Schizophrenia: clinical aspects Flashcards
Neurosis
Anxiety disorders
Depressive disorders
Obsessive compulsive disorder
Adjustment disorders
Somatisation disorders
Psychosis
Organic
Schizophrenia
Bipolar disorder
Depressive psychosis
Psychosis
Illness characterised by loss of boundaries with reality and loss of insight, with primary features of delusions and hallucinations
Deemed to be 1 week duration
Delusion
Belief held firmly but on inadequate grounds, not affected by rational argument or evidence to the contrary, not shared by someone of similar age, educational, cultural, religious or social background
Hallucination
Perception experienced in the absence of an external stimulus
In any sensory modality but auditory commonest in psychosis
Schneider’s first rank symptoms
Auditory hallucinations
Somatic hallucinations
Thought insertion, withdrawal or broadcast
Passivity phenomena
Delusional perception
Auditory hallucinations
Thoughts spoken aloud
Third person hallucinations
Running commentary
ICD 10 diagnosis of schizophrenia
Minimum of 1 of a-d or 2 of e-h for at least one month:
a. thought echo, insertion, withdrawal or broadcast
b. delusion of passivity or delusional perception
c. running commentary hallucinations
d. persistent delusions of other kinds
e. persistent hallucinations in any modulity
f. breaks in thought resulting in abnormal speech
g. catatonic behaviour
h. negative symptoms not due to depression or medication
Affective psychosis
Bipolar disorder
Depressive psychosis
Schizophrenia disorder
Organic psychosis
Epilepsy
Infections
Cerebral trauma
Cerebrovascular disease
Demyelination
Neurodevelopmental disorders
Endocrine
Metabolic
Immunological
Acute drug intoxication
Toxins
Dementias
Signs of schizophrenia
Bizarre appearance or behaviour
- self neglect
- talking to themselves
- social disturbances
- posturing
- clothing
- perplexity
Side effects of medication
Mental state examination: acute syndrome
Appearance: preoccupied and withdrawn
Mood: blunting of mood, disinhibition, perplexed, anxious
Disorder of thinking: vague, formal thought disorder
Delusions: primary, secondary
Hallucinations: auditory, visual, tactile, olfactory, gustatory
Insight: impaired
Cognition: normal orientation and memory
Mental state examination: chronic syndrome
Appearance and behaviour: lack of drive and activity, social withdrawal, self neglect
Movement abnormalities: stupor, catatonia, abnormal movments
Mood: blunting of mood, depression
Delusions: as in acute syndome
Hallucinations: as in acute syndrome
Insight: impaired
Cognition: normal orientation but often cognitive decline
Epidemiology
Prevalence: 0.2%-0.7%
Incidence: 2/10000 per year
Geography: increased rate in migrants, more prevalent in urban than rural areas
Sex: men have earlier onset and more negative symptoms
Onset: male peak 21-26, female peak 25-32
Social class: lower social drift hypothesis
Prognosis of schizophrenia
Better outcome in 3rd world and with introductory early intervention services
20% complete recovery and off treatment
25% persistent symptoms after first episode dementia praecox
> 50% have relapsing remitting illness
