Schizophrenia and Psychotic Illness Flashcards
Psychosis
This can be used to refer to a lack of insight. It represents an inability to distinguish between symptoms of delusion, hallucination and disordered thinking from reality
Hallucinations
These have the full force and clarity of real perception. They are located in external space, but there is no external stimulus present. They can be auditory or visual, tactile (physical contact with an imaginary object), olfactory and gustatory
Delusional Beliefs
An unshakeable idea or belief which is out of keeping with the persons social and cultural background; it is help with extraordinary conviction
Grandiose Delusions
The delusion that one possess particular qualities that make them superior, genuis, wealth etc
Paranoid Delusions
Feeling that everyone is out to get them
Hypochondriacal delusions
Feeling that they are ill or suffer from a serious medical condition
Self referential Delusions
Self-reference becomes paranoid delusion when one persists in believing oneself to be the target of hostile actions or insinuations, perpetrated by some enemy or band of enemies, when this is actually not the case.
Illnesses that have psychotic symptoms
Schizophrenia, delirium, severe affective disorder
Epidemiology of Schizophrenia
Affects 1 per 100 population
Males and females equally
Age of onset 15-35 years
Positive symptoms of schizophrenia
Hallucinations
Delusions
Disordered thinking
Negative Symptoms of Schizophrenia
Apathy
Lack of interest
Lack of emotions
Diagnostic Criteria of Schizophrenia
For more than a month in 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. beingable 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, 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.
Paranoid Schizophrenia
This is the most common in which delusions and auditory hallucinations are present
Catatonic Schizophrenia
Psychomotor disturbances are prominent, often alternating between motor immobility (stupor) and excessive activity, ridgidity, posturing (maintaining strange postures), echolalia (copying speech) and echopraxia (copying behaviours may occur.
Hebephrenic Schizophrenia
Behaviour is irresponsible and unpredictable. Mood inappropriate and affect incongruous, perhaps with giggling, mannerisms and pranks.
Residual Schizophrenia
There is a history of one of the types of schizophrenia but in the current illness negaitve and often cognitive symptoms predominate
Simple schizophrenia
Negative symptoms with out preceding overt psychotic symptoms
Biological Factors implemented in Schizophrenia
Cf Acknowledged heritability from twin/family studies Neuregulin Dysbindin Di George Syndrome Obstetric complications Maternal influenza Malnutrition and famine Winter birth Substance misuse
Jungs Concept of Collective Unconcious
“ a storehouse of latent memory traces from man’s ancestral past. These typical symbols of myth, fable and fairy stories are not accessible other than through altered consciousness, dreams or perhaps psychosis.”
Conrad aetiology of psychosis
a state of fear
the delusional idea appears
an effort to make sense of the experience by altering one’s view of the world
final breakdown, as thought disorder and behavioural symptoms emerge
Social and Psychosocial Factors in the development of schizophrenia
Occupation and social class, migration, social isolation, life events
Delirium or Acute Organic Brain Syndrome
Consequent upon brain or systemic disease
Prominent visual experience, hallucinations and illusions
Affect of terror
Delusions are persecutory and evanescent
Fluctuating, worse at night
Depressive Episode with Psychotic Symptoms
Delusions of guilt, worthlessness and persecution
Derogatory auditory hallucinations
Main Episode with Psychotic Symptoms
Delusions of grandeur; special powers or messianic roles. There will be gross overactivity, irritabiluty and behavioural disturbance.
Prognosis after first episode of schizophrenia
80% recovery
Good prognostic factors of schizophrenia
Absence of family history Good premorbid function - stable personality, stable relationships Clear precipitant Acute onset Mood disturbance Prompt treatment Maintenance of initiative, motivation
Poor prognostic factors of schizophrenia
Slow, insidious onset and prominent negative symptoms are associated with a worse outcome.
Mortality is 1.6 times higher than the general population.
Shorter life expectancy is linked to cardiovascular disease, respiratory disease and cancer.
Suicide risk is 9 times higher.
Death from violent incidents is twice as high.
36% of patients have a substance misuse problem and there are high rates of cigarette smoking.
Poorer if starts in childhood
