Schizophrenic disorder Flashcards
define psychosis
impairment of reality testing
disorders with psychotic symptoms/differential diagnosis
- brief psychotic disorder: psychotic symp less than 1 month
- schizophreniform disorder: symp > 1 month but < 6 month
-schizophrenia: symp for > 6 month
-mood disorder with psychotic features
-schizoaffective disorder:initially present with mood disorder + psychosis,mood disturbance disappears but psychotic symptoms persist for more than 2 weeks
-delusional disorder ( non bizarre unshakeable false beliefs with no hallucinations)
-psychotic disorder due to gen medical cond/prescribed meds (levodopa,steroids,bromocriptine)/illicit drug use inclusing alcohol
-post partum psychosis
phases of schizo
prodromal phase: negative symptoms
acute phase: positive symptoms
residual phase ( aft antipsychotics):negative symptoms
-relapses,remission or residual phase throughout life
Negative symptoms of schizophrenia:5A
1)Affective blunting (x emotional expressions
2)Alogia (poverty of speech)
3)Avolition (Lack of motivation)
4)Asocial (social withdrawal)
5)Apathy (detachment fr rest of the world/ lose interest in everything)
positive symptoms
-Delusions
-hallucinations
-disorganised speech (incoherence with looseness of association)
-disorganised or catatonic behaviour
schneider’s first rank symptoms of schizophrenia ( any 1 for diagnosis aft ruling out mood disorder,organic causes)
- thought echo: voices telling aloud what patient thinks
2.running commentary
3.3rd person auditory hallucination: 2 or more voices critically discussing about the patient
4.thought broadcasting/accessible thought:belief that his thoughts are conveyed to others
5.though withdrawal:belief in an external force removing one’s thoughts
6.thought insertion/alienation:beleif in an external force putting thoughts into one’s mind
- delusion of control(passivity phenomena)/made act, made affect:belief that ones feelings and emotions are under control by an external force
8.delusional perception: the unshakeable belief that normal events occuring around have a special meaning or convey a special message to the patient
elicit thought echo
do u hear voices that tell u aloud what you are thinking?
elicit running commentary
do you hear voices that critically comment on your action
elicit 3rd person auditory hallucination
do u hear 2 or more voices critically discussing about you
elicit thought broadcasting/accessible thought
do u believe that whatever u think is accessible to others and they come to know them
elicit though withdrawal
do you believe that an external force is taking away your thoughts and you are devoid of thoughts
elicit thought insertion/alienation
do you believe that your thoughts are not yours but put into u by an external agency or force
elicit delusion of control(passivity phenomena)/made act, made affect
do u believe that your emotions n actions are not under your ctrl but controlled by an external force and you are passively receiving them?
elicit delusional perception
do you believe that events occurring around you have a special meaning to you or convey a special message to u.
paranoid schizo
delusions + auditory hallucinations
disorganized/ hebephrenic schizo
disorganised behaviour + disorganised speech + affective blunting
catatonic schizophrenia
2 or more catatonic symptoms
residual schizo
no longer positive symptoms,only negative symptoms
simple schizophrenia
only negative symptoms
undifferentiated schizo
symptoms not fitting in any other types
elicit delusion of persecution
do u believe that others are plotting to harm u or working against u to endanger your life? if yes explain further
elicit delusion of reference
do u believe that wherever u go people are talking about u and making gestures referring to u
OR
do u think the programs in TV and radio are about u or have reference to u
delusion of infidelity
do u believe that your spouse/partner is unfaithful to u and having and affair with someone else?
if yes,explain further
true hallucinations: 5 req to dif fr pseudohallucination
1) must be perceptions without stimulus
when u hear the voices can you see the persons who are speaking
OR
when u hear the voices can others around you hear these voices
2) experience must be objective*
is the voice coming fr out there(objective) or within u
3) perceiving through sense organs*
are the voices perceived through the ears?
4)should occur in the awakened state whether clear or clouded consciousness
when do u hear the voices? is it related to sleep?
5) lack of insight*
is it a real experience or can it be your imagination
types of auditory hallucination
2nd person hallucination
3rd person hallucination
command hallucination
symptoms of paranoid schizo
bizzare delusions only
OR
any delusions + prominent auditory hallucinations
OR
prominent auditory hallucination only
what is meant by disorganised speech
incoherent with thought derailment
- looseness of association
symptoms in catatonic schizo:2 or more catatonic symp
1.motor immobility
stupor (mutism+akinesia)
posturing
waxy flexibility
2.catatonic excitement (opp to 1)- excessive purposeless motor activity
3.odd behaviour/speech which is repetitive
automatic obedience
negativism
mannerism
stereotypes
perseveration
ambivalence/ambitendence
echolalia/echopraxia
how to maximize compliance
psychoeducation to patient and family
depot antipsychotic injection
home visits
antipsychotic drops
comorbidities
depression/post psychotic depression
substance use disorder including alcohol
good prognostic indicators
female
late onset
good premorbid func in edu,job,marriage
no fam history
acute onset
prominent positive symp
duration of untreated psychosis less than a year
