Schizophrenia and Psychotic Disorders Flashcards
What is Schizophrenia?
Severe mental illness characterised by fundamental distortions of thinking, perception, emotion and behaviour
Describe the pathphysiology of schizophrenia
Unknown, dopamine hypothesis
What gender does schizophrenia effect more?
M=F although males tend to present earlier
What is the typical age of onset of schizophrenia?
15-35 years
What are the causes of schizophrenia?
Genetics/FH
Adverse/traumatic life event
Obstetric complications
Maternal influenza
Malnutrition and famine
Winter birth
Cannabis use, can’t cause schizophrenia but can modify the course of established illness
What are the good prognostic factors for schizophrenia?
Absence of family members
Good premorbid function: Stable personality and relationships
Clear precipitant
Acute onset
Late onset
Mood disturbance
Prompt treatment
Maintenance of initiative and motivation
What are the poor prognostic factors for schizophrenia?
Slow, insidious onset
Childhood onset
Prominent negative symptoms
FH
Prodromal phase of social withdrawal
Low IQ
Lack of obvious precipitant
What are the main symptoms of schizophrenia, according to ICD-10?
At least one of the following, for more than a month:
Alienation of thought
Delusions of control, influence or passivity
Hallucinatory voices
Persistent delusions
What are the types of alienation of thought?
Thought echo: Hears own thoughts out loud
Insertion: Feels someone else put thoughts in their head
Withdrawal: Feels thoughts are being stolen from head
Broadcasting: Feels that other people can hear their thoughts
What are the secondary symptoms of schizophrenia, according to ICD-10?
At least two of the following, for more than a month:
Persistent hallucinations
Speech symptoms, such as neologisms, alogia, incoherent or irrelevant speech
Catatonic behaviour
Negative symptoms
Give examples of negative symptoms
Marked apathy
Anhedonia
Poverty of speech/Alogia
Blunting
Withdrawal
Incongruity of emotional responses
What is incongruity?
There is an unpredictable and contradictory emotional response to events
Give examples of catatonic behaviour
Excitement
Posturing or waxy flexibility
Negativism
Mutism
Stupor
What are Schnyder’s first rank symptoms?
Delusions of thought alienation: Withdrawal, insertion, broadcasting
Auditory third person hallucinations
Passivity Phenomena: Delusions of control
Somatic passivity: Physical sensations
Delusional perception
How is schizophrenia managed?
Anti-psychotics: 6-8 week trial of each drug
Psychological interventions
Early intervention services/social services
Perinatal care
What class of anti-psychotics are first line in schizophrenia management?
Atypical
Give examples of atypical anti-psychotics
Olanzapine
Quetiapine
What anti-psychotic is given to treatment resistant schizophrenia?
Clozapine
What psychological interventions are used in schizophrenia management?
Social skills training
CBT
Cognitive remediation
What issues to early intervention services address in schizophrenia management?
Address substance abuse
Social skills training
Employment
Housing
Why is perinatal care essential in schizophrenia management?
Anti-psychotics are teratogenic
High risk of relapse in post-partum
What is psychosis?
Represents an inability to distinguish between symptoms of hallucination, delusion and disordered thinking from reality (lack of insight)
What 4 factors define a hallucination?
Have the full force and clarity of true perception, whereas illusions you are fully aware it is not real
Located in external space
No external stimulus, whereas illusions there is external stimuli making it look like something it is not
Not willed or controlled
What are second person hallucinations?
1 person is speaking to you, more likely with depression or personality disorder
What are third person hallucinations?
2 people speaking to each other, commentary, more likely in psychosis
What are pseudohallucinations?
Recognised by the patient as not real
What are hypnopompic hallucinations?
Occur as the individual awakes
What are hypnogogic hallucinations?
Occur when an individual is falling asleep
What are reflex hallucinations?
Occurs when a true sensory stimulus causes a hallucination in another sensory modality
What are Lilliputian hallucinations?
Visual hallucinations associated with micropsia, often occur in patients suffering from delirium
What are Xanthopsia hallucinations?
Describes visual perceptions that are predominantly yellow
What are illusions?
a misinterpretation of real/external stimulus
What is a delusion?
Unshakeable idea or belief which is out of keeping with the person’s social and cultural background, it is held with extraordinary conviction
What are grandiose delusions?
Expansive delusions where the person believes they are related to a higher figure or of extreme importance
What are Erotomaniac delusions?
Delusions of love
What are Nihilistic delusions?
Exaggerated form of negative thinking in which individual thinks they are dying or the world is ending
Give differential diagnoses of schizophrenia
Anaemia
Sarcoidosis
Cushing’s
Stroke
Epilepsy
How does FH affect scizophrenia epidemiology?
Although only 1 in 100 people get schizophrenia, about 1 in 10 people with schizophrenia have a parent with the illness
If one identical twin has schizophrenia, the other has a 50:50 chance of having it
What drugs can cause psychosis?
Corticosteroids
What is word salad?
Disorganised speech, sentences that do not make sense
What is alogia?
Little information conveyed by speech
What is tangentiality?
Wandering from a topic without returning to it
Can’t keep to a thought
What is Circumstantiality?
The inability to answer a question without giving excessive, unnecessary detail
However, this differs from tangentiality in that the person does eventually return the original point
What are neoligisms?
New word formations, which might include the combining of two words
What are clang associations?
When ideas are related to each other only by the fact they sound similar or rhyme
What is knight’s move thinking/derailment?
Severe type of loosening of associations, where there are unexpected and illogical leaps from one idea to another
What is perseveration?
The repetition of ideas or words despite an attempt to change the topic.
What is echolalia?
The repetition of someone else’s speech, including the question that was asked
What is somatisation disorder?
Multiple physical symptoms present for at least 2 years, in which patient refuses to accept reassurance or negative test results
What is conversion disorder?
Typically involves loss of motor or sensory function in which the patient doesn’t consciously feign the symptoms (factitious disorder) or seek material gain (malingering)
What is dissociative disorder?
Process of ‘separating off’ certain memories from normal consciousness
What is factitious disorder?
Also known as Munchausen’s syndrome, is the intentional production of physical or psychological symptoms
What is malingering?
Fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain
