Schizophrenia and Psychotic Disorders Flashcards
what is psychosis?
Psychosis is where you see or hear things that are not there (hallucinations) or believe things that are not true (delusions)
subset of symptoms seen in a number of mental disorders
what makes someone psychotic?
- Severe forms of mental illness
- Lack of insight
•Represents an inability to distinguish between symptoms of delusion, hallucination and disordered thinking from reality
what is the definition of psychosis?
“Psychosis represents an inability to distinguish between symptoms of hallucination, delusion and disordered thinking from reality.”
Clinical presentation of psychosis - you can get hallucinations, what are they?
•Have the full force and clarity of true perception
- located in external space
- no external stimulus
- not willed or controlled
- 5 special senses - auditory or visual, tactile, olfactory and gustatory (can affect any of the 5 senses)
Clinical presentation of psychosis - you can get delusional beliefs, what are they?
“ 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 - grandiose, paranoid (correctly persecutory), Hypochondriacal (convinced im ill, things wrong with me), self referential (everything refers to me)
May be more helpful not to consider psychosis as a major classification but consider the illnesses that may have psychotic symptoms - what are they?
- Schizophrenia
- Delirium
- Severe affective disorder:
- Depressive episode with psychotic symptoms
- Manic episode with psychotic symptoms
(Psychotic depression or mania with psychotic symptoms are both the most severe forms of each of its disease)
what is schizophrenia?
•A severe mental illness affecting:
- Thinking
- Emotion
- Behaviour
•Most common cause of psychosis
Schizophrenia is a mental health condition where you may see, hear or believe things that are not real.
what is the epidemiology of schizophrenia?
- Affects 1 per 100 population
- Males and females equally
- Age of onset 15-35 years earlier in men than women (mean of 28years vs 32 years)
what are the Symptoms of Schizophrenia?
Positive Symptoms:
- Hallucinations
- Delusions
- Disordered thinking
Negative Symptoms:
- Apathy
- Lack of interest
- Lack of emotions
Positive symptoms suggest a more acute illness
Negative symptoms suggest a poorer prognosis
how is a diagnosis of Schizophrenia (ICD 10) made?
For more than a month in the absence of organic or affective disorder:
At least one of the following:
- a) Alienation of thought as thought echo, thought insertion or withdrawal, or thought broadcasting
- b) Delusions of control, influence or passivity, clearly referred to body or limb movements actions, or sensations; delusional perception
- c) Hallucinatory voices giving a running commentary on the patient’s behaviour, or discussing him between themselves, or other types of hallucinatory voices coming from some part of the body
- d) Persistent delusions of other kinds that are culturally inappropriate and completely impossible (e.g. being able to control the weather)
And OR at least two of the following:
- e) Persistent hallucinations in any modality, when occurring every day for at least one month
- f) Neologisms (making up your own new terminology), breaks or interpolations in the train of thought, resulting in incoherence or irrelevant speech
- g) Catatonic behaviour, such as excitement, posturing or waxy flexibility, negativism, mutism and stupor
- h) “Negative” symptoms such as marked apathy, paucity of speech, and blunting or incongruity of emotional responses
what are the types of schizophrenia?
Further subdivided
Most common is paranoid schizophrenia
what is the Aetiology of Psychosis?
Considerations:
- Biological factors
- Psychological factors
- Social factors
- Evolutionary Theories
Each of the above can be considered as:
- Possible predisposing factor (puts you at risk of)
- Precipitating factor (makes it happen now)
- Perpetuating factor (keeps it going)
is there biological factors involved in schizophrenia?
- 50% concordance in MZ twins
- Roughly 10% risk if one parent affected; 40% if two parents; 10% on sibling; (1)10% for DZ twins). Also shown in adoption studies that children of schizophrenic parents adopted by those with out the illness maintain risk. Children without schizophrenic parents adopted by schizophrenic parents are at no increased risk.
what Biological factors may be involved in schizophrenia?
Neurochemistry:
- “Dopamine hypothesis” – increased level of dopamine in the brain (which causes these symptoms)
- Revised dopamine hypothesis – mesolimbic hyperdopaminergia and mesocortical hypodopaminergia
- Glutamate
- GABA
- Noradrenaline
- Serotoninergic transmission (serotonin)
Too much dopamine in the mesolimbic areas tends to cause more positive symptoms
And not enough dopamine in the mesocortical areas negative symptoms
All of these neurotransmitters are involved, probable that feedback loops influence that
what are some Social and Psychosocial Factors that ar einvolved in schizophrenia?
- Occupation and social class but be aware of “drift hypothesis” (As you become unwell you drift down the social classes)
- Migration
- Social Isolation
- Life Events as Precipitants
- Cultural factors NOT IMPLICATED
what is the management of schizophrenia? (SIGN)
Provision of information – explain diagnosis
Treatment as early as possible
Holistic approach to management is very helpful
Good evidence for family therapy and CBT
Specific guidelines for women that are pregnant
More facets to the treatment of schizophrenia than just prescribing
