4C Psychiatry Lectures > Schizophrenia > Flashcards

Schizophrenia Flashcards

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1
Q

How many people worldwide are affected by schizophrenia?

A

~24 million (about 1 in 300 people).

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2
Q

What is the lifetime prevalence of schizophrenia and related disorders?

A

Around 14.5 per 1000 people.

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3
Q

What is the male to female ratio in schizophrenia?

A

1:1 (equal).

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4
Q

At what age does schizophrenia usually start?

A

Late adolescence to early adulthood.

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5
Q

Why is the typical age of onset important in schizophrenia?

A

It overlaps with key developmental milestones (education, employment, relationships), contributing to functional disability.

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6
Q

What is the dopamine hypothesis of schizophrenia?

A

Schizophrenia is associated with hyperactivity of dopamine pathways → excess dopamine transmission in the mesolimbic pathway (positive symptoms) and reduced dopamine activity in the mesocortical pathway (negative & cognitive symptoms).

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7
Q

Which dopamine pathway is associated with positive symptoms of schizophrenia?

A

Mesolimbic pathway (excess dopamine).

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8
Q

Which dopamine pathway is associated with negative and cognitive symptoms of schizophrenia?

A

Mesocortical pathway (dopamine underactivity).

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9
Q

Which dopamine pathway is affected by antipsychotics leading to extrapyramidal side effects?

A

Nigrostriatal pathway (dopamine blockade → parkinsonism, dystonia, tardive dyskinesia).

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10
Q

Which dopamine pathway is associated with hyperprolactinaemia in antipsychotic use?

A

Tuberoinfundibular pathway (dopamine normally inhibits prolactin release).

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11
Q

What is the glutamate hypothesis of schizophrenia?

A

NMDA receptor hypofunction leads to altered glutamatergic signalling → contributes to cognitive deficits and possibly positive/negative symptoms.

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12
Q

What structural brain changes are seen in schizophrenia?

A

Enlarged lateral ventricles, reduced grey matter volume (esp. prefrontal cortex, temporal lobes, hippocampus), abnormal connectivity.

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13
Q

Which neurodevelopmental factors contribute to schizophrenia?

A

Obstetric complications, maternal infections, malnutrition, hypoxia, early brain injury.

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14
Q

What are the main genetic factors in schizophrenia?

A

Highly heritable (~80%). Polygenic inheritance with multiple susceptibility genes (e.g. COMT, DISC1, neuregulin). Increased risk with first-degree relatives.

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15
Q

What environmental risk factors are associated with schizophrenia?

A

Urban upbringing, cannabis use, childhood trauma, migration, social adversity, obstetric complications.

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16
Q

How does cannabis use affect schizophrenia risk?

A

Heavy use (esp. adolescence) increases risk 2–3 fold; risk is greater with earlier onset and higher potency (high-THC strains).

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17
Q

What is the role of neuroinflammation and immune dysregulation in schizophrenia?

A

Altered immune activation and microglial activity may disrupt neurodevelopment and synaptic pruning, contributing to pathophysiology.

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18
Q

List social and demographic risk factors for schizophrenia.

A

Lower socioeconomic class, migrant/ethnic minority status (especially first generation), urban upbringing.

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19
Q

What perinatal / prenatal risk factors increase schizophrenia risk?

A

Obstetric complications, prenatal nutritional deprivation, prenatal brain injury, maternal influenza.

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20
Q

What family / genetic and neurological risk factors predispose to schizophrenia?

A

Family history of schizophrenia, neurological abnormalities

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21
Q

Which early life psychosocial factor is associated with higher schizophrenia risk?

A

First-year parental separation.

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22
Q

How does substance misuse relate to schizophrenia risk?

A

Substance misuse (especially heavy adolescent cannabis, stimulants) increases risk and can precipitate earlier onset.

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23
Q

Name the core prodromal features often seen before frank psychosis.

A

Anxiety, poor sleep, social withdrawal, deteriorating function (missing lectures/work), suspiciousness, decline in self-care and motivation.

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24
Q

In the case vignette, John initially presents with anxiety, poor sleep, missing lectures and not socialising. These features are best described as:

A

Prodromal / early features of psychosis.

