Psych - Schizophrenia

Question 1

What is psychosis?

Answer 1

• Definition: misperception of through and perceptions that arise from the patient’s own mind/imagination as reality and includes delusions and hallucinations
• Approx 3% of general population has clinically significant psychosis
• Symptom, not a diagnosis

Question 2

Name some psychotic disorders

Answer 2

• Schizophrenia
• Schizoaffective disorder
• Delusional disorder
• Brief psychotic episodes
• Psychotic depression
• Bipolar affective disorder
• Drug induced psychoses

Question 3

What are risk factors for schizophrenia/developing psychotic disorders?

Answer 3

• Relative with schizophrenia
• Black Caribbean ethnicity
• Migration
• Urban environment
• Cannabis use

Question 5

Name other features of schizophrenia

Answer 5

• Impaired insight
• Incongruity/blunting of affect (inappropriate emotion for circumstances)
• Decreased speech
• Neologism
• Catatonia
• Negative sx: anhedonia, alogia (paucity of speech), avolition (poor motivation)

Question 6

What is Schizophrenia? What are the 1st rank symptoms?

Answer 6

-Mental illness characterised by episodes of psychosis

1st rank sx:

• Delusions: persecutory (someone is out to get me) or of reference (patient is mentioned on TV/knows people are talking about them)
• In mood disorders the delusions will be in keeping with the mood (ie grandiose if high or nihilistic/depressive if low)
• Formal thought disorder: loosening of association, neologism, concrete thinking (cannot deal with abstract)
• 2nd person auditory hallucination, usually talking in the 3rd person about patient
• Passivity: actions, feelings or impulses interfered with and/or somatic passivity (body controlled by others).
• Presence of 1st rank sx is highly suggestive of schizophrenia but these can also occur in 8% of pts with bipolar and approx 20% of patients with chronic schizophrenia may never exhibit them

Question 8

Name the subtypes of schizophrenia

Answer 8

• Paranoid: most common - delusions and auditory hallucinations will be of paranoid nature
• Catatonic: uncommon - psychomotor disturbances (immobility or excessive activity), rigidity, posturing, echolalia (copying speech), echopraxia (copying behaviours)
• Hebephrenic: disorganised - early onset and with poor prognosis, patients have irresponsible and unpredictable behaviour with inappropriate and incongruous affect
• Residual (chronic): there is a history of the types above - negative and cognitive sx dominate current illness
• Undifferentiated: uncommon - negative sx without preceding over psychotic sx

Question 9

What is schizoaffective disorder?

Answer 9

-Affective and schizophrenic sx occur together and with equal prominence

Question 10

What is delusional disorder?

Answer 10

-Fixed delusion or delusional system (associated delusions) with other areas of thinking and functioning well preserved

Question 11

What are the treatment principles for schizophrenia?

Answer 11

• Offer early intervention in community
• Oral atypical antipsychotics are 1st line (avoid 2 concurrent antipsychotics) - start with lowest positive dose. Try at least 2 antipsychotics before considering Clozapine
• Monitor weight, ECG, FBC, lipids, HBA1c profiles, prolactin levels
• Offer CBT to all patients
• Monitoring of CVS risk factor modification due to high rates of CVS in these patients (linked to antipsychotic medication and high smoking rates)
• Provide social support to increased engagement, hope and reduce stigma
• Support with substance misuse if any

Question 12

What is defined as a brief psychotic episode?

Answer 12

-Psychotic episode lasting less than the time required to make a schizophrenia diagnosis (1/12 for ICD-10 or 6/12 for DSM)