Schizophrenia

Question 1

What are the common causes of psychoses?

Answer 1

Substance abuse
Organic causes
Affective disorders
Schizophrenia
Dementia
Delirium
Temporal lobe epilepsy

Question 2

What are the first rank symptoms of schizophrenia?

Answer 2

Auditory hallucinations
Thought withdrawal/insertion/interruption/broadcast
Delusions
Passivity
Lack of insight

Question 3

What are the negative symptoms of schizophrenia?

Answer 3

Apathy
Self neglect
Blunted mood
Social withdrawal
Lack of motivation

Question 4

What are the risk factors for developing schizophrenia?

Answer 4

Genetic predisposition
Family history
Intrauterine and perinatal complications
Abnormal early cognitive/neuromuscular development
Poor parental relationship e.g. Hostile, overly critical parents
Social factors e.g. Inner city, migrants
Cannabis - especially if using since an early age

Question 5

What factors would suggest a better prognosis for schizophrenia?

Answer 5

Sudden onset
Female
Supportive family and friends
No negative symptoms
No family history
Later onset

Question 6

What type of delusions may schizophrenic patients get?

Answer 6

Persecutory
Paranoid
Grandiose

Question 7

What would you look for on MSE of a schizophrenic patient?

Answer 7

A - withdrawn, suspicious, self neglect. may have stereotyped movements
S - interrupted (due to though interruption), loosening of associations
E - blunted mood, low
P - auditory hallucinations
T - delusions
I - lack of insights
C - assess concentration, orientations, memory and attention to rule out dementia or delirium

Question 8

What issues are commonly associated with schizophrenia and should be screened for?

Answer 8

Depression
Drug and alcohol problems
Social issues

Question 9

How would you manage schizophrenia?

Answer 9

Non-pharm: MDT- gp, social support, CPN. risk assessment and prevention
Pharm: antipsychotics

Question 10

How are antipsychotics classed?

Answer 10

Typical

Atypical

Question 11

Name some typical antipsychotics

Answer 11

Haloperidol

Chlorpromazine

Question 12

Name some atypical antipsychotics

Answer 12

Clozapine
Risperidone
Olanzapine
Quetiapine
Aripiprazole

Question 13

What is the main difference between typical and atypical antipsychotics?

Answer 13

Antipsychotics have less extrapyramidal side effects so are generally preferred

Question 14

What are the general side effects of atypical antipsychotics?

Answer 14

Weight gain
Diabetes 
Sexual dysfunction
Drowsiness
Olanzapine and risperidone may still cause EP side effects at high doses 
Hyperprolactinaemia

Question 15

What are the serious side effects of clozapine?

Answer 15

Agranulocytosis

Cardiomyopathy and myocarditis

Question 16

What investigations would you do for a patient presenting with psychosis for the first time?

Answer 16

LFTs and FBC for alcoholism
Urinalysis for drugs of abuse
CT head if focal signs present (SOL, cerebral atrophy)
Consider syphillis, EEG

Question 17

What is the diagnostic criteria for schizophrenia?

Answer 17

At least one first rank symptom (auditory hallucinations, though disturbance, passivity, delusions)

Or at least 2 other symptoms (persistent hallucinations, incoherent or irrelevant speech, neologisms, catatonic phenomena, negative symptoms)

Question 18

define hallucination

Answer 18

a false perception where there is no external stimulus

Question 19

define delusion

Answer 19

a false, firmly held belief, held on inadequate grounds that is not inkeeping with the person’s cultural or religious background

Question 20

What are the extra pyramidal side effects of antipsychotics?

Answer 20

Parkinsonism eg. tremor, rigidity, bradykinesia

Acute dystonic reactions

Akathisia

Tardive dyskinesia

Question 21

What drugs are used to treat the extra pyramidal side effects of antipsychotics?

Answer 21

Anticholinergics e.g. procyclidine