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PBLs > Week 1 - Schizophrenia > Flashcards

Week 1 - Schizophrenia Flashcards

1
Q

What are positive symptoms of schizophrenia? Give some examples (4)

A

Symptoms that are new or increased experiences

Delusions
Hallucinations
Behavioural changes
Confusion and thought disorder

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2
Q

What are the 4 types of hallucinations a person can experience?

A

○ Auditory. The person most often hears voices in their head. They might be angry or urgent and demand that they do things. It can sound like one voice or many. They might whisper, murmur, or be angry and demanding.
○ Visual. Someone might see lights, objects, people, or patterns. Often it’s loved ones or friends who are no longer alive. They may also have trouble with depth perception and distance.
○ Olfactory and gustatory. This can include good and bad smells and tastes. Someone might believe they’re being poisoned and refuse to eat.
○ Tactile. This creates a feeling of things moving on your body, like hands or insects.

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3
Q

What are persecutors delusions?

A

The feeling someone is after you or that you’re being stalked, hunted, framed, or tricked.

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4
Q

What are referential delusions?

A

When a person believes that public forms of communication, like song lyrics or a gesture from a TV host, are a special message just for them.

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5
Q

What are somatic delusions?

A

These center on the body. The person thinks they have a terrible illness or bizarre health problem like worms under the skin or damage from cosmic rays.

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6
Q

What are eroto-manic delusions?

A

A person might be convinced a celebrity is in love with them or that their partner is cheating. Or they might think people they’re not attracted to are pursuing them.

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7
Q

What are religious delusions?

A

Someone might think they have a special relationship with a deity or that they’re possessed by a demon.

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8
Q

What are grandiose delusions?

A

They consider themselves a major figure on the world stage, like an entertainer or a politician.

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9
Q

What are negative symptoms of schizophrenia? Give some examples (6)

A

Refers to symptoms that represent a decrease in some factor

Anhedonia
Alogia
Affective flattening
Apathy
Self neglect
Avolition

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10
Q

What are cognitive symptoms in schizophrenia? Give some examples which can be affected (6)

A

• Refers to symptoms that affect patient’s thought processes and memory.

	○ Processing speed
	○ Working memory
	○ Attention and vigilance
	○ Verbal learning
	○ Reasoning and problem solving
	○ Social cognition
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11
Q

What is the family link in schizophrenia?

A

• 44% risk for MZ twins
• 15% risk for DZ twins
• Children of non-schizophrenic MZ twin 9x more likely to develop psychosis at some point
• Increased paternal age increases risk

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12
Q

Which ethnicity in the uk is most affected by schizophrenia?

A

Afro Caribbean

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13
Q

What are some psychological links/causes of schizophrenia? (3)

A

Childhood adversity:
• Abuse
• Bullying
• Parental loss or separation

Stressful life experiences (bereavement, job loss, eviction, relationship breakdown)

Migration (from a developing country)

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14
Q

What environmental factors are linked/cause schizophrenia? (6)

A

Obstetric complications:
• Malnutrition
• Viral infections
• Pre-eclampsia
• Emergency C-section

Drug abuse:
• Cannabis use (teenagers)
• Other drugs can cause psychotic symptoms: amphetamines, cocaine, LSD
• High dose corticosteroid use

Socioeconomic status:
• Lower socioeconomic classes
• Urban areas

Exposure to Toxoplasma gondii

Lower childhood IQ
Less developed motor skills

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15
Q

What are delusions of control?

A

The belief that their feelings, thoughts, and actions are being controlled by other people.

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16
Q

What are 1st person auditory hallucinations?

A

patients hear their own thoughts spoken out loud as they think them.

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17
Q

What are elementary auditory hallucinations?

A

are simple sounds e.g. whirring, buzzing, whistling or single words

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18
Q

What are complex auditory hallucinations?

A

occur as spoken phrases, sentences or even dialogue that are sub-classified into first, second, and third person.

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19
Q

What are 2nd person auditory hallucinations?

A

patients hear a voice, or voices, talking directly to them. Second person hallucinations can be persecutory, highly critical, complimentary or issue commands to the patient (command hallucination). These kind of hallucinations can often be mood-congruent -.e. a patient with low mood will more often experience hallucinations of a persecutory or critical nature, and similarly a patient with an elevated mood will more often experience hallucinations of a complimentary nature.

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20
Q

What are 3rd person auditory hallucinations?

A

patients hear a voice or voices speaking about them, referring to them in the third person. This may take the form of two or more voices arguing or discussing the patient among themselves; or one or more voices giving a running commentary on the patient’s thoughts or actions.

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21
Q

Where does the nigrostriatal pathway run to and from?

A

substantia nigra pars compacta –> striatum

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22
Q

What does blockade of the nigrostriatal pathway lead to in schizophrenia?

A

Extra pyramidal side effects

23
Q

List some potential side effects from schizophrenia (6)

A

Suicide
Cardiovascular disease
Substance abuse
Social isolation
Cancer
Financial problems

24
Q

How long can you be detained under section 2 of mha?

