Schizophrenia clinical features Flashcards
Neurosis
Mental disorder not caused by an organic disease
Includes:
- Anxiety
- Depression
- OCD
- Adjustment disorders
- Somatisation disorders [recurrent complaints about somatic symptoms without the diagnosis present]
Psychosis
Illness characterised by:
- Loss of boundaries with reality
- Loss of insight
- Delusions and hallucinations
Includes:
- Schizophrenia
- Bipolar
- Depressive psychosis
Delusion
Belief held on strong conviction that are not adequate
- Cannot be changed even in the presence of convicting evidence or rational argument
- The belief is not shared by someone of a similar background
Hallucination
Perception experienced in the absence of an external stimulus
Can be in any sensory modality
- Auditory being the most common
Could possibly be due to an internal perception attribution error
Schneider’s First Rank Symptoms
Delusional perception
Auditory hallucinations
- Third person hallucination
- Running commentary
- Thoughts aloud
Delusions of thought interference
- Thoughts being placed into one’s mind by an external source
Passivity phenomenon
- Feeling that one is not longer in control of their own body
Somatic hallucinations
ICD 10 diagnosis of schizophrenia
- a-d category
In order for schizophrenia to be present:
- Minimum of one of category a-d for at least a month
- Two of categories e-h for at least a month
A- thought echo, insertion, withdrawal or broadcast
B- Delusion of passivity or perception [ belief that a normal percept has a meaning specific for that person]
C- Running commentary hallucination/ 2 voices discussing the patient
D- Persistent delusion of other kinds
ICD 10 diagnosis of schizophrenia
- e-h category
At least two constitutes, for at least a month, constitutes as schizophrenia
E- Persistent hallucinations in any modality with brief
delusions
F- Breaks in thoughts resulting in abnormal speech
G- Catatonic behaviour
H- Negative symptoms not due to depression or medication in the absence of an organic disorder
Affective psychosis
Mood disorders, differential diagnosis of schizophrenia:
Biopolar disorder
Depressive psychosis
Schizoaffective disorder [schizophrenia and mood disorder]
Signs of schizophrenia
There are still no objective pathogonomic signs but can include:
Bizarre appearance of behaviour
- Self neglect
- Posturing
- Social disturbance [e.g unprovoked violent acts]
- Talking to themselves
Clinical interview is required for diagnosis
Mental state examination
Acute syndrome: Type I/ positive symptoms
- Appearance
- Mood
- Thinking
- Delusions
- Hallucinations
- Insight
- Cognition
Appearance
- Restless, unpredictable
Mood
- Blunting
- Disinhibited
- Perplexed
- Anxious
Thinking
- Disordered, vague
- Thought blocks
- Loosening of associations
Delusions
- Primary and secondary
Hallucinations
- All senses
Insight impaired
Cognition
- Orientation and memory normal initially
Mental state examination
Chronic: Type II/ negative symptoms
- Appearance
- Movement
- Mood
- Thinking
- Delusions
- Hallucinations
- Insight
- Cognition
Appearance
- Lack of drive and activity
- Social withdrawal
- Self neglect
Movement
- Stupor
- Catatonia
- Abnormal
Mood
- Depression
- Blunted
Delusions
- Primary and secondary [same as acute]
Hallucinations
- All modalities [same as acute]
Insight is impaired
Cognition
- Normal orientation but can decline
Epidemiology of schizophrenia
- Prevalence
- Incidence
- Geography
- Sex
- Onset
- Social class
Prevalence
- 0.2-0.7% of population
Incidence
- 2/10K annually
- Increasing in south London
Geography
- Increased rate in migrants [Afro-caribbean]
- More in urban areas
- ‘urban drift’?
- Incidence up to 5x internationally
Sex
- Men have more early onset and negative symptoms
Onset
- Male peak: 21-26
- Female peak: 25-32
Social class:
- Lower ‘social drift hypothesis’
Cannabis and psychosis
Increases vulnerability to psychosis
Chronic uses sensitises and increases vulnerability
Possible familial connection to psychosis and cannabis sensitivity
Cannabis has a larger impact on developing brain [ < 14 years old]
Prognosis of schizophrenia
-More than 50% are in remission from treatment and can have functional impairment in between episodes
25% have persistent symptoms after first episode
20% have complete recovery after treatment
5-10% suicides, particularly in men
