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Psychiatry > Psychosis and Schizophrenia > Flashcards

Psychosis and Schizophrenia Flashcards

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1
Q

define psychosis

A

mental disorder in which the thoughts, affective response or ability to recognise reality, and the ability to communicate and relate to others are sufficiently impaired to interfere grossly with reality

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2
Q

what are the classic characteristics of psychosis

A

hallucinations
delusions
disorder of the form of thought
lack of insight
inability to distinguish between subjective experience and reality
is harmful to individuals functioning and interpersonal relationships

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3
Q

what can psychosis occur in

A

organic conditions: delirium, dementia, brain injury, stroke

substance use: acute intoxication, withdrawal, delirium tremens

manic depressive psychosis: unipolar depression, bipolar depression
(schizoaffective disorder)
dementia praecox: shizophrenia

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4
Q

what is schizoaffective disorder

A

when someone has symptoms of both schizophrenia and mood disorder (BPAD, depression)

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5
Q

what are types of psychotic experiences

A

hallucinations
ideas of reference (thinking things have strong personal significance)
delusions
formal thought disorder (disorganised thoughts as evidenced by disorganised speech)
thought interference
passivity phenomena
loss of insight

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6
Q

what causes hallucinations

A

aberrent brain processing making you perceive things without stimulus

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7
Q

what is a hallucinations

A

a perception which occurs in the absence of an external stimulus

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8
Q

what are the qualities of a hallucination

A

is experienced as originating in real space (not in thoughts)
has same qualities as normal perception (vivid, solid, compelling)
not subject to conscious manipulation
can occur in any sensory modality: visual, auditory, olfactory, gustatory, tactile, hapatic

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9
Q

when only are hallucinations significant

A

only when in the context of other relevant symptoms

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10
Q

what are ideas of reference

A

innocuous or coincidental events will be ascribed significant meaning by the person:
messages in newspaper about them, news reports commenting on their life/ talking directly to them, knowing peoples conversations/ social media postings are about them, believing a radio station is broadcasting songs in a way to tell you something, seeing meaning in other peoples gestures

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11
Q

what are self referential experiences

A

the belief that external events are related to oneself

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12
Q

what are the qualities of self referential experiences

A

can vary in intensity from a brief thought to frequent and intrusive thoughts to delusional intensity

e.g.
the feeling that others are speaking about me/ laughing at me
the belief that TV or the radio are transmitting messaged aimed at me
the belief that i am the second coming of christ (grandiosity)

persecutory - other people to blame
paranoia- self referential

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13
Q

what is a delusion

A

a fixed, falsely held belief

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14
Q

what are the qualities of a delusion

A

held with unshakable conviction
impervious to logical argument/ evidence to the contrary
held outwith the usual social, cultural, religious and educational background of the patient
may be bizarre or imposisble

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15
Q

what is a primary delusion

A

arrives fully formed in the consciousness without need for explanation

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16
Q

what are the types of delusion

A

Paranoid
Persecutory
Grandiose
Religious
Misidentification- people replaced by imposters (e.g. FBI agents)/ thinking different people are the same person
Guilt
Sin
Poverty
Nihilistic (that you have lost everything are bankrupt is no point. Capgrass- think you are dead)
Of Love/ erotomanic/ De cleramabult- thinking you are in love/ someone in public eye has fallen in love with you
Jealousy- Othello syndrome. This can lead to homicide so red flag
Of reference

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17
Q

what are secondary delusions

A

often attempts to explain anomalous experiences e.g. hallucinations, passivity experiences, depression

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18
Q

what determines the content of a delusion

A

is culturally defined- persecutor is often recognisable to society/ culture as a danger/ threat

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19
Q

how must thought disorders be inferred

A

from patterns in speech-cannot be directly observed

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20
Q

what are types of thought disorder

A

neologisms- make up new words and expect you to know what they mean
circumstantiality (talk around question then make point)/ tangentiality (will talk around point then go off on tangent and not make point)
clanging and punning
loosening of associations/ knights move thinking (sequence of unrelated/ loosely related ideas)
verbigeration/ word salad

