Revision - Schizophrenia

Question 1

What is the % of risk of schizophrenia with one affected parent or sibling

Answer 1

10%

Question 2

What is the % of risk of schizophrenia if both parents affected or identical twin is affected?

Answer 2

50%

Question 3

What are the 6 subtypes of schizhophrenia?

Answer 3

1) paranoid

2) hebephrenic

3) catatonic

4) simple

5) residual

6) undifferentiated

Question 4

What 2 features characterise PARANOID schizophrenia?

Answer 4

1) Paranoid delusions

2) Auditory hallucinations

Question 5

What type of schizophrenia is typically diagnosed in adolescents/younger adults?

Answer 5

Hebephrenic

Question 6

Why is the outlook for hebephrenic schizophrenia poor?

Answer 6

As negative symptoms develop rapidly

Question 7

What 4 characteristics are seen in hebephrenic schizophrenia?

Answer 7

1. Mood changes
2. Fragmentary hallcuinations
3. Shallow affect
4. Unpredictable behaviour

Question 8

What 3 §psychomotor features are seen in catatonic schizophrenia?

Answer 8

1) posturing

2) rigidity

3) stupor

Question 9

What is posturing?

Answer 9

when a person holds a specific position, which would often be uncomfortable to people who aren’t experiencing catatonia

Question 10

What is stupor?

Answer 10

a state close to unconsciousness

Question 11

What is undifferentiated schizophrenia?

Answer 11

When patients’ symptoms do not fit neatly into one of the other categories

Question 12

What is residual schizophrenia?

Answer 12

The individual has suffered an episode of schizophrenia but there are no longer any delusions, hallucinations, disorganized speech or behavior

• Characterised by negative symptoms
• Positive symptoms have ‘burnt out’

Question 13

What type of schizophrenia is characterised by negative symptoms and patients have never experienced positive symptoms?

Answer 13

Simple

Question 14

What is delusional perception?

Answer 14

A true perception to which an individual attributes a false meaning.

Question 15

What are Schneider’s first-rank symptoms?

(6)

Answer 15

1) Thought insertion or withdrawal

2) Thought echo

3) Thought broadcasting

4) Delusional perception

5) Passivity/somatic passivity

6) 3rd person auditory hallucinations

Question 16

What are negative symptoms in schizophrenia? Give examples

Answer 16

1) Blunted affect (affect is a person’s expression of their emotional state)

2) Apathy

3) Social isolation / anhedonia (lack of interest/enjoyment from life’s experiences)

4) Poverty of speech (alogia)

5) Poor self-care

6) Avolition (severe lack of motivation/inability to complete purposeful tasks)

Question 17

How long must symptoms be present for before diagnosis of schizophrenia?

Answer 17

Requires a first rank symptom or persistent delusion to be present for at least one month AND no other cause for psychosis (e.g. drug intoxication).

Question 18

What class of drug is used in schizophrenia?

Answer 18

D2 (dopamine) receptor antagonists

Question 19

Give 3 examples of ‘typical’ antipsychotics

Answer 19

1) haloperidol

2) chlorpromazine

3) flupentixol decanoate (depot injection)

Question 20

Give 5 key side effects of typical antipsychotics

Answer 20

1) EPSEs

2) Raised prolactin

3) Metabolic

4) Anticholinergic

5) Neurological

Question 21

What extrapyramidal side effects are seen with ‘typical’ D2 receptor antagonist use?

Answer 21

1) parkinsonism

2) akathisia

3) dystonia

4) tardive dyskinesia

Question 22

What can hyperprolactinaemia due to ‘typical’ D2 receptor antagonist use cause?

Answer 22

Sexual dysfunction, risk of osteoporosis, amenorrhoea in women, galactorrhoea, gynaecomastia and hypogonadism in men

Question 23

What are the neurological side effects of ‘typical’ D2 receptor antagonist use?

Answer 23

1) seizures

2) NMS

Question 24

Give some examples of ‘atypical’ D2 receptor antagonists

(6)

Answer 24

1) Olanzapine

2) Risperidone (depot)

3) Clozapine

4) Quetiapine

5) Aripiprazole

6) Amisulpride

Question 25

Which antipsychotic is less likely to cause EPSEs than others? Why?

Answer 25

Aripiprazole - a partial dopamine agonist and so is less likely to cause EPSEs than others

Question 26

What 2 side effects are less common with atypical antipsychotics compared to typical?