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25
What is a delusion of reference?
False fixed belief that neutral external events (TV, radio, newspapers) have special personal meaning directed at the individual.
26
John hears the radio broadcasting messages about him. What psychopathology is this?
Delusion of reference.
27
Define an auditory hallucination.
Perception of sound (voices) without an external stimulus, experienced as real by the patient.
28
John hears voices commenting on his actions and commanding him. What specific auditory hallucination types are these?
Commenting voices (voices that narrate actions) and commanding voices (command auditory hallucinations).
29
What is thought broadcasting / thought reading in psychosis?
The delusional belief that others can read one’s thoughts or that one’s thoughts are being broadcasted to others.
30
John believes people can read his thoughts. This is an example of:
Thought broadcasting / thought-reading.
31
Which features in John’s story suggest deterioration of function? Why is this important?
Dropping out of university, missing lectures, social withdrawal — functional decline is a key red flag for psychotic illness and helps distinguish psychosis from isolated experiences.
32
Timeline: John’s symptoms progressed over six months to include radio messages and persistent voices. In exam terms, why is duration important?
Duration helps differentiate brief/reactive psychoses from chronic disorders (e.g., schizophrenia spectrum); progressive symptoms over months suggest a developing primary psychotic disorder.
33
Give three positive symptoms of psychosis illustrated in John’s case.
Auditory hallucinations (voices), delusion of reference, thought broadcasting.
34
Give two negative / prodromal symptoms in John’s case.
Social withdrawal and decline in occupational/academic function (missing lectures, dropping out).
35
When assessing a young person with these features, what urgent assessments should you perform?
Risk assessment (self-harm/violence), substance use history, full psychiatric history, MSE, physical/neuro exam, investigations to rule out organic causes (bloods, tox screen, imaging if indicated), collateral history.
36
Name two red flags in the vignette that mandate urgent mental health referral/admission consideration.
Commanding voices (risk of harm if commands are acted on) and rapid functional decline with florid psychotic symptoms.
37
What are positive symptoms of schizophrenia?
Abnormal additions to normal experience, e.g. hallucinations, delusions, thought disorder.
38
What are negative symptoms of schizophrenia?
Loss or diminution of normal functions, e.g. apathy, reduced speech, social withdrawal.
39
What are passivity phenomena in schizophrenia?
Abnormal beliefs that one’s thoughts/actions/feelings are controlled by external forces (thought insertion, withdrawal, broadcasting, made actions).
40
Which group of symptoms (positive or negative) generally responds better to antipsychotics?
Positive symptoms.
41
Which group of symptoms (positive or negative) is more strongly associated with functional decline and poorer prognosis?
Negative symptoms.
42
What is the difference between primary and secondary negative symptoms?
Primary: intrinsic to schizophrenia (e.g. avolition, alogia). Secondary: due to medication side effects, depression, institutionalisation, or positive symptoms.
43
What is stupor in catatonia?
Marked decrease in reactivity or mutism.
44
What is excitement in catatonia?
Increase in purposeless activity, not influenced by external stimuli.
45
Define waxy flexibility (catalepsy).
Patient’s body can be moulded into a position like wax and will maintain it.
46
What is stereotypy in catatonia?
Repeated, complex, non-goal-directed movements (e.g. rocking).
47
What is a mannerism in catatonia?
Begins a movement but before completing it, starts the opposite movement.
48
What is automatic obedience?
Patient obeys commands even when told not to.
49
What is meant by psychological pillow in catatonia?
Patient maintains their head elevated as though resting on an invisible pillow.
50
How many symptoms must be present for schizophrenia diagnosis (ICD-11), and for how long?
≥2 symptoms present most of the time for ≥1 month; at least one must be from (a–d).
51
List ICD-11 schizophrenia symptoms
a) Persistent delusions b) Persistent hallucinations (esp. auditory) c) Disorganised thinking (FTD) d) Experiences of influence/passivity/control e) Negative symptoms (affective flattening, alogia, avolition, asociality, anhedonia) f) Grossly disorganised behaviour g) Catatonia symptoms