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21
Q

what are the types of thought interference

A 
thought insertion (thoughts put into head)
thought withdrawal (thoughts taken out) 
thought broadcasting (everyone can see them)
thought blocking (cant think for a while)
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22
Q

what are the types of passivity

A

volition- made action
affect- made feelings
impulse- made urges
somatic- influence on the body

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23
Q

what questions can you use to carefully challenge someones beliefs

A

What would you say if someone said to you that [these beliefs] are not true?”
“Can you just explain to me how this is possible?”
“I just want to check that I am understanding this correctly, I don’t want to misunderstand you, I think what you are saying is that ……

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24
Q

what condition does 3rd person auditory hallucinations suggest

A

schizophrenia

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25
what conditions can you get formal thought disorder
schizophrenia mania dementia/ delirium
26
what conditions can you get poverty of thought in
schizophrenia (sometimes) depression dementia/ delirium (sometimes)
27
what conditions can you get self referential delusions in
``` schizophrenia substance misuse mania depression dementia/ delirium ```
28
what conditions can you get grandiose delusions in
schizophrenia substance misuse mania delirium/ dementia
29
what conditions can you get persecutory delusions in
``` schizophrenia substance misuse mania depression delirium/ dementia ```
30
what conditions can you get passivity phenomenon in
schizophrenia substance misuse delirium/ dementia
31
what conditions can you get 2nd person auditory hallucinations in
``` schizophrenia (sometimes) substance misuse mania depression delirium/ dementia ```
32
what conditions can you get 3rd person auditory hallucinations in
schizophrenia substance misuse delirium/ dementia
33
what conditions can you get visual hallucinations in
schizophrenia (sometimes) substance misuse delirium/ dementia
34
what conditions do you get fluctuant and variable symptoms
substance misuse | delirium/ dementia
35
what conditions can you get impaired conscious level
``` substance misuse (sometimes) delirium/ dementia ```
36
what is drug induced psychosis
psychotic episode related to substance misuse | not due to intoxication or withdrawal effects
37
what do you need to differentiate drug induced psychosis from
intoxication withdrawal co-morbidities of substance use (schizophrenia and BPAD)- pychotic symptoms in the context of substance misuse does not necessarily mean drug induced pyschosis
38
what are symptoms like in drug induced psychosis
may be florid/ insidious and chronic | tend to be short lasting if access to psychoactive substance is removed
39
what are the features of depressive psychosis
typified by mood congruent content of psychotic symptoms delusions of worthlessness / guilt / hypochondriasis / poverty hallucinations of accusing / insulting / threatening voices - typically 2nd person
40
what are the features of mania with psychosis
mood congruent content of psychotic symptoms delusions of grandeur / special ability / persecution / religiosity hallucinations- auditory, tend to be 2nd person flight of ideas
41
what is delirium
acute transient disturbance caused by e.g. withdrawal, infection, medial/ surgical inpatients...
42
what are the features of delirium
clouding of consciousness - subtle drowsiness to unresponsive, disorientation in time, pace and person, fluctuating severity (lucid intervals), worse at night impaired concentration/ memory (esp for new information) visual hallucination/ illusions / auditory hallucinations (often threatening) persecutory delusions psychomotor disturbance (agitation/ retardation) irritability insomnia
43
what does 'first rank' symptoms of schizophrenia mean
symptoms that are suggestive of schizophrenia, in the absence of drug use or organic impairment, but are NOT pathognomic e.g. can occur in 20% of manic episodes
44
what are the core psychotic symptoms of schizophrenia (first rank symptoms)
``` delusion delusional percept auditory hallucinations audible thoughts voices arguing/ discussing voices commenting on patients action thought disorder: passivity thought interference (withdrawal, insertion, broadcasting) passivity experiences (delusion of control): affect, impulse, volition, somatic ```
45
what person are auditory hallucinations in schizophrenia commonly in
3rd person
