Schizophrenia and Psychosis

Question 1

What is Schizophrenia?

Answer 1

=> Condition presenting in late teens/ early 20s characterised by:

• Psychotic symptoms
• Disorganisation symptoms
• Negative symptoms
• Cognitive impairment

Question 2

What are the risk factors of Schizophrenia?

Answer 2

• Being brought up in urban environment
• Stress
• Cannabis use
• Childhood abuse
• Parent or sibling with Schizophrenia
• Black Caribbean ethnicity

Question 3

What is psychosis?

Answer 3

• Used in the presence of delusions, hallucinations and disordered thought

Question 4

What are the clinical features of Schizophrenia?

Answer 4

=> Positive symptoms:

1. Thought insertion, thought broadcasting and/or thought withdrawal
2. Delusions that thoughts, feelings, impulses or actions are being controlled by external forces
3. Hallucinatory voices giving a running commentary on a patient’s behaviour, or even discussing a patient amongst themselves
4. Persistent delusions of other kinds that are culturally inappropriate or completely impossible

=> Negative symptoms:

5. Persistent hallucinations of any modality that occur over everyday for weeks
6. Breaks in train of thought resulting in irrelevant speech
7. Catatonic behaviour (eg. fixed, waxy posture)
8. Negative symptoms resulting in social withdrawal

Question 5

What is the diagnostic criteria for Schizophrenia? (ICD-10)

Answer 5

• One very clear symptom (or 2 less clear symptoms) from 1-4 (the positive symptoms)
• Or ≥ 2 from group 5-8 (the negative symptoms)

=> Only diagnose Schizophrenia when symptoms have lasted ≥ 6 months AND have been present for most of a month AND have caused a marked impairment in work or home functioning

Question 6

What are the investigations in suspected Schizophrenia?

Answer 6

=> MRI 
Reduced:
- Frontal lobe
- Parahippocampus lobe
- Temporal lobe
- Hippocampus 
- Amydala 

Larger lateral ventricles

=> Investigations to exclude differentials:

• Bloods (FBC, TSH)
• Drug screen
• Folate deficiency
• Vitamine B12
• HIV assay

Question 7

What is the management of Schizophrenia?

Answer 7

• Oral atypical antipsychotic first line (SGA)
• CBT

=> Antipsychotic medication:

• 1st GEN: Halperidol, Chlorpromazine, Prochlorperazine,
• 2nd GEN: Quetiapine, Olanzapine, Risperidone, Clozapine

Question 8

What are the adverse affects of 1st generation antipsychotics?

Answer 8

• Extrapyramidal effects (Parkinsonism, Acute Dystonia, Akathesia, Tardive Dyskinesia)
• Drowsiness
• Hypotension
• Erectile dysfunction
• Hyperprolactinoma

Question 9

What are the adverse affects of 2nd generation antipsychotics?

Answer 9

• Sedation
• Metabolic disturbances
• Breast symptoms
• Sexual dysfunction
• Agranulocytosis
• Prolonged QT
• Cardiovascular risk increased

Question 10

What are the different types of Scizophrenia?

Answer 10

• Paranoid
• Hebephrenic
• Catatonic

Question 11

What factors indicate a poorer prognosis?

Answer 11

• Acute
• Young male
• Childhood problems
• Low socioeconomic status
• Unmarried
• Unemployed
• Substance misuse