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Psychiatry Block > Schizophrenia and Psychotic Disorders > Flashcards

Schizophrenia and Psychotic Disorders Flashcards

1
Q

What is psychosis?

A

an inability to distinguish between symptoms of delusion, hallucination and disordered thinking from reality

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2
Q

What symptoms would we call ‘psychosis’?

A
  • hallucinations

- delusional thinking

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3
Q

What are hallucinations?

A
  • sensory perceptions of a stimulus that is not actually there
  • can be olfactory, visual, auditory, tactile (feeling things) or gustatory (taste)
  • have full force and clarity of true perception
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4
Q

What is a delusion?

A

an unshakeable idea or belief which is out of keeping with the person’s social and cultural background; it is held with extraordinary conviction

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5
Q

What are 4 examples of types of delusions?

A
  • grandiose
  • persecutory
  • hypochondriacal
  • self referential (A neutral event is believed to have a special and personal meaning. For example, a person with schizophrenia might believe a billboard or a celebrity is sending a message meant specifically for them.)
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6
Q

What are 3 conditions that may have psychotic symptoms attached to them?

A
  • schizophrenia
  • delirium
  • severe affective disorder (depression or mania)
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7
Q

What is the most common cause of psychosis?

A

schizophrenia

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8
Q

What is schizophrenia?

A

a severe mental illness affecting thinking, emotion and behaviour

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9
Q

What age tends to be the onset of schizophrenia?

A

15-35 years

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10
Q

What is meant by ‘negative’ symptoms and ‘positive symptoms of schizophrenia?

A

-a negative symptoms is when a normal behavior, thought pattern or emotion is missing.

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11
Q

What are positive symptoms of schizophrenia?

A
  • hallucinations
  • delusions
  • disordered thinking
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12
Q

What are negative symptoms of schizophrenia?

A
  • apathy
  • lack of interest
  • lack of emotions
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13
Q

According to ICD-10, what signs/ symptoms are required to be identified to have a diagnosis of schizophrenia?

A

For more than a month in absence of organic or affective disorder, at least one of:
-alienation of thought as thought echo, thought insertion or thought withdrawal, or thought broadcasting
-delusions of control, influence or passivity, clearly referred to body movements, actions or sensations (not in control of one’s body)
-hallucinatory voices
-persistent delusions of other kinds that are culturally inappropriate and impossible e.g. being able to control the weather
AND/OR
-persistent hallucinations in any modality, when occurring every day for at least one month
-neologisms, breaks or interpolations in 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

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14
Q

What are biological factors implemented in the aetiology of schizophrenia?

A
  • genetics
  • neurochemistry e.g. dopamine, glutamate, GABA
  • obstetric complications
  • maternal influenza
  • malnutrition and famine
  • winter birth
  • substance misuse
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15
Q

What might be a psychological factor in the development of schizophrenia?

A

having a fear and delusions coming out of that

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16
Q

What are social and psychosocial factors in the aetiology of schizophrenia?

A
  • migration
  • social isolation
  • life events as precipitants
  • families in which emotions are highly expressed
17
Q

How might you distinguish an organic cause such as delirium for the psychotic symptoms instead of schizophrenia?

A
  • consequent upon brain or systemic disease
  • prominent visual experience, hallucinations and illusions
  • affect of terror
  • delusions are persecutory and evanescent
  • fluctuating, worse at night
18
Q

How might you distinguish a depressive psychosis from schizophrenia?

A
  • delusions of guilt, worthlessness and persecution

- derogatory auditory hallucinations

19
Q

How might you distinguish a manic psychosis from schizophrenia?

A
  • delusions of grandeur; special powers or messianic roles

- gross overactivity, irritability and behavioural disturbance: manic excitement

20
Q

What general management would be in place for a person with schizophrenia?

A
  • collaboration with patient and family
  • antipsychotic medications e.g. olanzapine, risperidone, amisulpride - once in remission, maintenance treatment should be offered for a further 2 years
  • CBT
  • cognitive remediation
  • family intervention
  • social skills training
21
Q

What medication should be considered for treatment resistant schizophrenia?

A
  • clozapine
  • do not breast feed on this medication
  • only considered after non response to to 2 antipsychotics including a second generation antipsychotic
22
Q

What do we mean by ‘recovery’ when it comes to schizophrenia?

A

-being able to live a meaningful and satisfying life, as defined by each person, in the presence or absence of symptoms

23
Q

What proportion of people with schizophrenia will recover after a first episode of psychosis?

A

80%

24
Q

What are good prognostic factors on a diagnosis of schizophrenia?

A
  • absence of family history
  • good premorbid function e.g. stable personality, relationships
  • clear precipitant
  • acute onset
  • mood disturbance
  • prompt treatment
  • maintenance of initiative, motivation
25
Q

What are poor prognostic factors on a diagnosis of schizophrenia?

A
  • Slow, insidious onset and prominent negative symptoms are associated with a worse outcome.
  • Shorter life expectancy is linked to cardiovascular disease, respiratory disease and cancer.
  • Suicide risk is 9 times higher.
  • Death from violent incidents is twice as high.
  • 36% of patients have a substance misuse problem and there are high rates of cigarette smoking.
  • Poorer if starts in childhood

Psychiatry Block (14 decks)

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