Schizophrenia

Question 1

What is schizophrenia?

Answer 1

The most common form a psychosis

A mental disorder in which the thoughts, affective response or ability to recognise reality, and the ability to communicate and
relate to others, are sufficiently impaired to interfere grossly with the capacity to deal with reality

Question 2

What are some causes of psychosis?

Answer 2

Dementia praecox - Schizophrenia and paranoid illnesses

Manic depressive psychosis - Depression and bipolar disorder

Organic conditions - Delirium, dementias and strokes

Substance use - Acute intoxication, withdrawal, delirium tremens

Question 3

What is schizoaffective disorder?

Answer 3

Schizoaffective disordercombines the symptoms of schizophrenia withbipolar disorder. Patients havepsychosisand symptoms ofdepressionandmania.

Question 4

What is schizophreniform disorder?

Answer 4

Schizophreniform disorderpresents with the same features as schizophrenia but lastsless than six months.

Question 5

What is “ideas (Delusions) of reference”

Answer 5

Innocuous or coincidental events will be ascribed significant meaning by the person

Question 6

What are some examples of “Ideas of reference”

Answer 6

• Thinking that there are really messages in the newspaper about them
• Believing that the news report on the TV is commenting on their life or talking directly to them
• Seeing that objects or events have been arranged so as to specifically convey a hidden meaning to them
• Knowing that people’s conversations or social media postings are about them
• Believing that a radio station is broadcasting songs in such a way as to tell you something
• Seeing meaning in other peoples gestures

Question 7

What are some factors that increase risk of schizophrenia?

Answer 7

Genetic factors (78% heritability) - Polygenic
Environmental factors

Question 8

What are some gene alterations thought to be involved in schizophrenia?

Answer 8

• Neuregulin - a sigalling protein that mediates cell-cell interactions and plays critial roles in the growth and development of multiple organ systems
• Dysbindin - essential for adaptive neural plasticity
• DISC-1 - involved in neurite outgrowth and cortical development through its interaction with other proteins

Question 9

What are some environmental risk factors for schizophrenia?

Answer 9

• 2nd trimester viral illness
• Obstetric problems
• Childhood CNS infection
• Substance misuse
• Urban dwelling
• Social adversity or deprivation
• Neurodevelopmental changes
• Neurochemical signalling changes

Question 10

What are some obstetric problems that can increase risk of schizophrenia?

Answer 10

Pre-eclampsia
Foetal hypoxia
Emergency Caesarian section

Question 11

What are some substances that increase risk of psychosis?

Answer 11

• Amphetamines
• Cocaine
• Cannabis
• Novel psychoactive substances (‘legal highs’)

Question 12

What is the ICD-11 criteria for schizophrenia diagnosis?

Answer 12

At least 2 of the following symptoms must be present (By the individuals report or through observation) most of the time for a period of 1 month or more
1 of these must be a major symptom

Question 13

What are the 4 major criteria for schizophrenia diagnosis?

Answer 13

• Persistent delusions
• Persistent hallucinations
• Formal thought disorder
• Experiences of influence, passivity or control

Question 14

What are the 3 minor criteria for schizophrenia diagnosis?

Answer 14

• Negative symptoms (E.g. asociality, anhedonia, amotivation, anergia)
• Grossly disorganised behaviour that impedes goal-directed activity
• Psychomotor disturbance such as catatonic restlessness, agitation, posturing, waxy flexibility, negativism, mutism or stupor

Question 15

What is catatonia?

Answer 15

This is a state in which a person is awake, but does not respond to their environment

Question 16

What is a diagnosis of schizophrenia with the presence of a full syndrome of catatonia?

Answer 16

Catatonia associated with another mental disorder
Catatonic schizophrenia

Question 17

How may schizophrenia symptoms be clustered?

Answer 17

Positive symptoms
Negative symptoms

Question 18

What are some of the positive symptoms of schizophrenia?

Answer 18

Hallucinations
Delusions
Passivity phenomena
Disorder of the form of thought

Question 19

What are some negative symptoms of schizophrenia?

Answer 19

Affective blunting
Alogia (Paucity of speech)
Avolition (Lack of motivation)
Asociality (Loss of social interest)
Anhedonia (Loss of enjoyment)

Question 20

What are some of the subtypes of schizophrenia?

Answer 20

Hebephrenic
Catatonic

Question 21

What are the characteristics of hebephrenic schizophrenia?

Answer 21

• Prominent affective changes
• Fragmentary feeling
• irresponsible behaviour
• Shallow mood
• Incoherent speech
• Social isolation

Question 22

What is 1st line management of schizophrenia?

Answer 22

2nd generation antipsychotic (DA antagonist) e.g. risperidone or olanzapine - titrate up over 6-8 weeks

Question 23

What is 2nd line management of schizophrenia?

Answer 23

1st (e.g. haloperidol) or different 2nd generation antipsychotic - titrate up over 6-8 weeks

Question 24

What is 3rd line management of schizophrenia?

Answer 24

Check diagnosis, consider psychological input, optimise social supports, check compliance (consider depot?), consider combining two antipsychotics, consider clozapine

Question 25

Drug-induced psychosis vs schizophrenia

Answer 25

Drug-induced is usually short-lasting after the substance is removed

Question 26

Depressive psychosis vs schizophrenia

Answer 26

Depressive psychosis has delusions of worthlessness, guilt, hypochondriasis, poverty, sin and nihilism Depressive hallucinations tend to be 2nd person auditory, accusatory or insulting in character

Question 27

Mania with psychosis vs schizophrenia

Answer 27

Manic delusions are often of grandeur, special ability, persecution and religiosity Manic hallucinations tend to be 2n person auditory and positive (E.g. hearing God telling you you're great)

Question 28

What is persistent delusional disorder?

Answer 28

Systematised, fixed delusions are the major or only feature

Question 29

What is schizotypal disorder?

Answer 29

A disorder chracterised by eccentric behaviour and anomalies of thinking and affect which resemble those seen in SZ, though no definate and characteristic SZ anomalies occur at any stage

Question 30

What are the main symptoms of schizotypal disorder?

Answer 30

cold or inappropriate affect, anhedonia, odd or eccentric bhaviour, a tendency to social withdrawal, paranoid or bizarre ideas not amounting to true delisions, obsessive episodes which intense illusios, auditory or other hallucinaions and delusion-like ideas, usually occuring without external provocation

Question 31

What is induced delusional disorder

Answer 31

Psychoses that occur in one person due to contact with another with psychoses

Question 32

What are the french terms for induced delusional disorder?

Answer 32

Folie a deux, Folie a plusieurs