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Nervous System And Neuropsychiatry > Session 12 L2: Schizophrenia > Flashcards

Session 12 L2: Schizophrenia Flashcards

1
Q

What is the definition of psychosis?

A

Presence of hallucinations or delusions. Describes symptoms, not a diagnosis in itself

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2
Q

What are hallucinations?

A

Perception without stimulus. Can be in any sensory modality. Visual hallucinations are usually organic which means they are caused by problem with brain or eyes

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3
Q

What are some examples of hallucination in the normal population?

A

Hypnogogic – Going to sleep

Hypnopompic – Waking up

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4
Q

What are delusions?

A

Abnormal belief, outside of cultural norms, that is unshakeable

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5
Q

What are some positive symptoms of schizophrenia?

A
  • Delusions
  • Hallucinations
  • Thought disorder
  • Lack of insight
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6
Q

What are negative symptoms of schizophrenia?

A
  • Underactivity
  • Low motivation
  • Social withdrawal
  • Emotional flattening
  • Self-neglect
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7
Q

What are some negative symptoms of schizophrenia?

A
  • Underactivity
  • Low motivation
  • Social withdrawal
  • Emotional flattening
  • Self-neglect
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8
Q

What are first rank symptoms in schizophrenia?

A
  • Auditory hallucination
  • Passivity Experience
  • Thought withdrawal, broadcast or insertion
  • Delusional perception
  • Somatic hallucinations
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9
Q

What are auditory hallucinations?

A
  • Thought echo which is hearing thoughts aloud
  • Running commentary which is voices referring to patient in third person and conversing with each other about the patient
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10
Q

What is a passivity experience?

A

Patient believes an action or felling is caused by external force

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11
Q

What is thought withdrawal, broadcast or insertion?

A

Thought Withdrawal – thoughts are being taken out of the mind

Thought broadcast – thoughts are being made known to other e.g. via radio

Thought insertion – thought implanted by others

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12
Q

What are delusional perceptions?

A
  • Attribution of new meaning usually in the sense of self-reference to a normally perceived object
  • New meaning cannot be understood as arising from patient’s affective state or previous attitudes
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13
Q

What is a somatic hallucination?

A

Mimics feeling from inside

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14
Q

What is the ICD10 diagnosis criteria for schizophrenia?

A

At least one of the following:

  • Thought echo, insertion, withdrawal, broadcast
  • Delusions of control, influence or passivity, clearly referred to body/limb movements or specific thoughts actions or sensations, delusional perception
  • Hallucinatory voices giving a running commentary on the patient’s behaviour, or discussing them between themselves, or other types of hallucinatory voices coming from some part of the body
  • Persistent delusions of other kinds that are culturally inappropriate and completely impossible

At least 2 of the following:

  • Persistent hallucinations in any modality, when occurring every day for at least one month, when accompanied by delusions
  • Neologisms, breaks or interpolations in the train of thought, resulting in incoherent or irrelevant speech
  • Catatonic behaviour
  • Negative symptoms such as marked apathy, paucity of speech and blunting or incongruity of emotional responses
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15
Q

What are the types of schizophrenia?

A
  • Paranoid Schizophrenia
  • Simple schizophrenia
  • Hebephrenic schizophrenia
  • Undifferentiated schizophrenia
  • Catatonic schizophrenia
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16
Q

What is paranoid schizophrenia?

A

Delusion or hallucinations prominent

17
Q

What is simple schizophrenia?

A

Loss of drive and interest, aimlessness, idleness, self-absorbed attitude and social withdrawal. Marked decline in social, academic or work performance. No hallucinations/delusions

18
Q

What are Hebephrenic Scizophrenia?

A

Definite and sustained flattening or shallowness of affect or incongruity/inappropriateness of affect, aimless and disjointed behaviour or thought disorder affecting speech. Hallucinations/delusions must not dominate

19
Q

What is Undifferentiated Schizophrenia?

