Schizophrenia - Clinical features Flashcards
what treatment would be given for
i) neurosis
ii) psychosis
i) antidepressant eg SSRI
ii) antipsychotic medication
NEUROSIS
i) what is it characterised by?
ii) which disorders fall into this category? (5)
iii) what is a somatisation disorder?
i) characterised by anxiety and low mood
ii) anxiety, depression, OCD, adjustment disorder and somatisation disorder
iii) somatisation disorder is extreme focus on physical symptoms
PSYCHOSIS
i) how is it characterised?
ii) what is classed as a psychotic episode? (duration)
iii) what is it often associated with?
iv) is it more or less severe than neurosis?
v) is it from organic or inorganic brain disorders?
vi) which three disorders may it be associated with?
i) characterised by loss of boundaries with reality as well as delusions, hallucinations anc conceptual disorganisation
ii) psychotic episode = one week duration of symptoms at signficant severity
iii) often associated with some behavioural disturbance
iv) more severe than neurosis
v) can be from organic brain disorders
vi) can be associated with schizophrenia, bipolar and depressive psychosis
DELUSION
i) what is a delusion?
ii) are views held by religious cults delusions? why?
iii) an increase in what chemical in the brain is associated with this
iv) what is salience attribution? how is this implicated in delusion?
i) delusion is a firmly held belief on inadequate grounds which is not affected by rational argument of evidence to the contrary
ii) religious views are not delusions as it is defined as thoughts not shared by someone of a similar age, education, culture, religion or social background
iii) increase in dopamine
iv) salience attribution is paying attention to something and giving it more value than a healthy person would - in delusions this goes wrong
TYPES OF DELUSION
what are:
i) primary and secondary delusions
ii) persecutory
iii) of reference
iv) grandiose - what is this associated with?
v) of guilt/nihilistic
vi) passivity
give examples for each
i) primary delusion is the first belief (aliens have landed) and secondary is an idea based on the primary (aliens have landed which is why there is no pasta in tesco)
ii) persecutory - something is directed specifically at you (aliens are hiding pasta from you only)
iii) of reference - you are responsible for an event (you are responsible for 9/11)
iv) grandiose - heightened belief of yourself (you are a superhero) associated with mania
v) of guilt - low mood/psychotic depression (dont eat food because believe gut isnt working so no point)
vi) passivity - you are under the control of something external and they are making you do things (chip in brain)
HALLUCINATION
i) what is a hallucination?
ii) which modality is the most common in psychosis?
iii) what is internal perception attribution error?
iv) during a brain scan when a patient is hallucinating - do brain areas light up as if it actually happening?
i) a perception experienced in the absence of an external stimulus
ii) auditory is the most common in psychosis but can be any sensory modality
iii) int perception attribution error is when you hear a noise but there is nothing actually generating the noise
iv) yes - on brain scan areas light up as if the thing is actually happening
CONCEPTUAL DISORGANISATION
i) what is this characterised by? how is this picked up?
ii) do individuals actively complain about this?
iii) what is it also known as?
i) characterised by confused, disconnected and disorganised though processes demonstrated by what the patient is saying
ii) patients dont actively cpmplain about it - it is what you identify from what they are saying
iii) aka loosening of assoc of though/knight move through/schizo thought disorder/disorder of form of thought/formal though disorder
YOU CANT FOLLOW WHAT SOMEONE IS SAYING
SCHNEIDERS FIRST RANK SYMPTOMS
i) what needs to be absent for these to define schz?
ii) what are they? (5) give examples
i) organic disease needs to be absent
1) aud hallucinations - thoughts spoken out loud, running commentary, hear someone talking about you
2) somatic hallucinations - feel something on body (tactile), ants on skin
3) thought insertion, withdrawal or broadcast
4) passivity phenomena - feel that things are happening out of your control eg arms moving
5) delusion perception - aliens have landed and is usually associated with a change in something eg weather or traffic
give an example of
i) thought insertion
ii) thought withdrawal
iii) thought broadcast
in relation to schneiders first rank symptoms
i) insertion - feeling of a new thought in your mind that isnt yours
ii) withdrawal - thoughts are being taken out your mind eg with antenna
iii) broadcast - thoughts are known to other people around you
what is currently used for schz defining symptoms?
ICD10 diagnosis
- need specific symptoms in the absence of an organic disorder
DIFFERENTIAL DIAGNOSES
i) give three examples of affective psychoses
ii) give examples of four organic psychoses that need to be ruled out
iii) give another disorder that needs to be ruled out
i) bipolar, depressive psychosis, schizoaffective disorder
ii) epilepsy, infection, ceberal trauma, cerebrovascular disease, MS, velocardialfacial syndrome, toxins, dementias
iii) personality disorder
SIGNS OF SCHIZOPHRENIA
i) what are positive symptoms? give examples
ii) what are negative symptoms? give examples
iii) are there specific signs related to schz?
iv) do schz patients have normal cognition and attention?
i) things you can see eg preoccupied, blunted mood, anxiety, disordered thinking, delusions, hallucinations, impaired insight
ii) associated with more severe schz eg withdrawal and decreased movements, may have cognitive decline in later stages
iii) there arent specific signs related and all signs may be relatable to something else
iv) in the acute phase patients have normal cognition but impaired attention
what type of symptoms are mostly associated with
i) acute schz syndrome
ii) chronic schz syndrome
i) positive symptoms
ii) negative symptoms
EPIDEMIOLOGY
i) what is the prevalence worldwide?
ii) which is the incidence?
iii) is it more prevalent in urban or rural areas?
iv) which sex has an earlier onset? do they have more positive or negative symptoms?
v) what is the normal age of onset in M and F
i) 1%
ii) 2 per 100,000
iii) more prevalent in urban areas
iv) men have earlier onset and more negative symptoms
v) M = 21-26, F 25-32
THE COURSE OF SCHIZOPHRENIA
i) what does A represent?
ii) what does B represent?
iii) what is DUP?
iv) what is the relationship between DUP and prognosis?
i) A = the pre psychotic state - at risk mentally (if identified can get early help)
ii) B = onset of psychosis
iii) DUP is the time between onset and start of treatment
iv) the longer the DUP the worse the prognosis
PROGNOSIS
i) what do A, B and C refer to on the graph?
ii) what % have relapsing and remitting illness with some functional impairment between episodes?
iii) what % commit suicide? what gender is more at risk of this?
i) A = complete recovery, B = persistent symptoms agyer first episode/dementia praecox, C - relapsing and remitting disease
ii) 50% have relapse/remitting disease with some functional impariment between
iii) 5-10% commit suicide and this is particularly in men
