Schizophrenia

Question 1

What is the difference between hallucination, delusion, & illusion?

Answer 1

• Hallucination: seeing without external stimuli
• Delusion: false unshakeable idea (i am a prophet)
• Illusion: external stimuli shows something different

Question 2

What is schizophrenia?

Answer 2

• split (schisms) between thought content, affect, & behavior (if patient is sad they will laugh & vice versa)
• illness of the mind -> childlike behavior
• affects perceptions, thought, emotions, & behavior

Question 3

What is the epidemiology of schizophrenia?

Answer 3

• prevalence: 1 %
• males have 30-40% higher lifetime risk
• presents in early 20s in males & 3 to 4 years later in females
• not common to get it after 40 -> look for Parkinsons

Question 4

What are the phases of schizophrenia?

Answer 4

1- PRODROMAL: before first psychotic episode

• insidious & gradual
• patient becomes socially withdrawn & irritable
• has new interest in religion or occult physical complaints

2- ACTIVE
- hallucinations, delusions, disordered thoughts

3- RESIDUAL

• between episodes of psychosis
• flat affect (mask face no expressions even if patient has feelings)
• social withdrawal
• odd thinking (negative symptoms)

Question 5

What is the clinical classification of schizophrenia?

Answer 5

• from 0 - 7 days -> acute
• from 7 days to 1 month -> subclinical
• from 1 month to 6 months -> schizophreniform
• after 6 months -> diagnosis of schizophrenia

Question 6

What is the diagnostic criteria for schizophrenia?

Answer 6

CRITERIA A: 2 or more for 1 month AT LEAST

• delusions
• hallucinations
• disorganized speech
• disorganized or catatonic behavior
• negative symptoms

CRITERIA B: signs of disturbance continue for at least 6 months

• including the 1 months of criteria A (active symptoms)
• the 5 other months patient could just be disturbed

CRITERIA C
- significant impairment of function

CRITERIA D
- substance & general medical conditions excluded (no evidence of organic pathology)

all criterias must be present

Question 7

What are the negative symptoms?

Answer 7

• apathy
• lack of drive & initiative
• social withdrawal
• deterioration of social behavior
• poverty of thoughts
• flat affect

Question 8

What is the prognosis of schizophrenia?

Answer 8

• complete recovery 15% (no relapse)
• relapsing illness 70% (even with treatment)
• suicide 5% (in borderline more)

Question 9

How severe is the risk of relapse after the first psychotic episode?

Answer 9

• 90% of patients will be normal within a year (if not schizo yet)
• 80% will have a further episode within 5 years
• patients that discontinue antipsychotics are 5 times more likely to relapse over this time

Question 10

What are the good prognostic factors?

Answer 10

• acute onset
• precipitating factor
• affective symptoms
• good premorbid personality
• negative family history

Question 11

What are the poor prognostic factors?

Answer 11

• insidious onset
• no precipitating factor
• earlier age of onset
• family history of schizophrenia
• hebephrenic -> silly & childlike behavior, prominent affective symptoms (no manners)
• un systematized delusions
• high expressed emotion
• non-compliance
• neuro-cognitive deficits

Question 12

What are the indications for hospitalization?

Answer 12

• acute psychotic episode with significant impairment of function
• homicidal or suicidal
• catatonia & refusal of food
• refusal of treatment
• if the family requests it

Question 13

What medications are used to treat schizophrenia?

Answer 13

Atypical antipsychotics - lower side effects

• risperidone
• olanzapine
• quetiapine

Typical antipsychotic
- Haldol

Supportive psychological treatment

Question 14

What is schizoaffective disorder?

Answer 14

• both schizophrenic & affective symptoms (depressive)

- develop simultaneously

Question 15

What is the delusional disorder?

Answer 15

• present for at least 3 months
• can function well except area of delusion
• tend not to have cognitive & social impairment

Question 16

What is brief psychosis?

Answer 16

• symptoms similar to criteria A

- lasts more than 1 day but less than a months