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Year 2 - Theme 3 > Schizophrenia: Clinical aspects > Flashcards

Schizophrenia: Clinical aspects Flashcards

1
Q

Examples of neurosis

A 
• Anxiety disorders
• Depressive disorders
• Obsessive compulsive disorder
• Adjustment disorders
Somatisation disorders
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2
Q

Examples of psychosis

A
  • Organic
  • Schizophrenia
  • Bipolar disorder
  • Depressive psychosis
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3
Q

What is psychosis

A

An illness characterised by a loss of boundaries with reality and loss of insight, with primary features of delusions and hallucinations.
A psychotic episode is deemed to be 1 week duration of either of these symptoms at significant severity

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4
Q

What is delusion

A

Belief held firmly but on inadequate grounds, not affected by rational argument or evidence to the contrary, and not shared by someone of similar age, educational, cultural, religious or social background.

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5
Q

Types of delusion

A

primary (delusional perception), secondary, persecutory, -of reference, grandiose, -of guilt, nihilistic, -of passivity etc.

Due to error of salience of attribution
Content often has particular relevance
eg. Religious. Persecution by devil
Persecution by authority figure / government
Controlled by implant
Responsibility for world tragedy
Followed by seagulls

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6
Q

What is hallucination

A
  • A perception experienced in the absence of an external stimulus.
    In any sensory modality but auditory commonest in psychosis.
    ? due to internal perception attribution error
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7
Q

Schneider’s first rank symptoms(1946)

A
  • Delusional perception
  • Auditory hallucinations
  • Delusions of thought interference
  • Passivity phenomenon or delusions of control
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8
Q

ICD 10 diagnosis of schizphrenia

A

A minimum of one of a-d or two of e-h for at least 1 month:
a Thought echo, insertion, withdrawal or broadcast
b Delusion of passivity or delusional perception
c Running commentary hallucination or 2 voices discussing the patient
d Persistent delusions of other kinds
e Persistent hallucinations in any modality with accompanying brief delusions
f Breaks in thought resulting in abnormal speech (eg. incoherent, neologisms)
g Catatonic behaviour eg. Excitement, posturing, waxy flexibility, negativism
h Negative symptoms not due to depression or medication
In the absence of an organic disorder

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9
Q

Examples of affective psychosis(affective means mood is affected)

A

Bipolar disorder
Depressive psychosis
Schizoaffective disorder

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10
Q

Examples of organic psychosis

A

Epilepsy (temporal lobe)
Infections: encephalitis, subacute sclerosing panencephalitis, neurosyphillis, HIV
Cerebral trauma
Cerebrovascular disease
Demyelination: Multiple sclerosis etc
Neurodevelopmental disorders: velocardiofacial syndrome
Endocrine: thyroid disorders (hyper and hypo), Cushing’s syndrome,
Metabolic: hepatic failure, uraemia
Immunological: SLE
Acute drug intoxication: eg. Ketamine, Cannabis, LSD, PCP, Amphetamine, MDMA
Toxins eg. lead
Dementias

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11
Q

Signs of schizophrenia

A

Bizarre appearance or behaviour
Self neglect ‘Talking to themselves’
Social disturbance including unprovoked violent acts
Posturing
Clothing
Perplexity

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12
Q

Scizophrenia side effects of medication

A

Parkinsonian symptoms: tremor, rigidity, bradykinesia Tardive dyskinesias including orofacial, athetosis, dystonias
Skin discolouration
Severe weight gain

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13
Q

What is required for diagnosing schizophrenia

A
  • None of the symptoms are specific to schizophrenia
  • Clinical interview is required for diagnosis
  • No lab tests/predictive imaging
  • All lead to stigma
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14
Q

Acute syndrome(positive symptoms/type I)

A

• Appearance Preoccupied and withdrawn to restless and unpredictable
• Mood Blunting of mood, disinhibition, perplexed, anxious
• Disorder of thinking Vague, Formal thought disorder (loosening of associations)
○ Disorders of stream (thought block)
• Delusions Primary, secondary
• Hallucinations Auditory, visual, tactile (somatic), olfactory, gustatory
• Insight Impaired
• Cognition Normal orientation and memory (initially)

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15
Q

Chronic syndrome(negative symptoms/type II)