52
Which type of schizophrenia is most common and has the best prognosis?
Paranoid schizophrenia.
53
Clinical features of paranoid schizophrenia.
Dominated by delusions & hallucinations; negative symptoms, FTD, and catatonia uncommon.
54
Clinical features of hebephrenic (disorganised) schizophrenia.
Affective changes, disturbed behaviour, FTD, mannerisms, social isolation; fleeting/fragmented delusions & hallucinations; onset age 15–25; poor prognosis (rapid negative symptoms).
55
Clinical features of residual schizophrenia.
Chronic stage; progression from positive to mainly negative symptoms.
56
Clinical features of catatonic schizophrenia.
Catatonic symptoms (rare). Treatment: antipsychotics, benzodiazepines, ECT.
57
Causes of catatonic symptoms outside schizophrenia.
Encephalitis, CO poisoning, drug/alcohol use, mood disorders.
58
Clinical features of simple schizophrenia.
Insidious, progressive oddities of conduct, social decline, negative symptoms without overt psychosis.
59
What is post-schizophrenic depression?
Depressive episode after schizophrenia; some psychotic symptoms may remain but depression dominates. ↑ suicide risk.
60
What is undifferentiated schizophrenia?
Meets general criteria but does not fit a subtype, or features of >1 subtype without predominance.
61
Baseline bloods before starting antipsychotics?
FBC, U&Es, TFTs, LFTs, glucose, HbA1c, lipid profile, bone group.
62
Other important investigations in schizophrenia.
UDS, ECG, consider CT head to rule out organic causes.
63
When deciding hospital vs community management, what factors do you assess?
Severity, risk, housing, support, compliance, insight.
64
What is the first-line biological treatment for schizophrenia?
Antipsychotics (choice depends on tolerability/comorbidities).
65
When should clozapine be offered?
After failed trials of 2 different antipsychotics (one must be SGA).
66
What is the role of ECT in schizophrenia?
Consider in catatonia; not routine otherwise.
67
PRN medications used for agitation or insomnia in schizophrenia?
Short-term benzodiazepines or sedative antipsychotics.
68
Key psychological interventions in schizophrenia.
CBT for psychosis (reduce symptoms), family intervention (reduce relapse), art therapy (helpful for negative symptoms).
69
Key social interventions in schizophrenia.
Benefits, housing support, supported employment, volunteering/education, support groups (e.g. MIND).
70
After 2 years, what proportion of schizophrenia patients follow a benign course vs relapse/fail to recover?
~1/3 benign course; 2/3 relapse/fail to recover.
71
After 5 years, what proportion of schizophrenia patients fully recover?
~25%.
72
What is the strongest predictor of relapse in schizophrenia?
Non-adherence with treatment
73
By how much is premature death risk increased in schizophrenia?
2–3 fold.
74
Most common natural cause of premature death in schizophrenia?
Cardiovascular disease (also ↑ risk of diabetes, epilepsy, respiratory disease).
75
Predictors of poor outcome in schizophrenia.
Male gender, early age of onset, prolonged untreated illness, severe cognitive/negative symptoms.
76
Leading causes of premature death in schizophrenia aside from natural disease?
Suicide and accidents.
77
What is the core definition of schizoaffective disorder?
A mental illness with features of both schizophrenia (psychosis) and a mood disorder (depression or mania), with psychotic and affective symptoms present in the same episode.
78
What are the key psychotic symptoms in schizoaffective disorder?
Delusions, hallucinations, thought disorder, disorganised behaviour, catatonia, negative symptoms.
79
What are the mood (affective) symptoms seen in schizoaffective disorder?
Depressive: low mood, anhedonia, hopelessness, guilt, suicidality. Manic: elevated/irritable mood, pressured speech, decreased need for sleep, grandiosity, increased activity, distractibility, risk-taking.
80
What distinguishes schizoaffective disorder from schizophrenia with mood symptoms?
In schizoaffective disorder, mood symptoms are prominent and present for a substantial proportion of the illness episode, not just brief/reactive to psychosis.
81
What distinguishes schizoaffective disorder from mood disorders with psychotic features?
In schizoaffective disorder, psychotic symptoms occur even in the absence of mood symptoms for at least 2 weeks.
82
What are the two main types of schizoaffective disorder?
Bipolar type (with mania ± depression) and Depressive type (only depression).
83
Give an example presentation of schizoaffective disorder, depressive type.
