Schizophrenia & Psychosis# Flashcards

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1
Q

Define Psychosis

A

An inability to distinguish symptoms of delusion, hallucination or disordered thinking from reality

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2
Q

Define a delusion?

A

An unshakeable belief which is outside of their social & cultural background and held with extraordinary conviction

Come in many types e.g. grandiose, paranoid, hyperchondiacal etc

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3
Q

What leads to psychosis?

A

Biological factors e.g. Genetics, neurochemistry & complications as a foetus/birthing

Psychological factors e.g. Stress & fear

Social problems e.g. migration, isolation, major events or substance misuse

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4
Q

Who gets Schizophrenia?

A

Onsets mostly 15-35 yrs and affects both genders equally

Hits a surprisingly high 1 in 100 people

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5
Q

What’s the difference between +ve and -ve symptoms of schizophrenia?

A

+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

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6
Q

Before diagnosing schizophrenia, what other psychotic illnesses should be ruled out first?

A

Transient psychosis - often caused by substance abuse
Affective psychoses (Depressive or Manic Episode with Psychotic Symptoms)
Delirium
Other physical problem e.g. brain tumour

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7
Q

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?

A

Not likely, it sounds like a patient suffering from delirium.
The fear affect, evanescent delusions and worsening at night is all indicative

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8
Q

What pattern would the symptoms follow in a depressive psychosis?

A

Delusions are likely to be very -ve e.g. of guilt, worthlessness or persecution
Hallucinations are often derogatory voices

LOW MOOD

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9
Q

How would a manic psychoses present?

A

Delusions of grandeur, special powers or a messianic role

ELEVATED MOOD

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10
Q

How do we manage schizophrenia?

A

Early Intervention Services
Antipsychotics
Psychological Interventions
Perinatal Care

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11
Q

What are Early Intervention Services

A

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
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12
Q

What psychological interventions are common in schizophrenia?

A

CBTp
Family therapy
Cognitive Remediation
Social skills training

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13
Q

What do we mean by perinatal care with schizophrenic patients?

A

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

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14
Q

What are some good prognostic factors?

A
Absence of FH
Acute onset
No -ve symptoms
Female
Late Onset
Supportive Home & good Premorbid function
A clear Precipitant
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15
Q

What are some bad prognostic factors?

A

Insidious onset
Starts in childhood
-ve symptoms

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16
Q

What are the symptoms of disordered thinking?

A

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

17
Q

How do we diagnose Schizophrenia? (ICD-10)

A

Atleast one of … for >1month:

  • Alienation of thought
  • Delusions of control, influence or passivity
  • Hallucinatory voices (often a commentary)
  • Persistant impossible, culturally innapropriate delusions
18
Q

We can also diagnose schizophrenia with 2 of the following list: (still under ICD-10)

A
  • 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
19
Q

schizofrenia has a genetic link with which disorders?

A

Neuregulin (chromosome 8p)
Dys bindin (chromosome 6p)
Di George Syndrome

20
Q

Does schizophrenia have a genetic link with twins?

A

yes, 50% concordance in MZ twins

10% risk if one parent affected; 40% if two parents; 10% on sibling; 110% for DZ twins

21
Q

What neurochemical factors involved in schizofrenia?

A

Dopamine hypothesis” – increased level of dopamine in the brain

Revised dopamine hypothesis – mesolimbic hyperdopaminergia and mesocortical hypodopaminergia

Glutamate

GABA

Noradrenaline

Serotoninergic transmission

22
Q

other neurological abnormalities ?

A

Reduced brain volume 3%

Ventricular enlargement 25% (but overlaps with normal)

Cytoarchitectural abnormalities

Reduced frontal lobe performance

Eye tracking (saccadic) abnormalities

Soft neurological signs

EEG abnromalities

23
Q

Other biological factors involved in schizofrenia?

A

Obstetric complications

Maternal influenza

Malnutrition and famine

Winter birth

Substance misuse

24
Q

ddx of schizofrenia?

A

Delirium!!!
or
Acute Organic Brain Syndrome!!!