A

• Appearance and behaviour Lack of drive and activity. Social withdrawal.
Self neglect
• Movement abnormalities Stupor, Catatonia, abnormal movements and tone
• Mood Blunting of mood. Depression
• Delusions as in acute syndrome
• Hallucinations as in acute syndrome
• Insight Impaired
• Cognition Normal orientation but often cognitive decline

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16
Q

Prevalence of schizophrenia

A

0.2-0.7%

17
Q

Incidence of schizophrenia

A
  • 2/10 000 per year(increasing in S London)
18
Q

Population more affected by schizophrenia

A
  • Incidence up to 5x variation worldwide
  • Increased rate in migrants(particularly African Caribbean –> culturally isolated
  • More prevalent in urban than rural areas
  • Lower social class more affected
19
Q

Peak onset of schizophrenia for males and females

A
  • Male peak onset 21-26

- Female peak onset 25-32

20
Q

Prognosis of schizophrenia

A

Better outcome in 3rd world and with introduction of Early Intervention services

21
Q

What percentage of schizophrenic patients have complete recovery and are off treatment eventually

A
  • 20%
22
Q

What percentage of schizophrenic patients have persistent symptoms after first episode ‘dementia praecox’

A
  • 25%
23
Q

What is dementia praecox

A
  • Disused psychiatric diagnosis that originally designated a chronic, deteriorating psychotic disorder characterized by rapid cognitive disintegration, usually beginning in the late teens or early adulthood.
24
Q

What percentage of schizophrenic patients have a relapsing remitting illness with some functional impairment between episodes

A
  • 50%
25
Q

What can recurrent episodes of schizophrenia lead to

A
  • Progressive deterioration
26
Q

Difference in functional and symptom recovery

A
  • Functional recovery lags behind symptom recovery
27
Q

Suicide rate in schizophrenic patient population

A
  • 5-10% particularly men within 3 years of onset
28
Q

Factors for good prognosis in schizophrenia

A
  • Female
  • Married
  • Family history of affective disorder
  • Acute onset
  • Life event at onset
  • Early treatment
  • Affective symptoms
  • Good treatment response
29
Q

Factors for poor prognosis in schizophrenia

A
  • Male
  • Single
  • Family history of schizophrenia
  • Premorbidly schizoid
  • Slow onset
  • Long duration untreated
  • Negative symptoms
  • Obsessions
  • High expressed emotion in the family
  • Substance misuse
30
Q

How does schizophrenia increase vulnerability to psychosis

A
  • Impact of cannabis on developing brain is more potent(<14 years)
  • Schizophrenia patients more sensitive to cannabis than controls
  • Familial liability for psychosis is expressed as differential sensitivity to cannabis
  • Chronic use sensitises to effect and increases vulnerability to psychosis
31
Q

What is neurosis

A

a relatively mild mental illness that is not caused by organic disease, involving symptoms of stress (depression, anxiety, obsessive behaviour, hypochondria) but not a radical loss of touch with reality.

32
Q

Primary vs Secondary delusions

A

Primary delusions are not understandable and are psychologically irreducible, while secondary delusions are understandable in the context of preceding affects or other experiences.

33
Q

Examples of primary and secondary delusions

A

Primary - Schizophrenia patients

Secondary - Delusion of grandiosity in mania

34
Q

What is delusional perception

A

Part of a Primary delusion. It can occur ‘out of the blue’ (Autochthonous delusion) or as a two stage process where a normal perception occurs first and then a delusion if formed around it. (Delusional perception)

e.g. ‘When I saw the red car passing by me yesterday, I knew I was going to be killed.’

35
Q

What are auditory hallucinations

A

Third-person auditory hallucinations (arguing or talking about patient) – ‘He or she’
Running commentary on person’s actions or thoughts
Thought echo (Gedankenlautwerden) – Thoughts spoken aloud

36
Q

What are delusions of thought interference

A 
Thought insertion (put into your head)
Thought withdrawal (taken out of your head)
Thought broadcasting (broadcast so that other people know what you are thinking)
37
Q

What is the passivity phenomenon or delusions of control

A

Control of the following by an external force:

Impulses
Actions
Feelings
Somatic Passivity – Passive recipient of bodily sensations imposed from outside forces.

Year 2 - Theme 3 (9 decks)

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