogatory way
- Command hallucinations
- can be more dangerous, voices can be hard to resist, especially in severe psychosis
Causes of schizophrenia (Theories)
- The dopamine hypothesis - dopaminergic overactivity
- Serotonergic overactivity - due to the superiority of clozapine in treating treatment resistant schizophrenia
- Genetics - higher incidence in those with a family history. Association with the DISC1 gene (Disrupted In SChizophrenia)
- Drug abuse - particularly cannabis use at an early age
- Group A personality disorder
- Illness during pregnancy
- Winter births
- Adverse life events
Treatment for schizophrenia
Psychological therapy
- CBT
- Familiy intervention
- Art therapy
- Liase with social worker regarding housing difficulties and employment
Pharmacological therapy
- Antipsychotics
The Scottish Recovery Network definition of recovery
Being able to live a meaningful and satisfying life, as defined by each person, in the presence or absence of symptoms.
Schizophrenia good prognostic factors
- Absence of family history
- Good premorbid function - stable personality, stable relationships
- Clear precipitant
- Acute onset
- Mood disturbance
- Prompt treatment
Schizoprenia poor prognostic factors
- Slow, insidious onset
- Prominent negative symptoms are associated with a worse outcome
- Begins in childhood
