Schizophrenia

Question 1

what is required for a diagnosis of schizophrenia

Answer 1

at least 1 out of 4 of the main symptoms
or
at least 2 out of 4 of the additional symptoms
symptoms must be present for at least 6 months and significantly impair work/functioning

Question 2

list the 4 main symptoms of schizophrenia

Answer 2

thought disorder - echo, broadcasting, insertion or withdrawal
delusion of control, influence and passivity
hallucinations
persistent delusions that are culturally inappropriate

Question 3

list the 4 additional symptoms of schizophrenia

Answer 3

persistent hallucinations in any modality
neologisms
catatonic behaviour
negative symptoms

Question 4

describe catatonic behaviours

Answer 4

sudden strange purposeless movements such as excitement, posturing, waxy flexibility

Question 5

describe negative symptoms of schizophrenia

Answer 5

reduced amount of speech
reduced drive 
reduced social interaction 
apathy 
blunting of affect

Question 6

describe positive symptoms of schizophrenia

Answer 6

hallucinations
delusions
passivity phenomena
disorder of form and thought

Question 7

list the different types of schizophrenia

Answer 7

paranoid
hebephrenic
catatonic

Question 8

what is the most common type of schizophrenia

Answer 8

paranoid - typically presents with positive symptoms

Question 9

describe the behaviours seen in hebephrenic schizophrenia

Answer 9

delusions and hallucinations
behaviour is unpredictable and disruptive
mood is shallow and inappropriate
social isolation and -ve symptoms

Question 10

describe the behaviours seen in catatonic schizophrenia

Answer 10

mainly movement disorders
stupor and hyperkinesis
posturing and waxy flexibility may be seen

Question 11

what are paranoid psychoses

Answer 11

cluster of disorders such as persistent delusions, schizotypal and schizoaffective disorder
fixed delusions are the main feature

Question 12

what is the first line treatment for schizophrenia and give an example

Answer 12

second generation antipsychotic such as risperidone, quetiapine, olanzapine

Question 13

what is the second line treatment for schizophrenia and give an example

Answer 13

an alternative second generation antipsychotic or first generation such as haloperidol, chlorpromazine or zuclopenthixol

Question 14

what is the third line treatment for schizophrenia

Answer 14

clozapine

Question 15

why is clozapine third line in treating schizophrenia

Answer 15

severe side effects such as agranulocytosis, myocarditis, constipation, sialorrhoea, weight gain and sedation

Question 16

what are the main side effects of antipsychotics

Answer 16

extra-pyramidal side effects
neuroepileptic malignant syndrome
hyperprolactinaemia

Question 17

which generation of antipsychotics typically cause extra-pyramidal side effects

Answer 17

first generation - hence why second generation are tried first

Question 18

list the types of symptoms experienced with extra-pyramidal side effects

Answer 18

Parkinsonism
acute dystonic reaction
tardive dyskinesia

Question 19

what is acute dystonia

Answer 19

increasing muscle tone, onset within minutes

muscles appear flexed, oculogyric crisis and tongue protrusion

Question 20

how are extra-pyramidal side effects managed

Answer 20

treat with anticholinergics such as procyclidine, trihexiphenidyl

Question 21

what is neuroepileptic malignant syndrome

Answer 21

potentially fatal condition where increasing muscle tone, pyrexia, fluctuating BP/HR can result in rhabdomyolysis and renal failure

Question 22

describe the clinical features of hyperprolactinaemia

Answer 22

women - galactorrhoea, reduced libido and anorgasmia, amenorrhoea
men - gynaecomastia, erectile dysfunction
both - reduced bone density

Question 23

why is hyperprolactinaemia a side effect of antipsychotics

Answer 23

prolactin release is inhibited by dopamine, when dopamine gets blocked then increased prolactin release occurs

Question 24

list some additional side effects - more commonly seen in second generation antipsychotics

Answer 24

anticholinergic s/e - blurred vision, dry mouth, constipation, urinary retention 
weight gain 
postural hypotension 
prolonged QT interval 
photosensitivity