schizophrenia (longer) Flashcards
define psychosis
inability to distinguish symptoms of delusion, hallucination or disordered thinking from reality
define a delusion?
unshakeable belief which is out of keeping with person’s social & cultural background
it is held with extraordinary conviction
Come in many types e.g. grandiose, paranoid, hyperchondiacal etc
examples of delusion
grandiose
paranoid
hypochondriacal
self referential
aetiology of psychosis
biological factors
psychological factors
social factors
biological factors involved in the aetiology of psychosis
genetics
neurochemistry
obstetric complications
maternal influenza
malnutrition and famine
winter birth
substance misuse
biological factors involved in the aetiology of psychosis
genetics
neurochemistry
obstetric complications
maternal influenza
malnutrition and famine
winter birth
substance misuse
Who gets Schizophrenia?
Onsets mostly 15-35 yrs and affects both genders equally
Hits a surprisingly high 1 in 100 people
What’s the difference between +ve and -ve symptoms of schizophrenia?
+ve add something to the patient’s mind e.g. a hallucination, delusion or disordered thinking
-ve take something away e.g. apathy, anhedonia or lack of/incongruity of emotional affects & reactions
Before diagnosing schizophrenia, what other psychotic illnesses should be ruled out first?
Transient psychosis - often caused by substance abuse
Affective psychoses (Depressive or Manic Episode with Psychotic Symptoms)
Delirium
Other physical problem e.g. brain tumour
A psychotic patient is suffering from prominent visual hallucinations, is oft terrified, has persecutory and fleeting delusions all of which worsens at night. Is this schizophrenia?
Not likely, it sounds like a patient suffering from delirium.
The fear affect, evanescent delusions and worsening at night is all indicative
What pattern would the symptoms follow in a depressive psychosis?
Delusions are likely to be very -ve e.g. of guilt, worthlessness or persecution
Hallucinations are often derogatory voices
LOW MOOD
How would a manic psychoses present?
Delusions of grandeur, special powers or a messianic role
ELEVATED MOOD
How do we manage schizophrenia?
Early Intervention Services
Antipsychotics
Psychological Interventions
Perinatal Care
What are Early Intervention Services
Early services provided by a clinician in partnership with other professions e.g. social work to address social issues surrounding the patient including:;
- Housing
- Problems at work or with benefits
- Social skills training
- Substance abuse
- Support for families/carers
What psychological interventions are common in schizophrenia?
CBTp
Family therapy
Cognitive Remediation
Social skills training
What do we mean by perinatal care with schizophrenic patients?
A lot of anti-psychotics are teratogenic so you must counsel on this and help them if they wish to become pregnant
Also there is a high risk of relapse in the post-partum which patient’s must be counselled on and prepared for
What are some good prognostic factors?
Absence of FH Acute onset No -ve symptoms Female Late Onset Supportive Home & good Premorbid function A clear Precipitant
What are some bad prognostic factors?
Insidious onset
Starts in childhood
-ve symptoms
What are the symptoms of disordered thinking?
Thought Echo - Hear’s own thoughts outloud
Insertion - Someone else putting thoughts in my head
Withdrawal - Thoughts dropping from or being stolen from my head
Broadcasting - Other people can hear my thoughts
How do we diagnose Schizophrenia? (ICD-10)
Atleast one of … for >1month:
- Alienation of thought
- Delusions of control, influence or passivity
- Hallucinatory voices (often a commentary)
- Persistant impossible, culturally innapropriate delusions
We can also diagnose schizophrenia with 2 of the following list: (still under ICD-10)
- Persistant hallucinations of any kind (every day for 1 month)
- Breaks/interpolations in train of thought or neologisms –> Incoherent speech
- Catatonic behaviour e.g. random excitement, posture, waxy flexibility, negativism or stupor
- Negative symptoms e.g. apathy, anhedonia or lack of affect
