Schizophrenia & Psychosis# Flashcards
Define Psychosis
An inability to distinguish symptoms of delusion, hallucination or disordered thinking from reality
Define a delusion?
An unshakeable belief which is outside of their social & cultural background and held with extraordinary conviction
What leads to psychosis?
Biological factors e.g. Genetics, neurochemistry & complications as a foetus/birthing/ nutrition/ substance misuse
Psychological factors e.g. Stress & fear
Social problems e.g. migration, isolation, major events or substance misuse, cultural factors
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
Symptoms of a patient suffering with delirium.
The fear affect, evanescent delusions and worsening at night is all indicative
A psychotic patient is suffering from prominent
- visual hallucinations
- oft terrified
- persecutory and fleeting delusions
- all of which worsens at night.
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
what type of hallucinations present during psychosis?
- Have full clarity
- In external space
- Have no external stimulus
- All 5 senses are involved
Give examples of delusional beliefs?
- Grandiose
- Paranoid
- Hypochondrial
- Self-referential
What should you take care with when treating schizophrenia with anti-psychotics?
-Ask about Family history of • Hypertension • Diabetes • CVS - Perform • BP • Weight • Blood fasting glucose • FBC • ECG if on clozapine -Clozapine tends to be the preferred treatment • Associated lowered suicidal risk • EPSE: extrapyramidal movement disorders with antipsychotic medications o Try to give lowest dose possible o Procyclidine IM/IV
Give examples of Genetic factors which lead to psychosis/ schizophrenia
- CF
- Di George syndrome
- Dysbidin
- Neuroregulin
Give examples of Neurochemistry factors which lead to psychosis?
- Dopamine hypothesis
- Glutamate
- Gaba
- Seratogenic transmission
Other Biological factors which can lead to psychosis?
- Obstetric complications
- Maternal influenza
- Malnutrition
- Winter birth
- Substance misuse
