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Year 4 Psych- A > Schizophrenia and related disorders lecture > Flashcards

Schizophrenia and related disorders lecture Flashcards

• Be able to differentiate psychosis and schizophrenia • Identify the basic symptoms of schizophrenia • Outline the diagnostic categories of psychotic conditions • Be able to create a basic management plan for a patient with schizophrenia • Be aware of delusional disorders

1
Q

Definition of hallucination

A

A perception which occurs in the absence of a stimulus. To the person this has the impact of a real perception and is indistinguishable. It occurs externally (not in the mind).

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2
Q

illusion definiton

A

False perception of a real stimulus. Three types: affect, completion and pareidolia.

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3
Q

Illusion vs hallucination

A

An illusion is based on a real sensory stimulus that is interpreted incorrectly whereas a hallucination is created by the mind without any stimulus.

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4
Q

What are the 3 main types of illusions?

A
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5
Q

Definition of positive symptoms

A

A cluster of psychotic symptoms including hallucinations and delusions.

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6
Q

Definition of negative symptoms

A

A cluster of symptoms that often occur in chronic schizophrenia including poverty of speech, flat affect, poor motivation, poor attention and neglect.

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7
Q

Negative symptoms vs positive symptoms

A

A positive symptom is something added on to what most people experience
(i.e. a hallucination)

whereas negative symptoms are the lack of a normal experience
(i.e. lacking concentration)

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8
Q

Definition of delusion of control/passivity

A

The subject believes their thoughts, feelings and/or actions are not their own but are being imposed/controlled by an outside force.

Remember in passivity experiences the subject is ‘passive’ as they believe they are being controlled by another agent.

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9
Q

Definition of ideas of reference

A

The belief that innocuous events have direct personal significance to the subject (e.g. believing something on the TV is a direct message to them).

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10
Q

Definition of thought broadcast

A

The subject believes their thoughts are being shared with others (e.g. being broadcast on the radio)

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11
Q

Ideas of reference vs thought broadcast

A

These can be easy to mix up. In thought broadcast they believe their thoughts are being broadcast for others to receive. With ideas of reference they take special meanings from inanimate stimuli.

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12
Q

Definition of psychosis

A
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13
Q

List of some of conditions that cause psychosis

A
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14
Q

There are three clusters of psychotic symptoms:

A
  • hallucinations
  • delusions
  • thought disorders
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15
Q

What is a hallucination?

A
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16
Q

what is a delusion?

A

A false, unshakable belief held with intense conviction

Held despite evidence to the contrary

Not a belief held by others in the same culture

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17
Q
  • What is a thought disorder?
A
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18
Q

Definition of schizophrenia

A

This references the splitting of the mind from reality and not a split personality.

Schizophrenia is a specific diagnosis

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19
Q

Epidemiology of schizophrenia

A

More common in men

Earlier onset in men:
Male average onset 20 to 28 years
Female average onset 26 to 32 years

Incidence 0.1 %

Prevalence 0.5 to 1%

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20
Q

Aetiology of schizophrenia

A

More common in urban areas

Higher rates in those who have moved to the UK than in the UK itself or in their country of origin

More common with economic adversity/social exclusion

Higher rates in those who have experienced childhood trauma or abuse

Strong genetic links but no clear direct inheritance pattern so there must be multiple implicated genes
50% risk if both parents have schizophrenia
50% monozygotic twin concordance

Cannabis
Four times the risk if regular use before age 15

More common in winter births or if perinatal viral infections or trauma

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21
Q

Main Pathophysiology in schizophrenia

A

Dopamine is the most implicated neurotransmitter in schizophrenia

We know this as antipsychotics are dopamine antagonists and SPECT scans show increase DA receptor occupancy in patients with schizophrenia

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22
Q

how each of the DA pathways are affected in schizophrenia

A
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23
Q

example of main neurotransmitters

A
24
Q

positive symptoms vs negative symptoms and some features of each

A
25
Q

Schizophrenia ICD 10 Diagnostic Criteria

A
26
Q

ICD 10 and ICD 11 diagnostic criteria

A
27
Q
  • SUBTYPES OF SCHIZOPHRENIA ICD 10 only, Removed in ICD 11
A
28
Q

SCHIZOPHRENIA PROGNOSIS

A
29
Q

prognostic indicators in schizophrenia

A
30
Q

Acute psychotic disorder definition

A

Patient has psychotic symptoms…

…which last less than 28 days

If symptoms persist beyond 28 days then they will later be given the diagnosis of schizophrenia

