schizophrenia and psychotic disorders Flashcards
psychosis
represents an inability to distinguish between symptoms of hallucination, delusion and disordered thinking from reality
clinical presentation of psychosis
hallucinations
delusional beliefs
hallucinations
have full force and clarity of true perception
no external stimulus, not willed or controlled
5 special senses: auditory or visual, tactile, olfactory and gustatory
delusional beliefs
unshakable idea or belief which is out of keeping with the person’s social and cultural background: it is held with extraordrinary conviction
ex. paranoid, hypochondriacal, self referential, grandiosity
which illnesses may have psychotic symptoms
schizophrenia
delirium
severe affective disorder
schizophrenia
a severe mental illness affecting thinking, emotion, behaviour
schizophrenia: positive symptoms
hallucinations
delusions
disordered thinking
schizophrenia: negative symptoms
apathy
lack of interest
lack of emotions
schizophrenia: ICD 10
for more that a month in the absence of organic or affective disorder:
at least one of the following
auditory hallucinations
thought disorder
delusions control - passivity
delusional perceptions
schizophrenia: ICD 10
or at least 2 of the following
e. persistent hallucinations of any modality, when occurig every day for 1month+
f. neologisms, breaks or interpolations in the train of throught
g. catatonic behaviour
h. negative symptoms
schizophrenia: biological factors - genetics
genetics - high heritability
- neuregulin (chromosome 8p)
- dysbindin (chromosome 6p)
- Di George Syndrome
schizophrenia: biological factors - neurochemistry
dopamine hypothesis revised dopamine hypothesis glutamate GABA noradrenaline serotonin
schizophrenia: neurological abnormalities
reduce brain volume 3% ventricular enlargement 25% (but overlap with normal) cytoarchitectural abnormalities reduced frontal lobe performance eye tracking abnormalities soft neurological signs EEG abnormalities
other biological factors implicated in schizophrenia
obstetric complications maternal influenza malnutrition and famine winter birth substance misuse
schizophrenia: social and psychosocial factors
occupation and social class (but be aware of ‘drift hypothesis’)
migration
social isolation
life events as precipitants
delirium or acute organic brain syndrome
consequent upon brain or systemic disease
prominent visual experience, hallucinations + illusions
affect of terror
delusions are persecutory and evanescent
fluctuating, worse at night
affective psychoses
depressive episode with psychotic symptoms
manic episode with psychotic syndromes
schizoaffective disorder
mix of affective and schizophrenia like features at the same time
management of schizophrenia
psychological therapies: CBT
anti-psychotic drugs
prognosis and recovery in schizophrenia
recovery is not simply reduction/cessation of symptoms
being able to live a meaningful and satisfying life as defined by each person
80% recover after 1st episode
schizophrenia: good prognostic factors
absence of family history good premorbid function: stable personality + relationships clear precipitant acute onset mood disturbance prompt treatment maintenance of initiative, motivation
schizophrenia: poor prognostic factors
slow, insidious onset and prominent -ive symptoms
earlier illness starts
what about cognition in schizophrenia
chronic schizophrenic patients show poorer cognition than first onset patients
no decline in cognition in follow-up studies of first onset psychosis
dopamine hypothesis
too much dopamine in brsin causes symptoms
revised dopamine hypothesis
too much dopamine in mesolimbic pathways leads to positive symptoms
too little dopamine in mesocortical pathway leads to negative symptoms
hebephrenic schizophrenia
disorganised
catatonic szhizophrenia
unusual sudden movements
simple schizophrenia
mostly negative symptoms
paranoid schizophrenia
mostly positive symptoms
