Schizophrenia And Psychotic Disorders

Question 1

What is the term psychosis used to describe?

Answer 1

Severe form of mental illness
Lack of insight
An inability to distinguish between symptoms of delusion, hallucination and disordered thinking from reality

Question 2

What is the clinical presentation of psychosis?

Answer 2

Hallucinations:
Have the full force and clarity of true perception, 
Located in external space, 
No external stimulus, 
Not willed or controlled

Question 3

What senses are involved in hallucinations?

Answer 3

Auditory,
Visual,
Tactile,
Olfactory and gustatory

Question 4

What is a delusion?

Answer 4

An unshakeable idea or belief which is out of keeping with the persons social and cultural background and is held with extraordinary conviction

Question 5

Examples of delusional beliefs

Answer 5

Grandiose,
Paranoid,
Hypochondriacal,
Self referential

Question 6

Illnesses that can have psychosis

Answer 6

Schizophrenia,
Delirium,
Severe affective disorder (eg depressive episode or manic episode with psychotic symptoms)

Question 7

What is schizophrenia

Answer 7

A severe mental illness affecting thinking, emotion and behaviour

Question 8

Age of onset of schizophrenia

Answer 8

15-35 years

Question 9

Schizophrenia symptoms

Answer 9

Hallucinations, 
Delusions,
Disordered thinking, 
Apathy, 
Lack of interest, 
Lack of emotions

Question 10

Schizophrenia diagnosis from ICD 10 requires one of the following for more than a month in absence of organic or affective disorder

Answer 10

Alienation of thought,
Delusions of control,
Hallucinatory voices- from parts of body or running commentary of patients behaviour,
Persistent delusions- culturally inappropriate and completely impossible

Question 11

Schizophrenia diagnosis from ICD 10 requires one major criteria or at least 2 of….

Answer 11

Persistent hallucinations- every day for at least one month,
Neologisms- breaks or interpolations in train of thought = incoherence or irrelevant speech
Catatonic behaviour
“Negative” symptoms- apathy, paucity of speech, blunting or incongruity of emotional responses

Question 12

Types of schizophrenia

Answer 12

Paranoid, 
Hebephrenic, 
Catatonic, 
Undifferentiated, 
Post-schizophrenic depression,
Residual,
Simple,
Other

Question 13

Biological factors that can affect schizophrenia

Answer 13

Genetics:
CF,
Neuregulin, 
Dysbindin, 
Di George syndrome 

Neurochemistry:
Dopamine hypothesis,
Glutamate,
GABA,
Serotoninergic transmission

Other:
Obstetric complications, 
Maternal influenza,
Malnutrition and famine, 
Winter birth, 
Substance misuse

Question 14

Social and psychosocial factors that can increase risk of schizophrenia

Answer 14

Migration,
Social isolation,
Life events

Question 15

Differential diagnoses for schizophrenia

Answer 15

Delirium,
Acute organic brain syndrome,
Depressive episode with psychotic symptoms,
Manic episode with psychotic symptoms,
Schizoaffective disorder- mix of affective and schizophrenia life features

Question 16

What % of people recovery after first episode of psychosis

Answer 16

80%

Question 17

Good prognostic factors for recovery from schizophrenia

Answer 17

Absence of FH,
Good premorbid function, 
Clear precipitant,
Acute onset, 
Mood disturbance, 
Prompt treatment,
Maintenance of initiative and motivation