31
Q

schizzoaffective disorder definition and features

A

Schizophrenia can’t be diagnosed in the presence of extensive affective symptoms (mania or depression)

In schizoaffective disorder, psychotic and affective symptoms are simultaneously present and equally prominent

32
Q

delusional disorder definiton and features

A

Delusions are the most prominent feature. They are typically well formed and long standing (they can be life-long!)

Hallucinations aren’t present or are only fleeting

Delusions of control/passivity experiences aren’t compatible with this diagnosis

33
Q

definition of Othello Syndrome

A

They believe their partner is cheating on them. Risk to the partner and the other individual of violence and stalking.

34
Q

definition of Cotard’s Syndrome

A

A nihilistic delusion without other psychotic symptoms. They believe they are dead, rotting or have lost body parts

35
Q

De Clerambault’s Syndrome
definition

A

AKA Erotomania - They believe that someone from a higher social standing is in love with them and sends them secret messages to convey their love.

36
Q

Ekbom’s Syndrome definition

A

They believe they are infested with parasites despite no evidence of this. Risk of self harm through excoriation or trying to get the parasites out

37
Q

Folie a Deux
definition

A

AKA induced delusional disorder.
The dominant partner has a delusional belief and then the dependent partner develops the same belief.
The dominant partner requires treatment but the dependent partner recovers upon separation.

38
Q

Fregoli’s Syndrome
defintion

A

They believe multiple people are actually one individual in disguise who is persecuting them.

39
Q

Capgras Syndrome
definition

A

They believe a relative has been replaced by an imposter.

40
Q

Investigations in schizophrenia and psychotic disorders: including biological

A

Blood gases
CT Brain
ECG
EEG
Full blood count
HbA1c
HIV screen
Lipid profile
Liver function tests
Random blood glucose
Syphilis screen
Thyroid functions tests
U&E
Urine culture
Urine drug screen

41
Q

MANAGEMENT OF SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS

A
42
Q

Uses of antipsychotics:

A

Psychotic disorders
Affective disorders (mood stabilising effects)
Organic disorders (sedative effects)

43
Q

Onset of Action of antipsychotics

A

Sedative effects – hours
Side effects – hours to days
Antipsychotic effects – days to weeks

44
Q

Antipsyhcotic medications Classification:

A

Typical / First Generation
Haloperidol/Zuclopenthixol/Flupentixol

Atypical / Second Generation
Olanzapine/Risperidone/Quetiapine /Aripiprazole/Clozapine

45
Q

Different routes of administration of anti-psychotics and when to use them

A
46
Q

Prior to commencing antipsychotics, the following investigations need to be completed:

A
47
Q

The main action of antipsychotics is:

A

The main action of antipsychotics are post-synaptic dopamine antagonists

48
Q
  • Which pathway is the intended site of action of antipsychotics?
A
49
Q
  • DA antagonism in which pathway causes extra-pyramidal side-effects
  • DA antagonism in which pathway causes elevated prolactin
A
50
Q
  • Extra pyramidal side effects (epse) of antypsychotics
A
51
Q
  • Other Important side effects of antipsychotics
A
52
Q
  • Side effects of antipsychotics by class
A
53
Q

Clozapine indication and side effects

A
  • patients who have failed to respond to two other antipsychotics with at least one being 2nd generation

serious side effects:
* Agranulocytosis
* Myocarditis
* Reduced seizure threshold

Common side effects:
* Hyper-salivation
* Weight gain
* Sedation

54
Q
  • Clozapine monitoring requires:
A

Blood tests (weekly initially)
ECG / BP / HR / BMI

55
Q

Psychosocial interventions in psychosis

A
56
Q

what can be used to treat moderate/severe tardive dyskinesia

A

Tetrabenazine may be used to treat moderate/severe tardive dyskinesia

Year 4 Psych- A (20 decks)

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