Patient with low mood, hopelessness, anhedonia, alongside persecutory delusions and auditory hallucinations.
84
Give an example presentation of schizoaffective disorder, bipolar type.
Patient with elated mood, grandiose delusions, pressured speech, and auditory hallucinations.
85
Which negative symptoms may also be seen in schizoaffective disorder?
Avolition, alogia, social withdrawal, anhedonia, affective flattening.
86
What duration of illness is usually required for diagnosis (ICD-11/DSM-5)?
Symptoms must persist for at least 1 month (ICD-11) or ≥2 weeks of psychosis without mood symptoms (DSM-5 criterion).
87
According to ICD-11, which two sets of diagnostic requirements must be met for schizoaffective disorder?
Must meet full diagnostic criteria for schizophrenia and for a mood disorder (moderate/severe depressive episode, manic episode, or mixed episode).
88
In ICD-11 schizoaffective disorder, how do psychotic and mood symptoms typically relate in onset?
Onset of psychotic and mood symptoms is simultaneous or occurs within a few days of each other.
89
What is the required minimum duration of symptomatic episodes in ICD-11 schizoaffective disorder?
At least 1 month of both psychotic and mood symptoms.
90
In ICD-11, what exclusions must be ruled out before diagnosing schizoaffective disorder?
Symptoms must not be due to: Another medical condition Effects of a substance or medication on the CNS (including withdrawal).
91
Which types of mood episodes are compatible with ICD-11 schizoaffective disorder?
Moderate or severe depressive episode, manic episode, or mixed episode.
92
Key differentiator — how is schizoaffective disorder distinct from schizophrenia with mood symptoms?
In schizoaffective disorder, mood and psychotic symptoms are both fully syndromal and occur together, not just mild/reactive mood changes secondary to psychosis.
93
What is the general principle of schizoaffective disorder management?
A biopsychosocial approach: treat both psychotic and mood symptoms, plus psychosocial support.
94
First-line pharmacological treatment for psychotic symptoms in schizoaffective disorder?
Antipsychotics (e.g. risperidone, olanzapine, quetiapine).
95
Which drug is considered for treatment-resistant psychotic symptoms in schizoaffective disorder?
Clozapine (after ≥2 antipsychotic trials).
96
What medications are used if the mood component is depressive?
Antidepressants (e.g. SSRIs) alongside an antipsychotic.
97
What medications are used if the mood component is manic?
Mood stabilisers (e.g. lithium, valproate, carbamazepine) alongside an antipsychotic.
98
What is the role of ECT in schizoaffective disorder?
May be considered in severe depression, suicidality, or catatonia
99
Key psychological interventions for schizoaffective disorder?
CBT for psychosis (reduce distress from hallucinations/delusions) Family therapy (reduces relapse rates) Psychoeducation
100
Key social interventions for schizoaffective disorder?
Supported housing, benefits, occupational/educational support, peer support groups (e.g. MIND).
101
What must always be assessed in patients with schizoaffective disorder before management planning?
Risk assessment: suicide risk, self-neglect, risk to others, capacity/insight, safeguarding.
102
What is the importance of monitoring adherence in schizoaffective disorder?
Non-adherence is the strongest predictor of relapse → consider long-acting injectable (LAI) antipsychotics.
103
In an acute crisis, what factors determine hospital vs community management?
everity, risk, social support, housing, insight, compliance.
104
If hospitalisation is required, what legal framework may be used?
Mental Health Act (MHA) for compulsory admission if risks are high and no insight
105
A 30-year-old with schizophrenia would like some talking therapy. Which psychological therapy does NICE recommend for all patients?
Cognitive Behavioural Therapy (CBT).
106
A pregnant woman with schizophrenia asks how likely her child is to develop the condition. Her partner has no mental illness. What is the risk?
13%.
107
A 17-year-old boy has not attended school for 4 months, lost contact with friends, speech is incoherent, and he laughs or grimaces inappropriately. What subtype of schizophrenia does he have?
Hebephrenic (disorganised) schizophrenia.
108
Affective flattening is characterised by which of the following? Expressionless and unresponsive facial appearance Lack of eye contact Monotonous voice All of the above
All of the above.
109
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