Schizophrenia history Flashcards
what are the diagnostic criteria for schizophrenia?
At least one clear symptom from group A and 2< from group B
A:
- Thought echo, insertion, withdrawal or broadcasting
- Delusions of control, influence or passivity
- Hallucinatory voices
- Persistent delusions of other kinds that are culturally inappropriate and completely impossible
B:
- Persistent hallucinations of any modality, when accompanied either by fleeting or half-formed delusions or by persistent over-valued ideas
- Breaks or interpolations in the train of thought, resulting in incoherence or irrelevant speech or neologisms
- Catatonic behaviour
- negative symptoms, such as marked apathy, paucity of speech, and blunting or incongruity of emotional responses
How would you define a delusion?
A fixed false belief which is not congruent with a cultural norm
How would you define a hallucination?
A perception in the absence of a stimulus
How would you define psychosis?
An umbrella term for aa loss of contact with reality. There are many causes for psychosis, one of which is schizophrenia
What are the types of delusions?
- Persecutory: do you ever feel like people are out to get you?
- Delusions of reference: Are there ever messages in the newspaper or on television just for you?
- Delusions of perception: would you say you see things in the same way as others?
- Grandeur: do you have any special powers?
- Nihilistic: do you ever feel like things around you are rotting?
- Passivity: do you ever feel like you’re not in control of your thoughts to actions?
- Test conviction: is there a chance you might be wrong?
What are the types of hallucinations?
- Auditory
2. Visual/olfactory/gustatory
What would you ask about auditory hallucinations?
Do you ever hear things when there’s no-one around and nothing to explain it?
Do you recognise that voice?
How many voices are there?
Are they talking to you or about you?
Have they ever asked you yo harm yourself or others?
Do you hear your own thoughts being repeated back to you?
What are the types of thought interference?
- Thought insertion: do you ever feel like ideas are being deliberately put into your head?
- Thought withdrawal: do you ever feel your thoughts being taken away from you?
- Thought broadcast: Can others hear your thoughts without saying them out loud?
What are differential diagnoses for schizophrenia?
- Organic syndromes: dementia, brain tumour, temporal lobe epilepsy
- Drug-induced; amphetamines, LSD, cocaine
- Mood disorder: depression or mania with psychotic features
- Schizoaffective disorder
- Schizoid personality disorder
- Acute psychotic episode
What are the negative symptoms of schizophrenia?
Blunted affect Apathy Social isolation Poverty of speech Poor self-care
What investigations would you do for schizophrenia?
CT/MRI head
HIV and syphilis screen
Drug testing
Routine bloods including FBC and TFTs
How would you treat schizophrenia?
Paranoid schizophrenia, as with any psychotic disorder, is treated first-line with atypical antipsychotics such as Risperidone
NICE recommends Clozapine for children and young people whose schizophrenia has not responded to adequate doses of at least two different antipsychotics used sequentially for 6-8 weeks.
What are the first rank symptoms of Schizophrenia?
- Thought interference
- Auditory hallucinations
- Delusional perception (person believes that a normal percept has a special meaning to them)
- Delusions of control: false belief that other people have control over your behaviour or thoughts
What are common types of auditory hallucinations?
- Command
- Running commentary
- Third person (two people talking about the person)
- Thought echo
What would you also screen for in schizophrenia?
- Mood
- Insight
- Risk
- DRUGS and alcohol
