Schizophrenia: Clinical Aspects Flashcards
1
Q
Neurosis vs Psychosis
- Which of these fall under neurosis, which fall under psychosis?
- OCD
- Depressive disorder
- Anxiety disorder
- Schizophrenia
- Depressive psychosis
- Somatisation disorders
- Organic
- Adjustment disorder
- Bipolar disorders
A
-
Neurosis
- Anxiety disorder
- Depressive disorder
- OCD
- Adjustment disorders
- Somatisation disorders
-
Psychosis
- Organic
- Schizophrenia
- Bipolar disorders
- Depressive psychosis
2
Q
….: respond to antidepressant or SSRI vs ….: respond to antipsychotic medication
A
Neurosis: respond to antidepressant or SSRI vs Psychosis: respond to antipsychotic medication
3
Q
Neurosis: respond to … or … vs Psychosis: respond to … medication
A
Neurosis: respond to antidepressant or SSRI vs Psychosis: respond to antipsychotic medication
4
Q
What is Psychosis?
- An illness characterised by a loss of boundaries with … and loss of …, with primary features of …, …. and conceptual disorganisation.
- A psychotic episode is deemed to be 1 week duration of either of these symptoms at significant severity
- Often associated with some sort of … disturbance
A
- An illness characterised by a loss of boundaries with reality and loss of insight, with primary features of delusions, hallucinations and conceptual disorganisation.
- A psychotic episode is deemed to be 1 week duration of either of these symptoms at significant severity
- Often associated with some sort of behavioural disturbance
5
Q
What is Psychosis?
- An illness characterised by a loss of boundaries with reality and loss of insight, with primary features of delusions, hallucinations and conceptual ….
- A psychotic episode is deemed to be … … duration of either of these symptoms at significant severity
- Often associated with some sort of behavioural disturbance
A
- An illness characterised by a loss of boundaries with reality and loss of insight, with primary features of delusions, hallucinations and conceptual disorganisation.
- A psychotic episode is deemed to be 1 week duration of either of these symptoms at significant severity
- Often associated with some sort of behavioural disturbance
6
Q
What is a Delusion?
- … held firmly but on … grounds, not affected by … argument or evidence to the contrary, and … shared by someone of similar age, educational, cultural, religious or social background
- Types of delusion include: primary (Delusional perception), secondary, persecutory, -of reference, grandiose, -of guild, nihilistic, -of passivity etc.
A
- Belief held firmly but on inadequate grounds, not affected by rational argument or evidence to the contrary, and not shared by someone of similar age, educational, cultural, religious or social background
- Types of delusion include: primary (Delusional perception), secondary, persecutory, -of reference, grandiose, -of guild, nihilistic, -of passivity etc.
7
Q
What is a Delusion?
- Belief held … but on inadequate grounds, not affected by rational argument or … to the contrary, and not shared by someone of similar …, educational, cultural, … or … background
- Types of delusion include: primary (Delusional perception), secondary, persecutory, -of reference, grandiose, -of guild, nihilistic, -of passivity etc.
A
- Belief held firmly but on inadequate grounds, not affected by rational argument or evidence to the contrary, and not shared by someone of similar age, educational, cultural, religious or social background
- Types of delusion include: primary (Delusional perception), secondary, persecutory, -of reference, grandiose, -of guild, nihilistic, -of passivity etc.
8
Q
Types of delusion include: … (Delusional perception), secondary, …, -of reference, …, -of guilt, nihilistic, -of passivity etc.
A
Types of delusion include: primary (Delusional perception), secondary, persecutory, -of reference, grandiose, -of guilt, nihilistic, -of passivity etc.
9
Q
Types of delusion include: primary (… perception), …, persecutory, -of reference, grandiose, -of guilt, …, -of passivity etc.
A
Types of delusion include: primary (Delusional perception), secondary, persecutory, -of reference, grandiose, -of guilt, nihilistic, -of passivity etc.
10
Q
Grandiose Delusion - what is this?
A
Grandiose - mania or related mood, may think they are put on earth for a particular purpose
11
Q
… delusions occur when someone believes others are out to harm them despite evidence to the contrary.
A
Persecutory delusions occur when someone believes others are out to harm them despite evidence to the contrary.
12
Q
What is a Nihilistic delusion?
A
A delusion that nothing exists, or that a significant aspect of the self (such as one’s brain or the outside world) does not exist - associated with very low mood/psychotic depression
13
Q
What is a Delusion of passivity?
