Schizophrenia: Clinical features Flashcards
Which disorders constitute as neurosis?
Anxiety disorders Depressive disorders Obsessive compulsive disorder Adjustment disorders Somatisation disorders
Which disorders constitute as psychosis?
Organic
Schizophrenia
Bipolar disorder
Depressive psychosis
Define psychosis
Break from reality
An illness characterised by a loss of boundaries with reality and loss of insight, with primary features of delusions and hallucinations.
What is delusion?
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.
List the types of delusion
primary (delusional perception), secondary, persecutory, -of reference, grandiose, -of guilt, nihilistic, -of passivity etc.
What is a psychotic episode?
A psychotic episode is deemed to be 1 week duration of either of these symptoms at significant severity.
What does the content of delusions depend on?
The culture or personal beliefs of the patient
What are hallucinations?
A perception experienced in the absence of an external stimulus.
In any sensory modality but auditory commonest in psychosis.
What are hallucinations due to?
due to internal perception attribution error
Is psychosis different from schizophrenia?
No
Psychosis for many reasons
Psychotic episodes are part of schizophrenia
What is Schneider do?
Defined first rank symptoms pathognomic of schizophrenia
List Schneider’s first rank symptoms
Auditory Hallucinations:
- Thoughts spoken aloud
- Third person hallucinations
- Running commentary
Somatic hallucinations
Thought insertion, withdrawal or broadcast
Passisivity phenomena. Made acts/ impulses/ affect
Delusional perception
List the ICD 10 diagnosis of schizophrenia
A minimum of one of a-d or two of e-h for at least 1 month:
a Thought echo, insertion, withdrawal or broadcast
b Delusion of passivity or delusional perception
c Running commentary hallucination or 2 voices discussing the patient
d Persistent delusions of other kinds
e Persistent hallucinations in any modality with accompanying brief delusions
f Breaks in thought resulting in abnormal speech (eg. incoherent, neologisms)
g Catatonic behaviour eg. Excitement, posturing, waxy flexibility, negativism
h Negative symptoms not due to depression or medication
In the absence of an organic disorder
List some affective psychosis
Bipolar disorder
Depressive psychosis
Schizoaffective disorder
List some causes of organic psychosis
Epilepsy (temporal lobe)
Infections: encephalitis, subacute sclerosing panencephalitis, neurosyphillis, HIV
Cerebral trauma
Cerebrovascular disease
Demyelination: Multiple sclerosis etc
Neurodevelopmental disorders: velocardiofacial syndrome
Endocrine: thyroid disorders (hyper and hypo), Cushing’s syndrome,
Metabolic: hepatic failure, uraemia
Immunological: SLE
Acute drug intoxication: eg. Ketamine, Cannabis, LSD, PCP, Amphetamine, MDMA
Toxins eg. lead
Dementias
List some non-specific signs of schizophrenia
Non-specific signs – bizarre appearance of behaviour – self neglect, talking to themselves, social disturbance including unprovoked violent acts, posturing, clothing, perplexity
Describe the mental state examination in acute syndrome
Appearance Preoccupied and withdrawn to restless and unpredictable
Mood Blunting of mood, disinhibition, perplexed, anxious
Disorder of thinking Vague, Formal thought disorder (loosening of associations)
Disorders of stream (thought block)
Delusions Primary, secondary
Hallucinations Auditory, visual, tactile (somatic), olfactory, gustatory
Insight Impaired
Cognition Normal orientation
and memory (initially)
Describe the mental state examination in chronic syndrome
Appearance and behaviour Lack of drive and activity. Social withdrawal.
Self neglect
Movement abnormalities Stupor, Catatonia, abnormal movements and tone
Mood Blunting of mood. Depression
Delusions as in acute syndrome
Hallucinations as in acute syndrome
Insight Impaired
Cognition Normal orientation
but often cognitive decline.
What is the prevalence of schizophrenia?
0.2-0.7%
Describe the incidence of schizophrenia
2 in 10000 per year
Where is schizophrenia more prevalent?
Migrants
Urban drift
Lower social drift
Which gender is more likely to be affected?
Men
What is the onset of schizophrenia?
Male peak onset 21-26
Female peak onset 25-32
Describe the course of schizophrenia
At risk mental state - slow decrease in function Defined psychosis threshold Duration of untreated psychosis Treatment Function increases Relapse
Describe the prognosis of schizophrenia
Better outcome in 3rd world and with introduction of early intervention services
High suicide rate
Describe the components of a good prognosis of schizophrenia
Female Married Family history of affective disorder Good premorbid function Acute onset Life event at onset Early treatment Affective symptoms Good treatment response
Describe the components of a bad prognosis of schizophrenia
Male Single Family history of schizophrenia Premorbidly schizoid Slow onset Long duration untreated Negative symptoms Obsessions High Expressed Emotion in the family Substance misuse
Which drug is associated with schizophrenia?
Cannabis - genetically vulnerable
What can legal highs do to psychosis?
Can exacerbate psychosis
