5: Psychosis: Schizophrenia, schizoaffective disorders and differentials Flashcards

1
Q

What is psychosis?

A

Impaired relationship with reality

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2
Q

What are four features of psychosis?

A

Delusions

Hallucinations

Disordered thinking

Passivity

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3
Q

Is psychosis a disease?

A

No

Symptom

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4
Q

In psychosis, our thoughts (match / differ from) reality.

A

thoughts do not match reality

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5
Q

What is a delusion?

A

Irrational, deeply held belief about yourself or others

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6
Q

What are some examples of delusions?

A

Thought insertion - your thoughts are not your own, they’re someone else’s

Thought withdrawal - someone else is removing thoughts from your mind

Thought control - someone is controlling your thoughts

Thought broadcasting - other people can tell what you’re thinking

Delusions of grandeur - you’re someone famous, Jesus etc…

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7
Q

What is a delusion of reference?

A

Irrational idea that a person, object or idea is more personally significant than it actually is

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8
Q

Do patients with psychosis know that they are ill?

What is this sign called?

A

No

Lack of insight

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9
Q

What is thought disorder?

A

A feature of psychosis which include:

difficulty ordering thoughts, words or phrases

poverty of speech i.e not being able to muster anything to say

irrelevancies, tangents

illogical ideas

repetition of particular words or phrases

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10
Q

What is a hallucination?

A

Perception which occurs in the absence of an external stimulus

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11
Q

What are some forms that hallucinations can take?

A

Visual

Auditory

Olfactory

Gustatory (taste)

Tactile (touch)

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12
Q

Delusions that your thoughts, actions or perceptions are being controlled by someone else are also known as delusions of ___.

A

passivity

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13
Q

What type of delusion involves attachment of personal significance to events by a patient?

A

Ideas of reference

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14
Q

Patients may have ___ beliefs about hallucinations they have experienced.

A

delusional beliefs

e.g “my visions are being transmitted to me by the Mafia” - thought insertion delusion ABOUT a hallucination the patient has experienced

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15
Q

The content of delusions is often related to the ___ beliefs of the patient.

A

cultural beliefs

religious, popular culture, current events etc.

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16
Q

What is a neologism?

What symptom of psychosis is it an example of?

A

Newly invented word or phrase

Thought disorder

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17
Q

What is tangentiality?

A

Tendency to go off on unrelated strings of thought instead of holding to the same subject

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18
Q

What is Knight’s move thinking?

A

Tendency to jump from one subject to an unrelated one

compared to a knight jumping around a chessboard

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19
Q

What is word salad?

A

Strings of seemingly unrelated words or phrases

20
Q

Give some examples of thought disorder.

A

Neologisms - new words or phrases

Word salad

Tangentiality

Knight’s move thinking

Clanging and punning - relating words by sound rather than meaning

21
Q

Delusions that another party is controlling your thoughts, behaviour or perceptions are known as ___ delusions.

A

passivity delusions

22
Q

To confirm that a patient’s beliefs are psychotic, you need to challenge them with logic and reason.

What can you lose by doing this?

A

Patient relationship, rapport

so you need to be careful

23
Q

Apart from schizophrenia, what other conditions may cause psychotic symptoms?

A

Acute: delirium, dementia, stroke

Substance use: intoxication, withdrawal, delirium tremens

Mood disorders: dementia, bipolar, schizoaffective disorder

24
Q

Auditory delusions of schizophrenia often refer to the patient from which point of view?

A

Third person

(He/she/they are x, y, z)

It’s like you’re being talked about by other people

25
Q

Auditory delusions of depressive disorders often refer to the patient from which point of view?

A

2nd person

(You)

Self-criticism

26
Q

Patients with acute psychotic symptoms caused by an underlying substance abuse problem, delirium or head injury will not have schizophrenia or schizoaffective disorder.

True or false?

A

False

May be underlying

27
Q

Name two examples of schizoaffective disorders.

A

Depressive psychosis

Mania with psychosis

28
Q

What types of delusions and hallucinations do patients with depressive psychosis experience?

A

Delusions of guilt, worthlessness, poverty - downer delusions

2nd person auditory delusions - hearing putdowns, criticisms etc.

29
Q

What type of

a) delusions
b) hallucinations
c) thought disorders

do patients with manic psychosis experience?

A

a) Delusions of grandeur, reference, superhuman powers

b) 3rd person auditory delusions e.g God’s voice

c) Flight of ideas - tangentiality, clanging and punning, neologisms

30
Q

What acute psychiatric disorder, common in the elderly, can present as psychosis?

A

Delirium

31
Q

Which psychiatric manual is used to diagnose schizophrenia and related disorders?

A

ICD-10

32
Q

What are Schneider’s First Rank symptoms?

A

Symptoms used to diagnose schizophrenia

i.e delusions, hallucinations, thought disorder and passivity

33
Q

Based on ICD-10, how long must a patient be experiencing symptoms for before they can be diagnosed with schizophrenia?

A

1 month

34
Q

What are three important subtypes of schizophrenia?

A

Paranoid schizophrenia - characterised by paranoid delusions of persecution, threat etc.

Hebephrenic or disorganised - seen more in young patients, characterised by disordered thoughts

Catatonic - characterised by anhedonia, anergia, slowed movements

35
Q

Schizophrenia is often described in terms of positive and negative symptoms.

What is included under each heading?

A

Positive - the addition of something e.g delusions, hallucinations, disordered thinking, passivity

Negative - loss of something e.g amotivation, anergia, mutism, flattened affect

36
Q

Schizophrenia has a ___ period, with minor cognitive and behavioural symptoms.

A

prodromal period

weeks - months before onset

37
Q

What is a person’s lifetime risk of developing schizophrenia?

A

1%

38
Q

Schizophrenia is more common in (men / women).

A

men

39
Q

At what age range does schizophrenia present in

a) men
b) women?

A

a) 15 - 25

b) 25 - 35

remember than it’s more common in males AND they present earlier

40
Q

How do we know that schizophrenia has a genetic component?

A

Concordance in twin studies

41
Q

What maternal factors seem to have an effect on the child’s risk of developing schizophrenia?

A

Viral infection

Complicated birth

Fx of psychiatric illness

42
Q

The use of which drug increases your risk of developing schizophrenia?

A

Cannabis

43
Q

Cannabis is a ___ drug which seems to increase your risk of developing schizophrenia.

In which groups especially?

A

hallucinogenic drug

adolescents - developing brains

44
Q

Living where increases your chances of developing schizophrenia?

A

Urban areas e.g large cities

45
Q

What is the course of schizophrenia?

A

May be relapsing and remitting or progressively deteriorating, depends

46
Q

What is the suicide risk in patients with schizophrenia?

A

10 - 15%

47
Q

How common is homicide by the hands of patients with schizophrenia?

A

Relatively uncommon