Schizophrenia and Psychotic disorders Flashcards
What makes someone psychotic?
inability to distinguish between symptoms of delusion, hallucination and disordered thinking from reality
Clinical presentation of psychosis - hallucinations
Have the full force and clarity of true perception
located in external space
no external stimulus
not willed or controlled
grandiose means?
over confident think highly of themselves - I can do anything - think anything - be anything
paranoid (correctly persecutory) means?
everyone is against me etc
hypochondriacal means?
there are things wrong with me
self referential means?
everything refers to me
what illnesses may have psychotic symptoms? (4)
- schizophernia
- delirium
- severe affective disorder (depressive episode with psychosis)
- manic episode with psychosis
Common positive symptoms of schizophrenia?
Hallucinations
Delusions
Disordered thinking
Common negative symptoms of schizophrenia?
Apathy
Lack of interest
Lack of emotions
ICD-10 of schizophrenia (For more than a month in the absence of organic or affective disorder) - need one of the following?
- Alienation of thought
- passivity
- Hallucinatory voices
- Persistent delusions (ones that are impossible)
Need at least 2 of what symptoms to get a diagnosis?
- Persistent hallucinations in any modality, when occurring every day for at least one month.
- Neologisms (new terminology), breaks or interpolations in the train of thought
- Catatonic behaviour, such as excitement, posturing or waxy flexibility, negativism, mutism and stupor
- “Negative” symptoms such as marked apathy, paucity of speech, and blunting or incongruity of emotional responses.
Most common schizophrenia?
paranoid
Biological factors - genetic risks
Genetics
- monozygotic twins (50%), di = 10%
1 parent = 10%
2 parents = 40%
specific genes in schizophrenia
Neuregulin (chromosome 8p)
Dysbindin (chromosome 6p)
Di George Syndrome (22Q)
Neurochemical factors causing schizophrenia (6)
- Dopamine hypothesis” – increased level of dopamine in the brain
- Revised dopamine hypothesis – mesolimbic hyperdopaminergia and mesocortical hypodopaminergia
- Glutamate
- GABA
- Noradrenaline
- Serotoninergic transmission
Positive symptoms are caused by?
too much dopamine in mesolimbic areas - positive symptoms
negative symptoms are caused by?
not enough dopamine in the mesocortical areas
Neurological abnormalities that can be found in schizophrenic patients? (7)
- Reduced brain volume 3%
- Ventricular enlargement 25% (but overlaps with normal)
- Cytoarchitectural abnormalities
- Reduced frontal lobe performance
- Eye tracking (saccadic)
abnormalities - Soft neurological signs
- EEG abnromalities
Obstetric complications that can lead to schizophrenia?
- Maternal influenza
- Malnutrition and famine
- Winter birth
- Substance misuse
Social and Psychosocial Factors
Occupation and social class but be aware of “drift hypothesis
- Migration
- Social Isolation
- Life Events as Precipitants
- Cultural factors NOT IMPLICATED
Differential diagnosis for psychotic illnesses - Delirium or Acute Organic Brain Syndrome (however caused)
- Consequent upon brain or systemic disease
- Prominent visual experience, hallucinations and illusions
- Affect of terror
- Delusions are persecutory and evanescent
- Fluctuating, worse at night
Differential diagnosis for psychotic illnesses - Depressive episode with psychotic symptoms
SEVERE
- Delusions of guilt, worthlessness and persecution
Derogatory auditory hallucinations
Differential diagnosis for psychotic illnesses - Manic episode with psychotic symptoms
- Delusions of grandeur; special powers or messianic roles
- Gross overactivity, irritability and behavioural disturbance: Manic excitement
Schizoaffective Disorder is?
A mix of affective and schizophrenia like features