A

28 days

25
Q

How long can you be detained for under section 3 of mha?

A

Up to 6 months

26
Q

How long can you be detained under section 5(2) of mha?

A

Up to 72 hours

27
Q

How long can you be detained under section 5(4) of mha?

A

Up to 6 hours

28
Q

What are the 4 stages of assessing capacity?

A
  1. What is the relevant info that the patient needs to make the specific decision?
  2. What steps will you need to carry out to support the patient e.g. family members present, meeting in quiet room
  3. Prove that you have considered all aspects of capacity, complete the functional test
  4. Is there any impairment of mind that could be contributing to the situation
29
Q

What is the functional test for assessing capacity? (4)

A
  1. Can the patient understand the information
  2. Can the patient retain the information
  3. Can the patient weigh up the pros and cons
  4. Can the patient communicate their decision
30
Q

Who is excluded from the mental health act?

A

Anyone under the influence of drugs and/or alcohol is specifically excluded from detainment under the Mental Health Act.

31
Q

What is a section 131 of the mha?

A

Patient self admits themself
Patient must have capacity and consent to the admission

32
Q

What is the purpose of section 2 of mha?

A

Compulsory detention of a patient for assessment

33
Q

Who is involved in recommending a section 2 of the mha?

A

• AMHP/nearest relative
• Two doctors (one must be section 12 approved)

34
Q

What is the purpose of section 3 of the mha?

A

Compulsory detention of a patient for treatment

35
Q

Who is involved in recommending section 3 of the mha?

A

• AMHP/nearest relative
• Two doctors (one must be section 12 approved)

36
Q

What is the purpose of section 4 of the mha?

A

Admission for assessment in cases of emergency

37
Q

How long does a section 4 in the mha last for?

A

72hours

38
Q

What is the purpose of a section 5(2) of the mha?

A

Emergency order to detain an inpatient for an MHA assessment

39
Q

What is the purpose of section 5(4) of the mha?

A

Emergency order to prevent a patient leaving hospital to allow further assessment

40
Q

Which 2 sections of the mha can be recommended by police officers?

A

135
136

41
Q

What is the purpose of section 135 of the mha?

A

Removal of a person from private property to a place of safety

42
Q

How long can a person be detained for under section 135 of the mha?

A

72hours

43
Q

What is the purpose of section 136 of the mha?

A

Removal of a person from a public place to a place of safety without a warrant

44
Q

How long can a person be detained with section 136 of the mha?

A

24hours

45
Q

What are the 5 principles of the mental capacity act?

A

• assume a person has the capacity to make a decision themselves, unless it’s proved otherwise
• wherever possible, help people to make their own decisions
• do not treat a person as lacking the capacity to make a decision just because they make an unwise decision
• if you make a decision for someone who does not have capacity, it must be in their best interests
* treatment and care provided to someone who lacks capacity should be the least restrictive of their basic rights and freedoms

46
Q

What is the difference between primary and secondary psychosis?

A

Primary = cause is a psychiatric disorder
Secondary = cause is a medical condition

47
Q

What are some secondary causes of psychosis? (11)

A

Trauma
Autoimmune
Substance induced
Cerebrovascular
Space occupying lesion
Metabolic disorder e.g. Wilson’s
Dietary disorder e.g. b12 deficient
Infection
Degenerative disorder e.g. dementia, PD
Seizures
Endocrine disorder e.g. thyroid

48
Q

What are the 4 main dopamine pathways in the brain?

A

• Nigrostriatal
• Mesolimbic
• Mesocortical
• Tuberoinfundibular

49
Q

What is hypofunction of the mesocortical dopamine pathway in the brain associated with in schizophrenia?

A

Negative cognition symptoms of schizophrenia

50
Q

Where does the mesocortical pathway run to and from?

A

connects the ventral tegmental to the prefrontal cortex,

51
Q

What is dystonia?

A

Sudden, involuntary muscle contractions result from an imbalance between dopamine and acetylcholine in certain brain regions.

52
Q

What is tardive dyskinesia?

A

Long-term dopamine receptor blockade may lead to hypersensitivity and overactivity of dopamine receptors, resulting in involuntary, repetitive movements.

53
Q

Which antipsychotic group is most likely to cause weight gain symptoms?

A

Atypical antipsychotic

54
Q

What factors affect patients compliance with long term medication? (6)

A
  1. Patient beliefs about the therapy: misconceptions or erroneous beliefs.
  2. Lack of motivation: low motivation to change behaviour; negative attitude towards therapy.
  3. Cognitive impairment: difficulty in adhering to treatment regimens due to forgetfulness, reduced insight and others.
  4. Poor communication with health care provider: providers should have patients involved in designing their treatment plan
  5. Fear of Dependency
  6. Education: lack understanding of the role their therapies play in the treatment

PBLs (19 decks)

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