Schizophrenia clinical features Flashcards Preview

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Flashcards in Schizophrenia clinical features Deck (14)
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1

Neurosis

Mental disorder not caused by an organic disease

Includes:
- Anxiety
- Depression
- OCD
- Adjustment disorders
- Somatisation disorders [recurrent complaints about somatic symptoms without the diagnosis present]

2

Psychosis

Illness characterised by:
- Loss of boundaries with reality
- Loss of insight
- Delusions and hallucinations

Includes:
- Schizophrenia
- Bipolar
- Depressive psychosis

3

Delusion

Belief held on strong conviction that are not adequate
- Cannot be changed even in the presence of convicting evidence or rational argument
- The belief is not shared by someone of a similar background

4

Hallucination

Perception experienced in the absence of an external stimulus

Can be in any sensory modality
- Auditory being the most common

Could possibly be due to an internal perception attribution error

5

Schneider's First Rank Symptoms

Delusional perception

Auditory hallucinations
- Third person hallucination
- Running commentary
- Thoughts aloud

Delusions of thought interference
- Thoughts being placed into one's mind by an external source

Passivity phenomenon
- Feeling that one is not longer in control of their own body

Somatic hallucinations

6

ICD 10 diagnosis of schizophrenia
- a-d category

In order for schizophrenia to be present:
- Minimum of one of category a-d for at least a month
- Two of categories e-h for at least a month

A- thought echo, insertion, withdrawal or broadcast

B- Delusion of passivity or perception [ belief that a normal percept has a meaning specific for that person]

C- Running commentary hallucination/ 2 voices discussing the patient

D- Persistent delusion of other kinds

7

ICD 10 diagnosis of schizophrenia
- e-h category

At least two constitutes, for at least a month, constitutes as schizophrenia

E- Persistent hallucinations in any modality with brief
delusions

F- Breaks in thoughts resulting in abnormal speech

G- Catatonic behaviour

H- Negative symptoms not due to depression or medication in the absence of an organic disorder

8

Affective psychosis

Mood disorders, differential diagnosis of schizophrenia:

Biopolar disorder

Depressive psychosis

Schizoaffective disorder [schizophrenia and mood disorder]

9

Signs of schizophrenia

There are still no objective pathogonomic signs but can include:

Bizarre appearance of behaviour
- Self neglect
- Posturing
- Social disturbance [e.g unprovoked violent acts]
- Talking to themselves

Clinical interview is required for diagnosis

10

Mental state examination

Acute syndrome: Type I/ positive symptoms
- Appearance
- Mood
- Thinking
- Delusions
- Hallucinations
- Insight
- Cognition

Appearance
- Restless, unpredictable

Mood
- Blunting
- Disinhibited
- Perplexed
- Anxious

Thinking
- Disordered, vague
- Thought blocks
- Loosening of associations

Delusions
- Primary and secondary

Hallucinations
- All senses

Insight impaired

Cognition
- Orientation and memory normal initially

11

Mental state examination

Chronic: Type II/ negative symptoms
- Appearance
- Movement
- Mood
- Thinking
- Delusions
- Hallucinations
- Insight
- Cognition

Appearance
- Lack of drive and activity
- Social withdrawal
- Self neglect

Movement
- Stupor
- Catatonia
- Abnormal

Mood
- Depression
- Blunted

Delusions
- Primary and secondary [same as acute]

Hallucinations
- All modalities [same as acute]

Insight is impaired

Cognition
- Normal orientation but can decline

12

Epidemiology of schizophrenia
- Prevalence
- Incidence
- Geography
- Sex
- Onset
- Social class

Prevalence
- 0.2-0.7% of population

Incidence
- 2/10K annually
- Increasing in south London

Geography
- Increased rate in migrants [Afro-caribbean]
- More in urban areas
- 'urban drift'?
- Incidence up to 5x internationally

Sex
- Men have more early onset and negative symptoms

Onset
- Male peak: 21-26
- Female peak: 25-32

Social class:
- Lower 'social drift hypothesis'

13

Cannabis and psychosis

Increases vulnerability to psychosis

Chronic uses sensitises and increases vulnerability

Possible familial connection to psychosis and cannabis sensitivity

Cannabis has a larger impact on developing brain [ < 14 years old]

14

Prognosis of schizophrenia

-More than 50% are in remission from treatment and can have functional impairment in between episodes

25% have persistent symptoms after first episode

20% have complete recovery after treatment

5-10% suicides, particularly in men