Schizophrenia

Question 1

Schizophrenia is:

Changes in ____

Changes in _____

_________ affect

Decrease in ______ ______

______ usually intact in early stages

Answer 1

Thinking

Perception

Blunted/inappropriate

Social Functioning

Cognition

Question 2

Define schneider’s first rank sx?

Answer 2

In the absence of organic cerebral pathology, these are indicative (but not pathognomic) of schizophrenia

Question 3

What are the categories of schneider’s 1st rank sx

Answer 3

Auditory hallucinations

Thought alienation

Removal of free will/passivity

Delusional perception

Question 4

What are the things in auditory hallucinations? (schneider’s 1st rank sx)

Answer 4

Repeating thoughts

3rd person talking about the patient

Running commentary

Question 5

What is in thought alienation? (schneider’s 1st rank sx)

Answer 5

Insertion, withdrawal, broadcasting

Question 6

What is in passivity? schneider’s 1st rank sx

Answer 6

Made feelings

Made impulses

Made actions

Somatic passivity

Question 7

What is somatic passivity

Answer 7

Passive recipient of bodily sensations from an external agency

Question 8

What is delusional perception?

Answer 8

A normal perception is interpreted as something significant for them

Question 9

What are other features of schizophrenia?

Answer 9

Other persistent delusions or hallucinations

Overvalued ideas

Insertions into train of thought so that speech is incoherent or irrelevant

Neologisms

Catatonia, can be posturing or waxy flexibility

Negative symptoms in chronic

Change in personal behaviour

Circadian rhythm disturbance

Question 10

What are some negative sx schizophrenia?

Answer 10

apathy

slowness

blunted affect

Question 11

What should you exclude if there are negative sx schizophrenia?

Answer 11

Depression and antipsychotic SEs

Question 12

What are the five subtypes of schizophrenia

Answer 12

Paranoid

Hebephrenic

Catatonic

Simple

Residual/chronic

Question 13

What sort of auditory hallucinations might someone with paranoid schizophrenia get?

Answer 13

Command

Question 14

What is the most common type of schizophrenia?

Answer 14

Paranoid

Question 15

What is hebephrenic schizophrenia?

Answer 15

Irresponsible and unpredictable.

Pranks

Incoherent and rambling speech

Affect change- giggling when saying something awful

Poorly organised delusions

Frequent, fragmentary hallucinations

Question 16

What is the prognosis in hebephrenic schiz?

Answer 16

Poor

Question 17

What is simple schizophrenia?

Answer 17

Insidious onset of functional decline.

Negative sx develop without prior positive sx

Often only diagnosed confidently in retrospect

Question 18

In residual/chronic what symptoms predominate?

Answer 18

Negative

Question 19

What is residual/chronic schizophrenia often preceded by?

Answer 19

Another type

Question 20

Risk factors for schiz?

Answer 20

Bio:

Genetic

Born late winter/early spring

Maternal viral infection pre-natally

Obstetric complications

Relatives with schizotypal PD

Cannabis adolescence

Temporal lobe epilepsy

Social:

Psychosocial stress

High expressed emotion in family

Question 21

In chronic schizophrenia, social understimulation can lead to what?

Answer 21

Negative sx

Question 22

In chronic schizophrenia, social overstimulation can lead to what?

Answer 22

Relapse

Question 23

Imaging findings in schiz?

Answer 23

Increased ventricular size and decreased grey matter

Question 24

What is the schiz dopamine hypothesis?

Answer 24

Dopamine excess or overactivity in the mesolimbic dopaminergic pathway

Question 25

What are the four dopamine pathways relevant to schiz?

Answer 25

1. Mesolimbic 2. Mesocortical 3. Nigrostriatal 4. Tuberohypophyseal

Question 26

How is the mesolimbic pathway related to schiz sx?

Answer 26

Increase in dopamine activity causes positive sx

Question 27

How is the mesocortical pathway related to schiz sx?

Answer 27

dopamine hypoactivity- negative, cognitive and affective sx

Question 28

How is the nigrostriatal pathway related to schiz sx?

Answer 28

Drugs- extra pyramidal and tardive dyskinesia drug SEs

Question 29

How is the tuberohypophyseal pathway related to schiz sx?

Answer 29

Drugs- hyperprolactinaemia SEs

Question 30

Dopamine normally ____ prolactin release

Answer 30

Inhibits

Question 31

Investigations in psychosis?

Answer 31

Bloods: U&E, FBC, LFT, TFT, B12 and folate, syphilis Drug screen EEG ?CT/MRI Hearing and vision tests in elderly

Question 32

Why do you to EEG in psychosis?

Answer 32

Could be complex partial seizures of temporal lobe

Question 33

Differentials for psychosis

Answer 33

Organic Psychoactive substance use Mood disorders- negative sx depression; mania + schneider's 1st rank symptoms; personality changes and personality disorder

Question 34

Management of schizophrenia

Answer 34

Admit initially then regular f/u ANTIPSYCHOTICS generally atypicals first. Clozapine if fail to respond. IM if refusing. Maintenance APs in chronic ECT only really if catatonic stupor Psychosocial- social skills training, group work if exposed to high expressed emotion or move out so don't live w family, behaviour therapy.

Question 35

Do positive or negative symptoms respond better to APs?

Answer 35

Positive

Question 36

What can you give for parkinsonian SEs APs? In what case should you not give it??

Answer 36

Procyclidine Tardive dyskinesia

Question 37

Schizophrenia prognosis

Answer 37

1/3 full recovery 1/3 relapsing and remitting 1/3 chronic

Question 38

What improves prognosis in schiz?

Answer 38

Female Older age of onset Sudden onset and rapid resolution Good response to Rx No cog impairment No ventricular enlargement on CT/MRI

Question 39

What is schizoaffective disorder?

Answer 39

Episodic Have features of a mood disorder AND schizophrenia in the same episode

Question 40

What are the two types of schizoaffective disorder?

Answer 40

Manic and depressive types | schiz + manic sx = manic type etc

Question 41

Which type of schizoaffective disorder has the worst prognosis?

Answer 41

Depressive type- increased chance they will develop negative sx schiz

Question 42

Management schizoaffective disorder?

Answer 42

Similar to schizophrenia APs in manic type ADs in depressive type (essentially Rx of depression)