Schizophrenia (neuro) Flashcards
1
Q
Psychotic disorders: background
A
- Major psychoses (‘madness - cancer of mental illness’)
- Examples:
• Schizophrenia•
• Schizoaffective disorder = schizophrenia and bipolar disorder
• Delusional disorder
• Some depressive and manic illnesses - Schizophrenia is the most important of the above for the following reasons:
1. Early in onset
2. Prevalent
3. Disabling and chronic - Mental state that is out of touch with reality
- Abnormalities of perception, thought & ideas
- Profound alterations in behaviour (bizarre and disturbing alienation)
2
Q
Prevalence of schizophrenia
A
- Affects up to 1% of the population
- No significant influence of culture, ethnicity, background,
socioeconomic groups - Increased in urban areas
- Difference between sexes:
• Men show an earlier age at onset, higher propensity to negative symptoms, lower social functioning, and co-morbid substance abuse than that is women, whereas women display relatively late onset of the disease with more affective symptoms. - Before the illness can be recognised there is often a phase in late teenage years associated with social isolation, interest in fringe cults, social withdrawal
- A chronically disabling condition; responsible for a great deal of the population’s morbidity
- In the UK, the cost of treating a patient with schizophrenia through their life is about six times the cost of treating a patient with heart disease.
3
Q
Classes of schizophrenia
A
- Positive: • hallucinations (eg visual, auditory) • delusions • disorganised thought/speech • movement disorders - Negative: • social withdrawal • anhedonia • lack of motivation • poverty of speech • emotional flatness - Cognitive: • impaired working memory • impaired attention • impaired comprehension - 2 or more of these symptoms must persist for at least 6 months to be classed as schizophrenia
4
Q
Hallucinations
A
- Perception experienced without stimulus (functional hallucination)
- Most commonly auditory
- Patients hears:
• Voices talking about them (3rd person)
• Voices talking to them
• Voices giving a running commentary
• Voices echoing their thoughts (thought echo) - Patients may engage in a dialogue with the voices or obey their commands.
5
Q
Delusions
A
- A fixed/ unshakable belief.
- Not consistent with cultural/ social norms.
- Often paranoid or persecutory
• E.g. under control of an external influence, thoughts known to other people because they are transmitted by radio and TV
• Passivity of thoughts and actions
6
Q
Motor, volitional and behavioural disorders
A
- Peculiar forms of motility, stupor, mutism, stereotypy, mannerism, negativism, spontaneous automatism, impulsivity
• Stereotypies: purposeless, repetitive acts
• Bizarre postures, strange mannerisms
• Altered facial expression – grimacing
• State of catatonia – motionless, mute, expressionless, uncomfortable or contorted postures
• State of catalepsy – waxy flexible
• Bouts of extreme hyperactivity (destructiveness; walk around naked)
• Impulsive behaviour – violent acts; murder w/o reason
7
Q
Formal thought disorder
A
- A disorder of conceptual thinking, reflected in speech that is difficult to understand and rapid shifts from one subject to another.
- New words are invented (neologisms).
8
Q
Social withdrawal
A
- Patients withdraw from their families and friends and spend a lot of time on their own.
- Lack of initiative or motivation
- Do not want to do anything.
- No longer interested in things that used to interest them.
9
Q
Formal thought disorder
A
- Disturbances in thinking -> unintelligible speech
- Derailment of speech
- Loosening of associations; failure to follow train of though to its conclusion
- Poverty of speech (speech fails to convey sense/ information)
• Manifests as distorted or illogical speech
10
Q
Cognitive defects
A
- Deficits in SELECTIVE attention, problem solving
and memory - Blunted affect
- Decreased responsiveness to emotional issues.
- Incongruous affect
- Expression of affect inappropriate to circumstances.
11
Q
Insight
A
- An understanding of what is wrong.
- Insight lacking in schizophrenia.
- Patients usually do not accept that any thing is wrong or that treatment is necessary
12
Q
Four phases of schizophrenia
A
- The Prodrome:
• Late teens/early twenties: often mistaken for depression or anxiety
• Can be triggered by stress - The Active/Acute Phase
• Onset of positive symptoms
• Differentiation of what is and isn’t real becomes difficult - Remission
• Treatment -> return to ‘normality’ - Relapse
- Schizophreniform positive symptoms for at least a month, but under 6 months
13
Q
twin studies
A
- 50% chance of developing schizophrenia if one twin diagnosed
- ~14% chance of developing schizophrenia if one twin diagnosed
14
Q
‘Canditate’ genes
A
- we know the exact genetic anomalies that lead to these disorders:
• Sickle-cell disease
• cystic fibrosis
• colour blindness - Some of the ‘risk’ or ‘candidate’ genes for schizophrenia:
• COMT
• DISC1
• GRM3 - Possessing these abnormal genes does not mean you will definitely get schizophrenia – similarly, some people who have schizophrenia do not have these genetic abnormalities
15
Q
The aetiology of schizophrenia
A
Nature vs Nurture (genetics vs environmental factors) - genetics: • SCZ isn’t directly inherited, but can ‘run in families’ • ‘Candidate’ risk genes: • Gene deletions • Gene mutations - environmental factors: • Pregnancy/birth complications • Stress • Drug use
