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Flashcards in Schizophrenia and related disorders Deck (45)
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1
Q

What is psychosis?

A

This is an umbrella term to describe an experience of being out of touch with reality and struggling to distinguish what is real and what is not. It describes the experience of delusions, hallucinations and/or thought disorder.

2
Q

What is a delusion?

A

It is a false unshakable belief, despite evidence to the contrary, not held by others in the same culture and held with intense personal conviction and certainty.

3
Q

What is thought disorder?

A

It is an abnormality in the mechanism of thinking such that to the observer the person is not making sense.

4
Q

What is a hallucination?

A

A perceptual experience without an object or stimulus that appears subjectively real but uncontrollable by the patient.

5
Q

How many types of hallucination are there and what are they?

A

6 types- gustatory, auditory, visual, somatic, olfactory, tactile

6
Q

What conditions is psychosis present in?

A

Organis conditions such as delirium, dementia, brain disorders, porphyria, psychoactive substance misuse, schizophrenia, affective disorders (mania and depression), sleep or sensory deprivation and bereavement.

7
Q

What does schizophrenia mean?

A

Fragmentation of thinking

8
Q

How long must symptoms be present for before you can diagnose schizophrenia?

A

1 month

9
Q

Who is schizophrenia more common in gender wise?

A

Men

10
Q

What is the peak age onset for men and women?

A

Men 20-28, women 26-32

11
Q

What is the incidence per life time of SPD (schizophrenia disorder)?

A

0.5%-1%. it affects about 1% of the population

12
Q

What are the positive symptoms of SPD?

A

Hallucinations, delusions and thought disorder

13
Q

What is the good thing about positive symptoms?

A

They can be treated medically with a good prognosis

14
Q

What are the negative symptoms of SPD?

A

Anolition (lack of motivation), anhydonia, alogia (poverty of speech), asociality (lack of desire for relationships), affect blunt.

15
Q

What is the bad things about negative symptoms?

A

They often present late and are less responsive to treatment.

16
Q

How is schizophrenia characterised in ICD 10?

A

Fundamental and characteristic distortions of thinking and perception with affects that are inappropriate and blunt. Clear consciousness and intellectual ability are normally maintained.

17
Q

What does ICD 10 say in relations to SPD and depression?

A

It says the diagnosis of SPD should not be made in the presence of extensive depressive or manic symptoms unless SPD symptoms clearly came before this affective disturbance.

18
Q

What is schizoaffective disorder?

A

Schizophrenic symptoms and affective symptoms are prominent at the SAME TIME, in the SAME EPISODE of illness

19
Q

When should schizophrenia not be diagnosed?

A

In the presence of overt brain disease, including EPILEPSY and during states of drug intoxication.

20
Q

Describe paranoid schizophrenia?

A

relatively stable, often paranoid delusions, usually accompanied by hallucinations, particularly of the auditory variety, and perceptual disturbances.

21
Q

What is hebephrenic schizophrenia?

A

Affective changes are prominent, delusions and hallucinations fleeting and fragmentary, behaviour irresponsible and unpredictable and mannerisms common. Mood is shallow and inappropriate, thought is disorganised and speech is incoherent, tendency to social isolate and rapid development of negative symptoms, particularly flattening of affect and loss of volition.

22
Q

What is catatonic schizophrenia?

A

This involves disturbances in a persons movement, affected people may exhibit dramatic reduction in activity to the point that voluntary movement stops.
hat may alternate between extremes such as hyperkinesis and stupor, or automatic obedience and negativism. Constrained attitudes and postures may be maintained for long periods.
• ***Episodes of violent excitement may be a striking feature of the condition.
• The catatonic phenomena may be combined with a dream-like (oneiroid) state with vivid scenic hallucinations.

23
Q

What is simple schizophrenia?

A

insidious but progressive development of oddities of conduct, inability to meet the demands of society, and decline in total performance.
• The characteristic negative features of residual schizophrenia (e.g. blunting of affect and loss of volition) develop without being preceded by any overt psychotic symptoms.

24
Q

What is undifferentiated schizophrenia?

A

Psychotic conditions meeting the general diagnostic criteria for schizophrenia but not conforming to any of the subtypes or exhibiting the features of more than one of them without a clear predominance of a particular set of diagnostic characteristics

25
Q

What approach did Schneider take?

A

Phenomenological not aetiological

26
Q

What are schneider’s first principles?

A

Delusional perceptions, 3rd person auditory hallucinations, thought (echo, insertion, withdrawal, broadcast), passivity, somatic (experiences of bodily influence), made (acts, impulses, affects (emotions).

27
Q

What is the passivity phenomenon?

A

The core feature is the belief that one is no longer in control of one’s own body, feelings or thoughts.

28
Q

What do SPECT scans of schizophrenics show?

A

Greater occupancy of DA receptors.

29
Q

How do anti-psychotics work?

A

They are antagonists at post-synaptic DA receptors. (there are 5 types, mainly D2)

30
Q

What does increased mesolimbic dopamine activity cause?

A

Positive symptoms

31
Q

What does decreased mesocortical dopamine activity cause?

A

Negative symptoms

32
Q

Why does LSD cause hallucinations?

A

It is a 5-HT2A agonist (serotonin)

33
Q

How does clozapine work as an anti-psychotic?

A

It binds to 5-HT2A

34
Q

What does a reduction in the neurotransmitter glutamate cause?

A

Negative symptoms

35
Q

What is Phencyclidine?

A

It is angel dust, first came out as an anaesthetic. It is a dissociative drug, causes psychosis via being an NMDA receptors antagonist.

36
Q

What is the glutamate hypothesis of schizophrenia?

A

There may be irregular NMDA function

37
Q

Are schnieders first rank symptoms present in all people with schizophrenia?

A

They are absent in about 20% of people with schizophrenia.

38
Q

What is the difference between gedankenlautwerden and echo de le pensee?

A

The former is when thoughts are heard as they are being formulated and the second is when thoughts are heard shortly after they have been formulated?

39
Q

What is the potentially fatal side effect of clozapine?

A

Agranulocytosis

40
Q

What is the link between acetyl choline and schizophrenia?

A

Acetly choline receptor agonists have been shown to improve cognition in patients with schizophrenia.

41
Q

What is a risk factor for schizophrenia, which we haven’t mentioned yet….

A

Increased paternal age

42
Q

If you have 2 schizophrenic parents, what is your risk?

A

Around 45% (just 2% less than if your monozygotic twin had it!!!)

43
Q

What environmental factors may contribute to schizophrenia development?

A

Winter births, viral infections, neurosyphilis, encephalitis, temporal lobe epilepsy.

44
Q

Which life events can contribute to schizophrenia?

A
  • Social exclusion, economic adversity
  • Childhood trauma/abuse
  • Migration (higher rates in migrants)
  • Urban environment (higher rates)
  • Negative attitudes/ high expressed emotion (when your parents make a big fuss etc)
45
Q

Don’t forget about perinatal trauma!!! What does this involve?

A

Maternal stress, hypoxia