A
feel that you are under control of something externally - making you do things
14
Q
Delusion
- ?Due to error of … of …
- Pay attention to something you see - attribute with more value than someone who is healthy
- E.g. stones outside window - think stones are looking at you in strange way - if healthy, may think stones are weird but would dismiss these thoughts
A
- ?Due to error of salience of attribution
- Pay attention to something you see - attribute with more value than someone who is healthy
- E.g. stones outside window - think stones are looking at you in strange way - if healthy, may think stones are weird but would dismiss these thoughts
15
Q
Delusion
- ?Due to … of salience of attribution
- Pay attention to something you see - attribute with more … than someone who is healthy
- E.g. stones outside window - think stones are looking at you in strange way - if healthy, may think stones are weird but would dismiss these thoughts
A
- ?Due to error of salience of attribution
- Pay attention to something you see - attribute with more value than someone who is healthy
- E.g. stones outside window - think stones are looking at you in strange way - if healthy, may think stones are weird but would dismiss these thoughts
16
Q
Delusion content often has particular relevance, for example:
A
- Religious - persecution by devil
- Persecution by authority figure/govt
- Controlled by implant
- Responsibility for world tragedy
- Followed by seagulls
17
Q
A Hallucination is a perception experienced in the absence of ….
A
an external stimulus
18
Q
Define Hallucination
A
A perception experienced in the absence of an external stimulus
19
Q
Hallucination
- A … experienced in the absence of an external stimulus
- In any sensory modality but … commonest in psychosis
- ? Due to internal … attribution error
A
- A perception experienced in the absence of an external stimulus
- In any sensory modality but auditory commonest in psychosis
- ? Due to internal perception attribution error
20
Q
A hallucination can be in any sensory modality but auditory is commonest in …
A
psychosis
21
Q
This brain scan shows someone experiencing a …
A
hallucination
22
Q
Conceptual Disorganisation
- … processes are confused, disconnected or disorganized as demonstrated by what they say.
- This is something … and not … of by the individual.
- Also called Loosening of associations (of thought) or Knight’s move thought or Schizophrenic thought disorder or Disorder of form of thought or Formal thought disorder
A
- Thought processes are confused, disconnected or disorganized as demonstrated by what they say.
- This is something observed and not complained of by the individual.
- Also called Loosening of associations (of thought) or Knight’s move thought or Schizophrenic thought disorder or Disorder of form of thought or Formal thought disorder
23
Q
Conceptual Disorganisation
- Thought processes are confused, disconnected or disorganized as demonstrated by what they say.
- This is something observed and not complained of by the individual.
- Also called …. of associations (of thought) or Knight’s move thought or … thought disorder or Disorder of form of thought or Formal thought disorder
A
- Thought processes are confused, disconnected or disorganized as demonstrated by what they say.
- This is something observed and not complained of by the individual.
- Also called Loosening of associations (of thought) or Knight’s move thought or Schizophrenic thought disorder or Disorder of form of thought or Formal thought disorder
24
Q
Development of the entity of schizophrenia within ‘psychosis’
- Esquirol 1838 - Described course and prognosis of … and separated it from the diagnostic group of mood disturbances (melancholia) which had a better outcome.
- Melancholia - severe …/ deep …
A
- Esquirol 1838 - Described course and prognosis of insanity and separated it from the diagnostic group of mood disturbances (melancholia) which had a better outcome.
- Melancholia - severe depression/ deep sadness
25
Q
Development of the entity of schizophrenia within ‘psychosis’
- Kraepelin 1898 - Defined ‘dementia …’ with onset in adolescence of progressive, irreversible decline in mental function. Different forms:
- Hebephrenic - silly, giggly, odd ideas
- … - movement problems, stiff, still
- Paranoid - delusions
- Simplex - negative symptoms, detachment, inner world
- Distinguished … from manic depressive illness
A
- Kraepelin 1898 - Defined ‘dementia praecox’ with onset in adolescence of progressive, irreversible decline in mental function. Different forms:
- Hebephrenic - silly, giggly, odd ideas
- Catatonic - movement problems, stiff, still
- Paranoid - delusions
- Simplex - negative symptoms, detachment, inner world
- Distinguished schizophrenia from manic depressive illness
26
Q
Kraepelin 1898
- Defined ‘… praecox’ with onset in adolescence of progressive, irreversible decline in mental function.
- Different forms:
- … - silly, giggly, odd ideas
- Catatonic - movement problems, stiff, still
- Paranoid - delusions
- … - negative symptoms, detachment, inner world
- Distinguished schizophrenia from manic … illness
A
- Defined ‘dementia praecox’ with onset in adolescence of progressive, irreversible decline in mental function.
- Different forms:
- Hebephrenic - silly, giggly, odd ideas
- Catatonic - movement problems, stiff, still
- Paranoid - delusions
- Simplex - negative symptoms, detachment, inner world
- Distinguished schizophrenia from manic depressive illness
27
Q
Bleuler 1911
- Coined the term … ‘splitting of the mind’ - nothing to do with what we now know about psychosis - and described fundamental symptoms: abnormal associations, autism, abnormal affect, ambivalence
A
- Coined the term schizophrenia ‘splitting of the mind’ - nothing to do with what we now know about psychosis - and described fundamental symptoms: abnormal associations, autism, abnormal affect, ambivalence
28
Q
Schneider 1946
- Defined … … Symptoms pathognomic of schizophrenia
A
- Defined First Rank Symptoms pathognomic of schizophrenia
29
Q
… - (of a sign or symptom) specifically characteristic or indicative of a particular disease or condition.
