1 - PSY - Psychosis and Schizophrenia Flashcards Preview

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Flashcards in 1 - PSY - Psychosis and Schizophrenia Deck (23):
1

define psychosis - including?

state in which there is a loss of contact with reality - including hallucinations, delusions, formal thought disorder

2

define hallucination

percept without object - experienced in external space

3

define delusions

pathological belief - cannot be rationalised away, held with no proof, personal significance, not based in pts culture/faith

4

define formal thought disorder

pattern of disordered language reflecting disordered from of thought - derailment, flight of ideas, circumstantial/tangential thoughts

5

positive symptoms of schizophrenia

delusions
hallucinations
disorganised behaviour
thought disorder

6

negative symptoms of schizophrenia

social withdrawal
avolition
poverty of speech
reduced attention
blunted affect

7

schneiders first rank symptoms of schizophrenia...

A - auditory hallucinations
B - broadcasting of thought
C - controlled thought (delusions of control including passivity)
D - delusional perception

8

Give examples of these symptoms:
Thought echo-
Third person auditory hallucinations-
delusional perception-
made volition-
somatic passivity

- hearing thought spoken aloud
- voices referring to pt as "he/she"
- ascribes a delusional idiosyncratic value to a percept - "heard bell ring and I knew i would win wimbledon"
- pt reports their will is under external control
- sensations in body believed to be controlled by external force

9

Organic causes of psychosis - 5 areas

-delirium
-medication - steroids, stimulants, dopamine agonists
- endocrine - cushings, hyper/hypothyroidism
- neuro disorder - ms, huntingtons and wilsons, epilepsy
-systemic diseases - SLE

10

Schizophrenia diagnostic criteria

Sx > 28 days
no organic cause found
first rank symptoms/persistent hallucinations and delusions
may also have negative/cognitive symptoms

11

Schiz epidemiology - lifetime risk? m to f? peak incidence?

1/100 roughly
m=f
m 23yo
f 26yo
urban>rural

12

Schiz aetiology
- bio - 3
- psycho - 2
- social - 4

bio - genetic factors FHx, obstetric complications increase risk, dopamine theory (how AP meds work)
psycho - cognitive errors, premorbid person (schizotypal disorder)
socail - migration, urban living, life events, ethnicity

13

Prodrome

when pt gradually develops symptoms before meeting diagnostic criteria - negative Sx, distress/agitiation, transient psychotic Sx

14

Good prognostic factors for schiz

female
acute onset
early Tx
prominent mood Sx

15

Poor prognostic factors

high expressed emotion
substance misuse
prominent negative Sx
early onset
No insight/compliance

16

Investigations - physical?

examination
bloods
urine for drugs (probs most important)
ECG
others if indicated

17

Investigations - psychosocial

collateral history

if indicated - OT assessment, social assessment, carer assessment

18

common reasons for non compliance

lack of insight, SE of meds, med/prescriber delusions, pt feels better when "ill", pt think meds not required after remission

19

what physical health problems are schiz pts more at risk of

CV disease, diabetes, stroke
due to AP increasing risk of metabolic syndrome, smoking, poor diet and exercise

20

Treatment resistant schiz - define?

lack of response to adequate doses of 2 diff AP's

21

Treatment resistant schiz - do what before diagnosing?

review diagnosis
rule of co morbid substance misuse
ensure dose,duration and compliance with prev treatment

22

Treatment resistant schiz- what drug? risks? monitoring? other SE's?

Clozapine, neutropenia + (rare) fatal agranulocytosis

FBC for 18weeks, then every 2 weeks for a year, then every 4 weeks

hypersalivation, cardiomyopathy, myocarditis, dm and sezures

23

Psychological treatment of schiz

Cbt, family intervention therapy, psychoeducation

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