Answer 26

1) EPSEs 2) Hyperprolactinaemia

Question 27

Difference between an illusion and a hallucination?

Answer 27

An illusion is based on a real sensory stimulus that is interpreted incorrectly whereas a hallucination is created by the mind without any stimulus

Question 28

What are the 3 types of illusions?

Answer 28

1) Affect 2) Completion 3) Pareidolia

Question 29

What is a ‘pareidolia’ illusion?

Answer 29

Seeing shapes in inanimate objects (e.g. faces in clouds)

Question 30

What is a ‘completion’ illusion?

Answer 30

The mind completes partial images (e.g. triangles optical illusion)

Question 31

what is an ‘affect’ illusion?

Answer 31

Based on current affect (e.g. see a monster in the cupboard when scared)

Question 32

What are the 3 clusters of psychotic symptoms?

Answer 32

1) hallucinations 2) delusions 3) thought disorder

Question 33

What 4 neural pathways can dopamine be implicated in in schizophrenia?

Answer 33

1) Mesolimbic 2) Nigrostriatal 3) Tuberoinfundibular 4) Mesocortical

Question 34

Positive symptoms of schizophrenia are due to increased dopamine activity in which neural pathway?

Answer 34

Mesolimbic

Question 35

Stopping an antipsychotic within 6 months increases risk of relapse by how much in schizophrenia?

Answer 35

4x

Question 36

What is acute psychotic disorder?

Answer 36

Psychotic symptoms last <28 days

Question 37

What is schizoaffective disorder?

Answer 37

Psychotic and affective symptoms are simultaneously present and equally prominent

Question 38

What is delusional disorder?

Answer 38

Delusional disorder is a type of psychotic disorder. Its main symptom is the presence of one or more delusions.

Question 39

Are hallucinations present in delusional disorder?

Answer 39

No, or are only fleeting

Question 40

Examples of delusional disorders: (7)

Answer 40

1) Othello syndrome 2) Folie a deux 3) Cotards syndrome 4) Capgras syndrome 5) Fregoli's syndrome 6) De Clerambault’s syndrome 7) Ekbom's syndrome

Question 41

What delusional disorder involves the belief that someone from a higher social standing is in love with them and sends them secret messages to convey their love?

Answer 41

De Clerambault's aka erotomania

Question 42

What is Fregoli’s syndrome?

Answer 42

They believe multiple people are actually one individual in disguise who is persecuting them

Question 43

What delusional disorder involves the belief that a relative has been replaced by an imposter?

Answer 43

Capgras syndrome

Question 44

Prior to commencing antipsychotics, investigations need to be completed. What observations need to be completed? Why?

Answer 44

1) BP & BMI --> metabolic side effects 2) ECG --> some can cause QT prolongation

Question 45

What neural pathway is the intended site of action of antipsychotics?

Answer 45

Mesolimbic

Question 46

In which neural pathway does dopamine antagonism cause elevated prolactin?

Answer 46

Tuberoinfundibular

Question 47

In which neural pathway does dopamine antagonism cause EPSEs?

Answer 47

Nigrostriatal

Question 48

Give 3 examples of ACUTE extra-pyramidal side effects (EPSEs) from antipsychotics

Answer 48

1) Parkinsonism 2) Acute dystonia 3) Akathisia

Question 49

Give an example of a CHRONIC EPSE from antipsychotics

Answer 49

Tardive dyskinesia

Question 50

What class of drug is acute dystonia as a result of antipsychotics managed with?

Answer 50

Anticholinergics e.g. procyclidine

Question 51

What class of drug is parkinsonism as a result of antipsychotics managed with?

Answer 51

An§ticholinergics

Question 52

What is akathisia as a result of antipsychotics managed with?

Answer 52

Sedatives or medication change

Question 53

What is tardive dyskinesia?

Answer 53

Tardive dyskinesia (TD) is a condition where your face, body or both make sudden, irregular movements which you cannot control. I.e. choreoathetoid movements

Question 54

How do anticholinergics affect tardive dyskinesia as a result of antipsychotics?

Answer 54

Make it WORSE

Question 55

What is the recurrence rate of postnatal psychosis?

Answer 55

25-50%

Question 56

What treatment is recommended for ALL people with schizophrenia?

Answer 56

CBT