A

Insufficient symptoms to meet criteria of any subtypes or so many symptoms fit more than one criteria

20
Q

What are the theories associated with the pathophysiology of schizophrenia?

A
  • Dopamine Pathways (most common)
  • Brain changes
  • Limbic pathway
  • Basal Ganglia
  • Autoimmune hypothesis
21
Q

What are the dopamine pathways associated with schizophrenia?

A

Mesolimbic Pathway – From ventral tegmental area to limbic structures (amygdala, septal area, hippocampal formation) and nucleus accumbens

Mesocortical Pathway – From ventral tegmental area to frontal cortex and cingulate cortex

22
Q

What are the brain changes associated with the pathophysiology of Schizophrenia?

A
  • Enlarged ventricles

- Reduced hippocampal formation, amygdala, para-hippocampal gyrus and prefrontal cortex

23
Q

Why is the limbic pathway associated with schizophrenia?

A

-Role in regulating emotional behaviour

24
Q

What is the basal ganglia involvement in the pathophysiology of Schizophrenia?

A
  • Even untreated patients can present with motor symptoms.

- Nigostriatal pathway from the substantia nigra pars compacta to the striatum

25
Q

What is the autoimmune hypothesis of schizophrenia?

A
  • Anti-NMDA encephalitis
  • Antibodies bind to NMDA receptor, and the receptor is internalised which leads to hypofunction.
  • Treated with corticosteroid and intravenous immunoglobulin
26
Q

Describe the typical antiphysichotic used fo rshizophrenia?

A
  • Block D2 receptors in all CNS dopaminergic pathways
  • Main action is on mesolimbic and mesocortical pathways
  • Side effects are problems
27
Q

Describe the atypical antipsychotic used fo schizophrenia?

A
  • Low affinity for D2 receptors

- Milder side effects as dissociate rapidly from D2 receptors

28
Q

Where are D2 receptors found?

A
  • Striatum
  • Substantia Nigra
  • Pituitary Gland
29
Q

How do D2 receptor work?

A

Work via Gi receptors

30
Q

What is Catatonia?

A

More than two weeks, one or more of

  • Stupor / mutism
  • Excitement
  • Posturing
  • Negativism
  • Rigidity
  • Waxy flexibility
  • Command automatism
31
Q

Why do untreated patient develop catatonia if dopamine promotes movement?

A

Probably due to less GABA binding so loss of inhibitory effect

32
Q

What are prognostic factors?

A
  • Absence of family history
  • Good premorbid function
  • Acute onset
  • Mood disturbance
  • Prompt treatment
  • Maintenance of initiative and motivation
33
Q

What is the prognosis of schizophrenia?

A
  • Focus on early intervention and better treatments available mean prognosis is better
  • Moderately good long term global outcome in about 50%
34
Q

What is drug induced psychosis?

A
  • Psychosis induced by a psychoactive substance

- Methamphetamine, cannabis, cocaine, amphetamines, LSD, ecstasy, ketamine (but can be pretty much anything!)

35
Q

What are ICD10 criteria for drug induced psychosis?

A
  • Onset of psychotic symptoms during or within two weeks of substance use
  • Persistence of the psychotic symptoms for more than 48 hours
  • Duration of the disorder not exceeding six months
36
Q

What is affective psychosis?

A
  • Psychotic experiences are normally congruent with mood
  • For example, manic patients may have grandiose delusions, hear the voice of God talking to them etc
  • Depressed patients may have delusions of guilt or nihilism, unpleasant auditory hallucinations
37
Q

What is postpartum psychosis?

A
  • Affects 1 in 1000 women
  • Very severe and needs to be recognised quickly to avoid harm to mother or baby
  • Can present in patients with no previous psychiatric history
38
Q

When is postpartum psychosis more common?

A
  • Previous bipolar disorder
  • Psychotic illness
  • Mother or Sister suffered
39
Q

What is the onset of post part psychosis?

A
  • Onset within days to weeks of delivery

- Can develop over hours to days

Nervous System And Neuropsychiatry (20 decks)

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