A
Pathognomic - (of a sign or symptom) specifically characteristic or indicative of a particular disease or condition.
61
Q
Prognosis of Schizophrenia
- … outcome in 3rd world and with introduction of … … Services
- …% complete recovery and off treatment, demonstrated by line a
- 25% have persistent symptoms after first episode or what was originally described as ‘dementia praecox’ Line B
- >…% have a relapsing remitting illness with some functional impairment between episodes. Line C
- Recurrent episodes may lead to progressive deterioration
- Functional recovery lags behind symptom recovery
- Suicide in 5-10% particularly men within 3 years of onset
A
- Better outcome in 3rd world and with introduction of Early Intervention Services
- 20% complete recovery and off treatment, demonstrated by line a
- 25% have persistent symptoms after first episode or what was originally described as ‘dementia praecox’ Line B
- >50% have a relapsing remitting illness with some functional impairment between episodes. Line C
- Recurrent episodes may lead to progressive deterioration
- Functional recovery lags behind symptom recovery
- Suicide in 5-10% particularly men within 3 years of onset
62
Q
Prognosis of Schizophrenia
- Better outcome in 3rd world and with introduction of Early Intervention Services
- 20% complete recovery and off treatment, demonstrated by line a
- 25% have persistent symptoms after first episode or what was originally described as ‘dementia praecox’ Line B
- >50% have a relapsing remitting illness with some functional impairment between episodes. Line C
- … episodes may lead to progressive deterioration
- … recovery lags behind symptom recovery
- Suicide in 5-10% particularly … within 3 years of onset
A
- Better outcome in 3rd world and with introduction of Early Intervention Services
- 20% complete recovery and off treatment, demonstrated by line a
- 25% have persistent symptoms after first episode or what was originally described as ‘dementia praecox’ Line B
- >50% have a relapsing remitting illness with some functional impairment between episodes. Line C
- Recurrent episodes may lead to progressive deterioration
- Functional recovery lags behind symptom recovery
- Suicide in 5-10% particularly men within 3 years of onset
63
Q
Prognosis of Schizophrenia
- Better outcome in … world and with introduction of Early Intervention Services
- 20% complete recovery and off treatment, demonstrated by line a
- 25% have persistent symptoms after first episode or what was originally described as ‘dementia praecox’ Line B
- >50% have a relapsing remitting illness with some functional impairment between episodes. Line C
- Recurrent episodes may lead to … deterioration
- Functional recovery lags behind symptom recovery
- … in 5-10% particularly men within 3 years of onset
A
- Better outcome in 3rd world and with introduction of Early Intervention Services
- 20% complete recovery and off treatment, demonstrated by line a
- 25% have persistent symptoms after first episode or what was originally described as ‘dementia praecox’ Line B
- >50% have a relapsing remitting illness with some functional impairment between episodes. Line C
- Recurrent episodes may lead to progressive deterioration
- Functional recovery lags behind symptom recovery
- Suicide in 5-10% particularly men within 3 years of onset
64
Q
Prognosis of Schizophrenia
- 20% complete recovery and off treatment, demonstrated by line a
- 25% have persistent symptoms after first episode or what was originally described as ‘dementia praecox’ Line B
- >50% have a … … illness with some functional impairment between episodes. Line C
- Suicide in …-…% particularly men within 3 years of onset
A
- Better outcome in 3rd world and with introduction of Early Intervention Services
- 20% complete recovery and off treatment, demonstrated by line a
- 25% have persistent symptoms after first episode or what was originally described as ‘dementia praecox’ Line B
- >50% have a relapsing remitting illness with some functional impairment between episodes. Line C
- Recurrent episodes may lead to progressive deterioration
- Functional recovery lags behind symptom recovery
- Suicide in 5-10% particularly men within 3 years of onset
70
Q
Substance-induced harm
A
- Majority can smoke cannabis but in those predisposed to psychosis,can cause lots of problems
71
Q
Cannabis increases vulnerability to psychosis
- Impact of cannabis on developing brain is more potent (
- … patients more sensitive to cannabis than controls
- … liability for psychosis is expressed as differential sensitivity to cannabis
- … use sensitises to effect and increases vulnerability to psychosis
- Many new cannabinoid analogues available
- ? Effect of … on psychosis
A
- Impact of cannabis on developing brain is more potent (<14 years)
- Schizophrenia patients more sensitive to cannabis than controls
- Familial liability for psychosis is expressed as differential sensitivity to cannabis
- Chronic use sensitises to effect and increases vulnerability to psychosis
- Many new cannabinoid analogues available
- ? Effect of CBD on psychosis
72
Q
Cannabis … vulnerability to psychosis
A
- Cannabis increases vulnerability to psychosis
- Impact of cannabis on developing brain is more potent (<14 years)
- Schizophrenia patients more sensitive to cannabis than controls
- Familial liability for psychosis is expressed as differential sensitivity to cannabis
- Chronic use sensitises to effect and increases vulnerability to psychosis
- Many new cannabinoid analogues available
- ? Effect of CBD on psychosis