46
what is the diagnostic criteria for schizophrenia
(1) At least one of the following: Thought echo, thought insertion or withdrawal, or thought broadcasting. Delusions of control, influence or passivity, clearly referred to body or limb movements or specific thoughts, actions, or sensations; delusional perception. Hallucinatory voices giving a running commentary on the patient's behaviour, or discussing him between themselves, or other types of hallucinatory voices coming from some part of the body. Persistent delusions of other kinds that are culturally inappropriate and completely impossible (e.g. being able to control the weather, or being in communication with aliens from another world). (2) or at least two of the following: Persistent hallucinations in any modality, when occurring every day for at least one month, when accompanied by delusions (which may be fleeting or half-formed) without clear affective content, or when accompanied by persistent over-valued ideas. Neologisms, breaks or interpolations in the train of thought, resulting in incoherence or irrelevant speech. Catatonic behaviour, such as excitement, posturing or waxy flexibility, negativism, mutism and stupor. "Negative" symptoms such as marked apathy, paucity of speech, and blunting or incongruity of emotional responses (it must be clear that these are not due to depression or to neuroleptic medication).
47
what are three subtypes of schizophrenia
paranoid (most common) hebephrenic (immature/ innapropriate/ silly) catatonic (movement disorder predominates, responds well to treatment- will hold posture for longer than you voluntarily could, will hold pose you put them in, wont respond to speech)
48
what are 4 other form of paranoid psychosis
Persistent Delusional Disorder Systematised, fixed delusions the majority/ only feature Schizotypal disorder Eccentricity and aloofness, social withdrawal, paranoid quasi-delusional ideas, magical thinking, and transient auditory hallucinations Acute and Transient Psychotic Disorder Schizophernia-like symptoms, lasting < one months Schizoaffective Disorder (bipolar + SZP) First rank symptoms + depression/ mania
49
what are the positive syndromes in schizophrenia
hallucinations delusions passivity disorder of form of thought
50
what are the negative syndromes in schizophrenia
``` reduced speech reduced motivation/ drive reduced interest/ pleasure reduced social interaction blunting of affect ```
51
who gets schizophrenia
lifetime risk 1% more common in males onset in young adults (15-25 males, 25-35 women) higher incidence in lower socioeconomic class
52
what are the risk factors for schizophrenia
genetics UK african-caribbean birth complications (prematurity, prolonged labour, fetal distress, hypoxia) prenatal exposure to viral infections, maternal stress, malnutrition winter/ spring birth drug use (cannabis) urban dwelling social adversity/ deprivation neurodevelopmental changes (enlarged ventricles, thinner cortices) neurochemical changes (excess dopamine signalling)
53
what are the premorbid features of schizophrenia
subtle motor, cognitive and social deficits in childhood | become greater as time goes on
54
what are the prodromal features of schizophrenia
gradual onset of non specific symptoms odd ideas and experiences eccentricity, altered affect, odd behaviours
55
what is the prognosis of schizophrenia
1/3rd only have one episode, are treated and return to wellness 1/3rd have repeated episodes returning to wellness inbetween 1/3rd have recurrent episodes but residual symptoms, dont return to wellness, decline over time
56
what are poor prognostic indicators for schizophrenia
``` poor pre morbid adjustment insidious onset early onset - childhood/ adolescence long duration of psychosis cognitive impairment enlarged ventricles ```
57
what are good prognostic indicators for schizophrenia
``` older age of onset female marked mood disturbance especially elation family history of mood disorder shorter time of untreated psychosis ```
58
how common is suicide in schizophrenia
10-15% completed suicide rate | high risk in first week after discharge
59
how common is homicide in schizophrenia
rare | take notice of command hallucination and delusions of jealousy
60
what causes schizophrenia
genetically disposed | mediated or exacerbated by environmental factors
61
what is the heritability of schizophrenia
79%
62
do opiates cause psychosis
no
63
what drugs increase the risk of schizophrenia
amphetamines cocaine cannabis novel psychoactive substances

Psychiatry (27 decks)

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