Schizophrenia Flashcards
First rank symptoms
- Auditory hallucinations: commenting on patient’s behaviour, two or more discussing patient in third person, repeating or anticipating thoughts
- Thought alienation: insertion, deletion, broadcasting
- Passivity phenomena: bodily influence, experiences imposed on individual
- Delusional perceptions: normal object perceived → delusional belief
NOTE: not that sensitive or specific
ICD-10
Clearly present most of the time for 1 month or more
At least one very clear or two or more less clear symptoms from:
a) thought echo, withdrawal, insertion or broadcasting
b) delusions of control, influence or passivity, clearly referred to body or limb movements or specific thoughts, actions or sensations; delusional perceptions
c) hallucinatory voices giving a running commentary on the patient’s behaviour, or discussing the patient among themselves, or other types of hallucinatory voices coming from some part of the body
d) persistent delusions of other kinds that are culturally inappropriate and completely impossible, such as religious or political identity, or superhuman powers and abilities
OR at least two symptoms from:
e) persistent hallucinations in any modality, accompanied by either fleeting or half-formed delusions without clear affective content, or by persistent overvalued ideas
f) breaks or interpolations in train of thought → incoherent or irrelevant speech, or neologisms
g) catatonic behaviour eg. excitement, posturing, waxy flexibility, negativism, mutism and stupor
h) ‘negative’ symptoms eg marked apathy, paucity of speech → social withdrawal and lowering of social performance. It must be clear these are not due to depression or neuroleptic medication
OR (simple schizophrenia):
i) significant and consistent change in overall quality of some aspects of personal behaviour, manifested as loss of interest, aimlessness, idleness, a self-absorbed attitude and social withdrawal.
Prodromal and residual symptoms
Marked social isolation and withdrawal Impairment in social role (eg wage earner) Peculiar eccentric behaviour Poor personal hygiene Blunted or inappropriate affect Vague speech Odd beliefs Unusual perceptual experiences Lack of initiative or energy
Positive features of schizophrenia
Seen during acute phase: Hallucinations Delusions Ideas of reference Thought disorder - abnormal patterns of thought reflected in speech, characterised by loss of associations
Negative features of schizophrenia
More chronic, responsible for long term social impairment: Social withdrawal Emotional blunting Underactivity Lack of motivation
Subtypes
Simple
Hebephrenic
Paranoid
Catatonic
Simple schizophrenia
Negative symptoms predominate
Hebephrenic schizophrenia
Mood inappropriate with giggling and shallowness, behaviour is irresponsible. Delusions and hallucinations are fragmented. Thoughts disorganised. Onset typically 15-25.
Paranoid schizophrenia
Complex delusions and hallucinations. Delusions may be persecutory, grandiose or religious
Catatonic schizophrenia
Psychomotor disturbances varying from stupor to sudden outbursts of activity. Waxy flexibility, automatic obedience and negativism.
Epidemiology
Equal both sexes
More common in deprived socially isolated areas of large cities, but most likely because patients drift there
Genetics
Theories
Dopamine
Neurological insult at early age/perinatally
Genetics
Good prognosis associated with
Sudden onset
Precipitants
Family history of affective illness
Good premorbid adjustment
Poor prognosis associated with
Early and/or insidious onset Lack of precipitants Lack of affective components Abnormal pre-morbid personality Family history Exposure to high expressed emotion in the patient's family Low IQ Negative symptoms
With treatment, average outcome rates:
25% good recovery
50% chronic fluctuating course
15% continuous symptoms requiring long term care
10% severe incapacity
