Session Five (Schizophrenia) Flashcards
1
Q
Describe the stigma around schizophrenia in UK society?
A
- Surveys have found most Brits think of Sz patients as dangerous, unpredictable and impossible to treat.
- Significant issues around finding and keeping work.
- These issues are fueled by popular media who paint people with Sz as “Schizos”?
2
Q
Briefly describe some of the historical perspectives of Sz?
A
- Historical treatment; Long term institutionalisation, restraint, sedation, anything to calm the patients to make them easier to manage
- Kraepelin described 2 debilitating and untreatable neurological disorders with no obvious causes; Manic depressive insanity, Dementia praecox (marked by hallucinations, delusions, incoherent speech, blunted emotions, lack of insight. Early Sz diagnosis)
- Bleuler coined the term Sz, and described it as a loosening of the associations between the different functions of the mind; thoughts, emotions, co-ordination, cognitions become separate and fight for control.
- Schneider revolutionised the field by focusing not on the contents of the delusions but on the CONVICTIONS with which they were held. Described 1st rank symptoms, which if present he said could distinguish Sz from psychosis
3
Q
What are Schneider’s 1st rank symptoms?
A
- Thought broadcasting
- Thought insertion
- Thought withdrawal
- Third person hallucinations
- Running commentary
- Thought echo (think a thing, hear that thought back a couple of seconds later)
- Made feelings and impulses (I’m not unhappy, they are projecting unhappiness into my brain)
- Delusions of control
- Delusional perception
4
Q
What are the positive symptoms of psychosis?
A
- Delusions (paranoid delusions, beliefs that comments on the tv or radio are directed at the self)
- Perceptual Abnormalities (distortions or exaggerations of perception in any of the senses, auditory or visual are most common)
- Thought disorder (key aspect, tangential speech, lack of association, incoherent)
- Disorganised behaviour (agitation, social inhibition, odd behaviours, difficulty with goal-directed behaviour, purposelessness)
5
Q
What are the negative symptoms of Sz?
A
AAA:
- Affective flattening (reduction in range and intensity of emotional expression, tone of voice, eye contact, body language)
- Alogia (poverty of language, reduction in fluency and productivity of language. reflects thought slowing or blocking)
- Avolition (reduction, difficulty or inability to initiate and persist in goal-directed behaviours e.g. loss of interest in social activities)
6
Q
What scoring system is used for Schizophrenia?
A
PANSS (Positive and Negative Syndrome Scale)
Scores based on 30 items on a 7 point scale. Items divided into:
- Positive (delusions, hallucinations, excitement, conceptual disorganisation..)
- Negative (blunted affect, withdrawal, poor rapport, lack of spontaneity)
- General (anxiety, guilt feelings, tension, depression, motor retardation, unusual thought content…)
7
Q
Why can it sometimes be difficulty to diagnose Sz properly?
A
- “Psychosis” refers to the presence of hallucinations, delusions and odd behaviour
- These are viewed as classic of Schizophrenia, but all can also be caused by organic conditions, substance abuse disorders, depression, bipolarism.
- Further confusing this is the fact many schizophrenics have co-morbidities that include depression and substance abuse disorders
- Furthermore, most diagnostic models fall victim to issues relating to cultural bias (misinterpretation of normal behaviour as abnormal) or pathologising of behaviour that is just unusual (e.g. eccentricity)
8
Q
What are some benefits of both the ICD and DSM diagnostic manuals for Sz?
A
- ICD makes a distinction between first onset Schizophrenia and multiple episode Schizophrenia. This emphasises how different these presentations are and allows them to be treated more effectively.
- DSM uses a multi-axial approach that allows us to gain a greater picture of the patient as a whole.
(Ax1 = The actual disorder, Ax2 = Personality disorder and mental retardation, Ax3 = General medical condition, Ax4 = Psychosocial and environmental factors surrounding the patient, Ax5 = Global assessment of function). This approach allows view the patients condition as a whole.
9
Q
What are the broad similarities between the DSM and ICD definitions
A
Both use a: - At least one of... - Or two of.... - For a duration of... - With an absence of... Criteria
10
Q
What are some of the subtler symptoms of Sz worth bearing in mind?
A
Poor rapport with therapist/interviewer and difficulty in holding a regular conversation due to tangental nature of speech are actually very common signs of the condition.
11
Q
What is the Psychosis Continuum?
A
- Theory outlined by John et al in 2004
- Looked into how common vaguely psychotic symptoms are
- Found that 5.5% of people suffered one or more items associated with Sz without having a psychotic disorder
- True subclinical psychotic experiences prevalence = 8%
- Half of which are associated with a degree of distress.
- Suggests behaviours we brand as abnormal may just be severe versions of actually normal behaviour.
- A meta-analysis by van Os et al supports this
12
Q
What evidence is there that Schizophrenia may not even exist?
A
- John et al found that minor psychotic symptoms are prevalent in the general population.
- These minor symptoms are correlated with things like Low IQ, Low education, Living in cities, Cannabis dependence, Life events, Neuroticism and Being an ethnic minority
- All of which are notable risk factors for Sz
- Provides further support for the idea that Sz may not be a condition in and off itself but a more severe version of very common psychotic symptoms.
- Therefore perhaps not a CATEGORICAL illness, rather a continuum.
- However there are issues of cause and effect here, to what extent are low IQ, education, etc caused by Sz rather than the other way around.
13
Q
Schizophrenia may not be a distinct condition but an extreme form of a normal variant. What might this imply about diagnosis?
A
- Suggests Sz may not be a categorical definition but rather one that exists on a continuum
- Also suggests diagnosis may not be necessary.
- Avoiding diagnosing someone with Sz is a good way of avoiding stigma
- BUT diagnosis is still necessary for effective treatment.
- A categorical division between healthy and unhealthy should only be made at the point it seems useful to initiate treatment.
14
Q
What is the Psychosis Prodrome?
A
- Period characterised by mental state features that represent a change from a person’s premorbid functioning
- For Sz, the age to look for this in is 18-35
3 Broad features to look out for:
- Attenuated psychosis syndrome
- Brief limited intermittent psychosis (<7 days)
- Family history of psychosis and a decline in global functioning (general health)
MRI studies have managed to identify grey matter volume alterations prior to the onset of psychosis. 31% transitioned to psychosis (Pantelis et al 2003)
15
Q
Who is more at risk of developing Sz?
A
- Men (also have earlier onset)
- People of low SE group
- People in urban areas
- Homeless people
16
Q
What is the impact of Sz on a person’s life expectancy?
A
- Reduces it by 20-25 years
- 5-10% die by suicide
17
Q
What causes Sz?
A
- Brief answer, no idea.
- Sz is an etiologically complex disorder arising from the interaction of a range of factors acting at various stages of life.
- Some genetic elements, as evidenced by MZ twin studies
