Schizophrenia and Psychosis Flashcards
What are the symptoms of schizophrenia?
Acute schizophrenia - positive symptoms
- Hallucination - Delusion - Interference with thinking - Some recover, some progress to…
Chronic symptoms - negative symptoms
- catatonism - Lack of drive - retardation - Social withdrawal
Positive symptoms respond well to anti-psychotic treatments, when progress into chronic makes it harder to treat.
What is hallucination
False perception without an external stimulus
* Auditory: running commentary; voices discussing the person in third person; hearing one's own thoughts aloud (thought echo) * Visual: may suggest an organic brain disease * Olfactory: smelling gas * Gustatory: can taste 'poison' in food * Tactile: insects crawling upon skin, sexual sensations
Tactile - very common in delirium treatments in alcohol intoxication. Sexual sensations can be common if the patient has delusional love affairs etc.
What is delusion?
- A false, fixed belief
- Firmly held belief, despite evidence to the contrary
- Not in keeping with the patient’s socio-cultural background
- Grandiose (‘special gifts’), persecutory and bizarre
- Religious pattern for those who have faith
What is Schneider’s first rank symptoms of schizophrenia, also the ICD 10 criteria for diagnosing schizophrenia?
Proposed this group of symptoms but said they were in no way essential to diagnose schizophrenia.
Perception is real but perceived in a delusional way.
what are the positive symptoms
positive symptoms – any change in behaviour or thoughts, such as hallucinations or delusions.
what are the negative symptoms
negative symptoms – where people appear to withdraw from the world around then, take no interest in everyday social interactions, and often appear emotionless and flat.
About F20.0 paranoid schizophrenia
The most common type.
Negative symptoms can be present but must not dominate the positive symptoms.
About F20.1 hebephrenic schizophrenia
This presentation is getting much more rate in industrialised countries
What is the epidemiology of schizophrenia?
Prevalence around 1% of population, and this is the same anywhere in the world.
Does schizophrenia have a genetic component
There is a very strong relationship with genetics
Prevalence of Schizophrenia
Prevalence around 1% of population, and this is the same anywhere in the world.
Neuroimaging of schizophrenia
Haas been proved that there are some structural changes in the brains of patients with schizophrenia. Interestingly, none of them are specific for schizophrenia however, so they can’t be used as diagnostic criteria.
Neuroimaging can help to exclude other causes - organic causes.
- Enlarged lateral ventricles
- L. Temporal lobe abnormalities
- Broca’s area (responsible for speech light up in fMRI)
in hallucinations (since they are misperceptions of
someones own internal thoughts) - Brain volume reduction 3%
- Significant loss of grey matter , up to 25%
- Parietal, temporal, frontal loss
- Have abnormal brains before starting medication
Illusion VS Hallucination
Illusion - there is a stimuli but you’re not receiving it as it is, its just been changed for you. Hallucination is different as there is no stimuli there in the first place.
What are the psychological factors triggering schizophrenia
-Stereotyping -‘Schizophrenogic mother’- the mothers fault / due to parenting
-Double bind - in period of development, if parents are communicating with the child in a confusing way - calling to a child but sounding like rejection.
-Expressed emotion- such as constant arguments, over engaged family
Predicts relapse
-Life events
What is the social learning theory
Learning behaviour form others e.g. parents, and it is reinforced by the parents continuing to behave in this way
About antipsychotic medication for schizophrenia
Good evidence to treat acute schizophrenia - mainly for positive symptoms
What are the side effects of antipsychotic medication for schizophrenia?
Extra pyramidal side effects - shakes, movement problems, rigidity, involuntary facial movements, eye rolling etc.
Can get so bad that people may have to stop treatment.
Course and outcome of schizophrenia
Roughly half patients have multiple episodes…Static impairment means that it isn’t getting worse.
Duration of untreated psychosis (DUP) is a predictor of outcome- so the longer people go untreated, the worse the outcome.
2 fold increase in standardised mortality ratio
- Higher suicide rate (?up to 7%, usually near onset)
- Physical health- Higher rate of MI, stroke, diabetes
- 80-90% smoke versus 20% general population
What is the difference between neurosis and psychosis?
Neurosis is anything where you feel negative. Psychosis is where you lose touch with reality and you lose insight, which is the critical distinction. You don’t know that you are ill if you are psychotic. This makes it more dangerous as you don’t seek help and you also believe your own delusions.
About drug induced psychosis
If drug induced need to stop the drug. Change the environment to lose the cues.
Family history - has a genetic factor so can make someone predisposed, meaning that any drugs etc can have an ever greater risk than those without this predisposition.
About alcohol withdrawal and psychosis
Of all the drugs, we chose to legalise potentially the worst one because this is the only one which you can die from the withdrawal symptoms (10% mortality in normal individuals, up to 30% if have another comorbidity eg diabetes or a chest infection etc).
Alcohol works on GABA which is to do with inhibition. Higher level functioning parts of the brain (planning, scheduling, attention etc) are inhibited. The remaining active parts of the brain is the brain stem - eg breathing, and also the limbic system which is to do with the emotional response. Therefore you start to display behaviours like fighting, doing inappropriate emotionally driven things as you are still able to react in this way but not reason.
If you drink habitually you constantly suppress the neocortex. You get tolerance (needing higher amounts to get the same effect) and withdrawal. If drinking a lot daily then you are permanently inhibiting brain function. If you suddenly stop drinking then the brain turns back on what you’ve turned on - get massive activation, brain switching on all at once, and this is why you get terrible withdrawal - hallucinations (usually visual), delusions, tremors. If this is untreated there is a high mortality rate. Treated using a drug that inhibits a measure of the same thing, using benzodiazepine (also a GABA inhibitor). If you’re not used to it then it will totally inhibit you and put you to sleep.
When taking these drugs while withdrawing from alcohol your body biologically has what the alcohol was doing so you don’t get the withdrawal symptoms. These drugs are however very addictive so to come off of these we lower the dose daily over around 8-10 days. Any longer than this then it is addiction territory. Must NOT drink whilst on these drugs or will get respiratory depression. However, less likely to drink on this medication as they are not biologically n withdrawal any more anyway.
Takes about 48 hours for withdrawal effects from alcohol to take place.
About psychosis and comorbidity
You can get psychosis with other conditions; psychotic depression for example. There is some overlap with depression which is interesting as there is a neurosis and a psychosis.
