Schizophrenia & Psychosis Flashcards
Define schizophrenia
A form of psychosis that can be chronic or relapsing and remitting
Schizophrenia risk factors
1% background risk
Family history
Trauma in childhood
Heavy cannabis use in childhood
Maternal poor health
Birth trauma
Living in the city
Living in/emigrating to more developed countries
Schizophrenia differentials
Delirium
Substance induced psychotic disorder
Organic psychosis (e.g. infection, brain injury, CNS diseases)
Metabolic disorder
Dementia and depression
Clinical features of schizophrenia
First rank features: auditory hallucinations, thought disorders, delusional perceptions, passivity phenomena
Negative symptoms
Auditory hallucinations in schizophrenia
Classically a third person running commentary
Can also be thought echo or command hallucinations
Thought disorders in schizophrenia
Thought insertion (thoughts implanted into the patient)
Thought withdrawal (thoughts being removed from the patient)
Thought broadcasting (‘others can hear my thoughts’)
Delusional perceptions in schizophrenia
A 2 stage process where a normal object is perceived and there is a delusional insight into its meaning e.g. “I saw the Queen on the television and I knew that the mafia would be set to murder me”
Passivity phenomena in schizophrenia
Sensation of an external influence controlling the thoughts or actions of the sufferer
Negative symptoms in schizophrenia
Alogia (poverty of speech)
Anhedonia (inability to derive pleasure)
Incongruity/blunting of affect
Avolition (poor motivation)
Investigations in schizophrenia
Clinical diagnosis
CT/MRI head
HIV and syphilis screen
Drug testing
Routine bloods including FBC and TFTs
Management of schizophrenia
Oral atypical antipsychotics are first-line e.g. risperidone
CBT should be offered to all patients
Factors associated with poor prognosis in schizophrenia
Strong family history
Gradual onset
Low IQ
Prodromal phase of social withdrawal
Lack of obvious precipitant
Factors associated with better prognosis in schizophrenia
High IQ/education level
Sudden onset
Obvious precipitating factor such as a traumatic life event
A strong support network
Positive symptoms predominant
Define psychosis
A term used to describe a person experiencing things differently from those around them
In which conditions may psychosis occur?
Schizophrenia
Depression (psychotic depression, a subtype more common in elderly patients)
Bipolar disorder
Puerperal psychosis
Brief psychotic disorder: where symptoms last less than a month
Neurological conditions e.g. Parkinson’s disease, Huntington’s disease
Prescribed drugs e.g.corticosteroids
Certain illicit drugs e.g. cannabis, phencyclidine
