Schizophrenia

Question 1

What are the four first rank symptoms of schizophrenia?

Answer 1

1. Auditory hallucinations (2nd/3rd person, thought echo)
2. Thought disorder (insertion, withdrawal, broadcasting)
3. Passivity phenomena (somatic passivity, made act/feeling/drive)
4. Delusional perceptions

Question 2

What are the other features of schizophrenia that aren’t first rank?

Answer 2

1. persistent hallucinations in any modality
2. neologisms, breaks in train of thought, incoherent/irrelevant speech
3. Catatonia
4. Negative sx

Question 3

What are -ve sx?

Answer 3

incongruity/blunting of effect
anhedonia
alogia - poverty of speech
avolition - poor motivation

Question 4

What is the diagnostic criteria of schizophrenia? How long is the time frame?

Answer 4

1 or more of the first rank sx for 1 month or more
OR
Any 2 of the other symptoms
decrease in function!

Question 5

What are the four different causes of psychosis? give examples

Answer 5

1. Affective disorders (schizophrenia, depression, bipolar)
2. Transient psychosis (drugs/alcohol)
3. Med conditions (dementia, delirium, tumour)
4. Schizophrenia like non-affective disorders (brief psychotic disorder, delusional disorder, schizophreniform disorder)

Question 6

what are the four subtypes of schizophrenia?

Answer 6

1. Paranoid - mainly hallucinations +/- delusions
2. Hebephrenic - fluctuating affect prominent w fleeting fragmented delusions and hallucinations
3. Catatonic - stupor, posturing, waxy flexibility, negativism
4. Simple and residual - mainly negative sx

Question 7

What are prodromal sx to schizophrenia? how early do they precede the first episodes of psychosis?

Answer 7

Decline in functioning:
transient/attenuated psychotic sx
odd thoughts beliefs etc
conc. problems
altered affect (immediate emotional responses)
social withdrawal 
reduced interest in activities

Question 8

Give an MRI sign in schizophrenics and 2 social factors linked to causing it.

Answer 8

Small amygydalas, frontal lobes temporal lobes. Social: Brought up in a city, being a migrant

Question 9

What is the main aetiological theory behind schizophrenia?

Answer 9

Unusual neurodevelopment via genetics/insult to brain in development.

Question 10

What are the two strands of management?

Answer 10

Antipsychotics and psychosocial interventions

Question 11

Describe three schizophrenia-like disorders.

Answer 11

Schizoaffective disorder: mania/depression with schizophrenia at the same time at the same intensity.
Schizotypal disorder: Personality disorder (see later).
Schizophreniform disorder: Failure to meet threshold for schizophrenia (usually due to time) but some symptoms and a decrease in function.

Question 12

What psychological therapy has strong evidence? Give 2 other non-pharmacological methods.

Answer 12

CBT for psychosis. Also: family therapy, social support (!)(money, job house)

Question 13

Give 5 Ix to monitor in antipsychotic use.

Answer 13

Glucose, lipids, prolactin, LFT, U+E, ECG, BP, weight

Question 14

Which drug is first line?

Answer 14

Any antipsychotic. All have efficacy but different side effects. Normally antipsychotics begin working on psychosis in a couple of weeks

Question 15

Define treatment resistant schizophrenia. What is used to treat it?

Answer 15

if 2 sets of 6 week trials of antipsychotics failed (incl. 1 non-clozapine SGA)
USE CLOZAPINE

Question 16

What if there is a failure to respond to this?

Answer 16

Can combine. Can use lamotrigine to augment. ECT can be used.

Question 17

When should antipsychotics be stopped?

Answer 17

A guide is 3 years, before this 80% relapse. But there is no completely safe time.

Question 18

Give the treatment for: acute dystonia, akathisia, and tardive dyskinesia.

Answer 18

Dystonia: IM/PO procyclidine. Akathisia: Lower dose or change or stop medicine. Propranolol can be tried. Tardive dyskinesia: May be irreversible, tetrabenzine can be used.

Question 19

What is the prognosis like for schizophrenia?

Answer 19

Generally not great. 10% have one episode, 40% are better in 15 years. On average, schizophrenics die 25 years earlier than a normal person

Question 20

The cause of psychosis can be tricky to find. With auditory hallucinations what is it likely to be? What about non-auditory? When should a CT be done?

Answer 20

Auditory: likely to be a mental disorder – schizophrenia/depression etc. Non-auditory: 90% have substance abuse/withdrawal/physical illness. CT head needed in any olfactory, tactile, or gustatory hallucinations, or any suspicion of neurological disease