Psychotic Disorders Flashcards
(36 cards)
What is psychosis?
Psychosis is a term used to describe a person experiencing things differently from those around them.
What are some features of psychosis?
hallucinations (e.g. auditory)
delusions
thought disorganisation
alogia: little information conveyed by speech
tangentiality: answers diverge from topic
clanging
word salad: linking real words incoherently → nonsensical content
Associated features with psychosis
agitation/aggression
neurocognitive impairment (e.g. in memory, attention or executive function)
depression
thoughts of self-harm
Symptoms of psychosis
schizophrenia: the most common psychotic disorder
depression (psychotic depression, a subtype more common in elderly patients)
bipolar disorder
puerperal psychosis
brief psychotic disorder: where symptoms last less than a month
neurological conditions e.g. Parkinson’s disease, Huntington’s disease
prescribed drugs e.g. corticosteroids
certain illicit drugs e.g. cannabis, phencyclidine
Peak age of first-episode psychosis ?
The peak age of first-episode psychosis is around 15-30 years.
What is Schizoaffective disorder ?
Schizoaffective disorder combines the symptoms of schizophrenia with bipolar disorder. Patients have psychosis and symptoms of depression and mania
What is Schizophreniform disorder ?
Schizophreniform disorder presents with the same features as schizophrenia but lasts less than six months.
What is schizophrenia?
Schizophrenia is a severe, long-term mental health disorder characterised by psychosis. It most often presents between ages 15 and 30 and earlier in men than women. The symptoms must be present for at least six months before schizophrenia is diagnosed.
Simple explaination of schizophrenia for patients
Schizophrenia is a condition that affects how the brain processes information. Normally, the brain is very good at understanding reality, deciding what is important and what is not, and organising thoughts in a structured way. With schizophrenia, the brain struggles to understand the world, makes mistakes in deciding what information is important and organises thoughts in a confused way. This can lead to strong beliefs that do not fit with reality, called delusions. They may also experience voices that are not there, called hallucinations. The disorganised thoughts can lead to unusual speech and behaviours, which is called thought disorder. When these symptoms occur, it is called psychosis
Differential Dx for schizophrenia / psychosis
Mania
Psychotic depression
Drugs (e.g., hallucinogens and cannabis)
Stroke
Brain tumours
Cushing’s syndrome (e.g., patients taking systemic steroids)
Hyperthyroidism
Huntington’s disease
Causes of schizophrenia
Schizophrenia is considered to be the result of genetic and environmental factors. Specific genes that increase the risk of schizophrenia have been identified. Having an affected family member is a risk factor.
Prodome phase of schizophrenia
A prodrome phase often precedes the full symptoms of psychosis. During this prodrome phase, the patient may experience subtle symptoms, such as poor memory, reduced concentration, mood swings, suspicion of others, loss of appetite, difficulty sleeping, social withdrawal and decreased motivation.
Key features of psychosis in schizophrenia
Psychosis is the central feature of schizophrenia. The key features of psychosis, called positive symptoms, are:
Delusions (beliefs that are strongly held and clearly untrue)
Hallucinations (perceiving things that are not real)
Thought disorder (disorganised thoughts causing abnormal speech and behaviour)
What is “Lack of Insight” in schizophrenia?
Lack of insight is an important feature of psychosis. They lack awareness that the delusions and hallucinations are not based in reality.
Positive symptoms for schizophrenia
Auditory hallucinations (hearing voices, particularly a voice narrating the patient’s actions)
Somatic passivity (believing that an external entity is controlling their sensations and actions)
Thought insertion or thought withdrawal (believing that an external entity is inserting or removing their thoughts)
Thought broadcasting (believing that others are overhearing their thoughts)
Persecutory delusions (a false belief that a person or group is going to harm them)
Ideas of reference (a false belief that unconnected events or details in the world directly relate to them)
Delusional perceptions
What is delusional perception in schizophrenia?
A delusional perception occurs when the patient experiences an ordinary and unremarkable perception (e.g., a cat crossing the road) that triggers a sudden, often self-related delusion (e.g., “and I knew I would be meeting the aliens on behalf of humanity”).
What are negative symptoms for schizophrenia?
Negative symptoms of schizophrenia include the four As:
Affective flattening (minimal emotional reaction to emotive subjects or events)
Alogia (“poverty of speech” – reduced speech)
Anhedonia (lack of interest in activities)
Avolition (lack of motivation in working towards goals or completing tasks)
What is “reduced levle of functioning” in schizophrenia?
A reduced level of functioning is an important feature. This involves reduced or impaired:
Social engagement
Productivity and achievement at work or school
Self-care
Patterns in schizophrenia
Schizophrenia may involve different patterns of symptoms. When observed over time (e.g., over at least one year), the active-phase symptoms of psychosis may be:
Continuous
Episodic (relapsing and remitting)
A single episode only
How is schizophrenia diagnosed?
A specialist will make the diagnosis based on the DSM-5 criteria. The symptoms (including the prodrome phase) must have been present for at least six months, with symptoms of the active phase (delusions, hallucinations, and thought disorder) present for at least one month (or less if treatment is successful).
Management of schizophrenia
A specialist psychiatry service will manage patients with schizophrenia:
Early intervention in psychosis services are available for the first episodes of psychosis
Crisis resolution and home treatment teams provide urgent support for patients in a crisis
Acute hospital admission (under the Mental Health Act when required)
Community mental health team for ongoing monitoring and management
Tx for schizophrenia
Antipsychotic medications
Cognitive behavioural therapy
Monitoring for Tx for schizophrenia
Key associations with schizophrenia and antipsychotic drugs are metabolic syndrome and cardiovascular disease. Physical health is monitored, including smoking status, alcohol consumption, illicit drug use, weight, activity levels, blood lipids and glucose, with interventions when indicated (e.g., smoking cessation and statins).
How do antipsychotic medications work?
Antipsychotic medication work by inhibiting dopamine receptors, specifically D2 receptors.
