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
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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
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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
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