Session 12 L2: Schizophrenia Flashcards
What is the definition of psychosis?
Presence of hallucinations or delusions. Describes symptoms, not a diagnosis in itself
What are hallucinations?
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
What are some examples of hallucination in the normal population?
Hypnogogic – Going to sleep
Hypnopompic – Waking up
What are delusions?
Abnormal belief, outside of cultural norms, that is unshakeable
What are some positive symptoms of schizophrenia?
- Delusions
- Hallucinations
- Thought disorder
- Lack of insight
What are negative symptoms of schizophrenia?
- Underactivity
- Low motivation
- Social withdrawal
- Emotional flattening
- Self-neglect
What are some negative symptoms of schizophrenia?
- Underactivity
- Low motivation
- Social withdrawal
- Emotional flattening
- Self-neglect
What are first rank symptoms in schizophrenia?
- Auditory hallucination
- Passivity Experience
- Thought withdrawal, broadcast or insertion
- Delusional perception
- Somatic hallucinations
What are auditory hallucinations?
- 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
What is a passivity experience?
Patient believes an action or felling is caused by external force
What is thought withdrawal, broadcast or insertion?
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
What are delusional perceptions?
- 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
What is a somatic hallucination?
Mimics feeling from inside
What is the ICD10 diagnosis criteria for schizophrenia?
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
What are the types of schizophrenia?
- Paranoid Schizophrenia
- Simple schizophrenia
- Hebephrenic schizophrenia
- Undifferentiated schizophrenia
- Catatonic schizophrenia
What is paranoid schizophrenia?
Delusion or hallucinations prominent
What is simple schizophrenia?
Loss of drive and interest, aimlessness, idleness, self-absorbed attitude and social withdrawal. Marked decline in social, academic or work performance. No hallucinations/delusions
What are Hebephrenic Scizophrenia?
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
What is Undifferentiated Schizophrenia?
Insufficient symptoms to meet criteria of any subtypes or so many symptoms fit more than one criteria
What are the theories associated with the pathophysiology of schizophrenia?
- Dopamine Pathways (most common)
- Brain changes
- Limbic pathway
- Basal Ganglia
- Autoimmune hypothesis
What are the dopamine pathways associated with schizophrenia?
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
What are the brain changes associated with the pathophysiology of Schizophrenia?
- Enlarged ventricles
- Reduced hippocampal formation, amygdala, para-hippocampal gyrus and prefrontal cortex
Why is the limbic pathway associated with schizophrenia?
-Role in regulating emotional behaviour
What is the basal ganglia involvement in the pathophysiology of Schizophrenia?
- Even untreated patients can present with motor symptoms.
- Nigostriatal pathway from the substantia nigra pars compacta to the striatum
What is the autoimmune hypothesis of schizophrenia?
- Anti-NMDA encephalitis
- Antibodies bind to NMDA receptor, and the receptor is internalised which leads to hypofunction.
- Treated with corticosteroid and intravenous immunoglobulin
Describe the typical antiphysichotic used fo rshizophrenia?
- Block D2 receptors in all CNS dopaminergic pathways
- Main action is on mesolimbic and mesocortical pathways
- Side effects are problems
Describe the atypical antipsychotic used fo schizophrenia?
- Low affinity for D2 receptors
- Milder side effects as dissociate rapidly from D2 receptors
Where are D2 receptors found?
- Striatum
- Substantia Nigra
- Pituitary Gland
How do D2 receptor work?
Work via Gi receptors
What is Catatonia?
More than two weeks, one or more of
- Stupor / mutism
- Excitement
- Posturing
- Negativism
- Rigidity
- Waxy flexibility
- Command automatism
Why do untreated patient develop catatonia if dopamine promotes movement?
Probably due to less GABA binding so loss of inhibitory effect
What are prognostic factors?
- Absence of family history
- Good premorbid function
- Acute onset
- Mood disturbance
- Prompt treatment
- Maintenance of initiative and motivation
What is the prognosis of schizophrenia?
- Focus on early intervention and better treatments available mean prognosis is better
- Moderately good long term global outcome in about 50%
What is drug induced psychosis?
- Psychosis induced by a psychoactive substance
- Methamphetamine, cannabis, cocaine, amphetamines, LSD, ecstasy, ketamine (but can be pretty much anything!)
What are ICD10 criteria for drug induced psychosis?
- 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
What is affective psychosis?
- 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
What is postpartum psychosis?
- 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
When is postpartum psychosis more common?
- Previous bipolar disorder
- Psychotic illness
- Mother or Sister suffered
What is the onset of post part psychosis?
- Onset within days to weeks of delivery
- Can develop over hours to days
