Schizophrenia and Psychotic Disorders Flashcards
What is psychosis?
Inability to disinguish between symptoms of delusion, hallucination and disordered thinking from reality
Involves a lack of insight
What are the characteristics of hallucinations that may be suffered by a patient who is psychotic?
- Have the full force and clarity of true perception
- Located in external space
- No external stimulus
- Not willed or controlled
- Can affect any of the 5 senses
Describe the characteristics of the delusions that a psychotic patient may suffer from
- Unshakeable ideas or belief
- Out of keeping with the persons social or cultural background
- Held with extraordinary conviction
What are some examples of types of delusions psychotic patients may suffer from?
- Grandiose
- Paranoid (persecutory, “they’re all out to get me”
- Hypochodriacal (I’m sick etc.)
- Self referential (everything refers to me)
What are the main conditions associated with psychotic symptoms?
Schizophrenia
Delerium
Severe affective disorders (depression / mania with psychosis)
How prevalent is schizophrenia? When does it tend to affect people?
1 in 100 of population has it
Usually develops between 15-35 years of age
Affects men and women equally
What is schizophrenia?
Severe mental illness affecting the way you think, your emotions and your behaviour
What are the main symptoms of schizophrenia?
Hallucinations
Delusions
Disordered thinking
Apathy
Lack of interest
Lack of emotions
What is the diagnostic criteria for schizophrenia?
Having one of the following for more than a month:
- Alienation of thought
- Delusions of control, influence or passivity
- Hallucinatory voices
- Persistent delusions that are culturally inapporpriate and impossible
OR having at least two of the minor diagnostic symptoms
What is meant by “alienation of thought” that is experienced by schizophrenic patients?
They are experiencing:
- a thought echo
- someone inserting foreign thoughts into their mind
- someone withdrawing their thoughts from their mind
- their thoughts being broadcasted elsewhere
What is meant by “delusions of control, influence or passivity” that is experienced by schizophrenic patients?
- Their body is being controlled from elsewhere
- They are feeling things that aren’t there
- They are being influenced by things that aren’t there
What is meant by “hallucinatory voices” that are experienced by schizophrenic patients?
Voices are heard that:
- Give a running commentary on patients behaviour
- Discuss the patient amongst themselves
- Are speaking to them
What are the minor diagnostic symptoms that are used to diagnose schizophrenia?
Persistent hallucinations in any modality
Neologisms (making up words), breaks or interpolations in train of thought
Catatonic behaviour (abnormal movements, posturing, stupor)
Negative symptoms (apathy, lack of interest, lack of emotions)
Approximately how heritable is schizophrenia?
If one parent is schizo 10% risk for kid
40% if both parents
50% for monozygotic twins
10% for dizygotic twins
What is the revised dopamine hypothesis with regards to schizophrenia?
Mesolimbic hyperdopaminergia - too much dopamine in mesolimbic areas causes more positive symptoms
Mesocortical hypodopaminergia - too little dopamine in mesocortical areas seems to cause more negative symptoms
*there is also involvement of glutamate, GABA, noradrenaline and serotoninergic transmission
What are some neurological abnormalities that can be seen in schizophrenic patients?
Reduced brain volume of around 3% Ventricular enlargement of around 25% Cytoarchitectural abnormalities Reduced Frontal lobe performance Eye tracking abnormalities Soft neurological signs EEG abnormalities
What are some other factors that may precipitate schizophrenia?
Obstetric complications Maternal influenza Malnutrition and famine Winter birth Substance misuse
What are some social factors that may act as precipitants of schizophrenia?
Occupation and social class
Migration (higher proportion in migrant populations)
Social isolation
Significant life events
What does it mean when a psychotic episode occurs with an affective disorder
That the affective disorder is instantly described as severe
How does the type of affective episode experienced alongside psychosis tend to influence the nature of the psychosis?
Depressive episode - generally causes delusions of guilt, wothlessness and hopelessness. Often derogatory auditory hallucinations
Manic episode - delusions of grandeur or messianic roles. Person may become grossly overactive
What is schizoaffective disorder?
Mixture of schizophrenic and affective features
schizo + depression / mania
How is schizophrenia treated?
Antipsychotic
Cognitive behavioural therapy
Psycho education and support
Clozapine if treatment resistant (no result after 2+ antipsychotics)
Do people tend to recover from schizophrenia?
20% never have a second episode
50% relapsing remitting symptoms
30% ongoing symptoms
What are some factors that indicate good prognosis in the treatment of schizophrenic patients?
Absence of family history Good premorbid function (personality / relationships) Clear precipitant Acute onset Prompt treatment Maintenance of initiative / motivation
