T3L3 schitzophrenia clinical aspects Flashcards
neurosis vs psychosis
neurosis:
- anxiety disorders
- depressive disorders
- OCD
- adjustment disorders
- somatisation disorders (phantom pain)
psychosis:
- organic
- schizophrenia
- bipolar
- depressive psychosis
what is psychosis
- illness characterised by loss of boundaries with reality and loss of insight, with primary features of delusions and hallucination
psychotic episode- 1 week of these symptoms at significant severity
what is delusion
- belief held firmly but on inadequate grounds, not affected by rational argument or evidence to the contrary, and not shared by someone of similar age, educational, cultural, religious or social background.
types:
- nihilistic
- persecutory
- primary (delusional perception)
- due to error of salience of attribution
- context of often has particular relevance - religious, persecution, controlled by impant, responsibility for world tragedy, followed by seagulls
what is hallucination
a perception experienced in the absence of an external stimulus
- in any sensory modality but auditory is commonest in psychosis
schneiders first rank symptoms
- auditory hallucinations
- somatic hallucinations
- thought insertion/withdrawal/broadcast
- passive phenomena- acts/impulses/affect
- delusional perception
ICD 10 diagnosis of schizophrenia
minimum of 1 a-d or 2 of e-f for at least a month:
a Thought echo, insertion, withdrawal or broadcast
b Delusion of passivity or delusional perception (e.g. the toilet flushed and then I knew)
c Running commentary hallucination or 2 voices discussing the patient
d Persistent delusions of other kinds
e Persistent hallucinations in any modality with accompanying brief delusions
f Breaks in thought resulting in abnormal speech (eg. incoherent, neologisms)
g Catatonic behaviour eg. Excitement, posturing, waxy flexibility, negativism
h Negative symptoms not due to depression or medication
schizophrenia differential diagnosis
Affective psychosis:
Bipolar disorder
Depressive psychosis
Schizoaffective disorder
Organic psychosis:
Epilepsy (temporal lobe)
Infections: encephalitis, subacute sclerosing panencephalitis, neurosyphillis, HIV
Cerebral trauma
Cerebrovascular disease
Demyelination: Multiple sclerosis etc
Neurodevelopmental disorders: velocardiofacial syndrome
Endocrine: thyroid disorders (hyper and hypo), Cushing’s syndrome,
Metabolic: hepatic failure, uraemia
Immunological: SLE
Acute drug intoxication: eg. Ketamine, Cannabis, LSD, PCP, Amphetamine,
Toxins eg. lead
Dementias
Personality disorder
clinical signs of schizophrenia
- could be none
- self neglect
- talking to themselves
- social disturbance
- posture
- clothing
side effects of medication
- tremor
- weight gain
- skin discolouration
how to make scitz diagnosis
- clinical interview
- no lab tests
- mental state exam
mental state exam
“a snap shot” in psychiatry of a person’s presentation
Appearance Behaviour Speech Mood and Affect Thought form (e.g. the way the thoughts are forming) Thought content (what you are talking about e.g. delusions) Hallucinations Insight Cognition
ACUTE SCITZ SYNDROME mental state exam- type I
Appearance Preoccupied and withdrawn to restless and unpredictable
Mood Blunting of mood, disinhibition, perplexed, anxious
Disorder of thinking Vague, Formal thought disorder (loosening of associations)
Disorders of stream (thought block)
Delusions Primary, secondary
Hallucinations Auditory, visual, tactile (somatic), olfactory, gustatory
Insight Impaired
Cognition Normal orientation
and memory (initially)
CHRONIC SCITZ SYNDROME mental state exam - type II
Appearance and behaviour Lack of drive and activity. Social withdrawal.
Self neglect
Movement abnormalities Stupor, Catatonia, abnormal movements and tone
Mood Depression. Blunting of Affect
Delusions as in acute syndrome
Hallucinations as in acute syndrome
Insight Impaired
Cognition Normal orientation
but often cognitive decline.
epidemiology
- 1%
- increase in migrants
- increase in afro carribean
- men earlier onset and more -ve symptoms
- lower social class
course and prognosis of sxitz
s22 s23 s24
20% complete recovery
25% persistent symptoms (bad)
50% relapsing remitting illness with some functional impairment between illnesses
good prognosis:
- female
- married
- good premorbid function
- early treatment
bad prognosis:
- male
- single
- fam history
- long duration untreated
weed
increases vulnerability to psychosis
- bigger impact younger
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