Schizophrenia and Psychosis

Question 1

Psychosis definition

Answer 1

Individual is experiencing a reality that is different to those around them

Question 2

Psychosis
- 5 symptoms

Answer 2

Psychosis
- 5 symptoms

1. Hallucinations
2. Delusions
3. Formal thought disorder
4. Fragmentation of the boundaries of self
5. Loss of insight

Question 3

Causes of psychosis

Answer 3

• schizophrenia
• drugs e.g. hallucinogens, cannabis
• mania
• psychotic depression
• steroid-induced (cushings syndrome)
• stroke
• brain tumours
• hyperthyroidism
• huntington’s disease
• postpartum psychosis

Question 4

Delusion
- Definition

Answer 4

Delusion
- Definition

1. Fixed, firm belief
2. Cannot be reasoned away
3. Despite evidence to contrary
4. Out of sociocultural norms

Question 5

Schizophrenia definition

Answer 5

Chronic psychotic disorder characterised by negative and positive symptoms

Question 6

Schizophrenia subtypes

Answer 6

• Paranoid
• Catatonic
• Disorganised
• Schizoaffective (if doesnt fit schizophrenia or affective disorders fully)
• Undifferentiated (sx don’t fit 1 subtype)

Question 7

Paranoid schizophrenia features

Answer 7

• Prominent hallucinations and delusions
• Persecutory delusions

Question 8

Catatonic schizophrenia

Answer 8

• Prominent psychomotor disturbances
• Rigidity
• Abnormal voluntary movement

Question 9

Disorganised schizophrenia

Answer 9

• Early onset
• Unpredictable behaviour and speech
• Inappropriate mood and affect
• Fleeting hallucinations and delusions

Question 10

Schizoaffective disorders

Definition + subtypes

Answer 10

Episodic disorders where both affective and schizophrenic symptoms are prominent but which do not justify a diagnosis of either schizophrenia or depressive or manic episodes.
- schizoaffective manic
- Schizoaffective depressive
- Schizoaffective mixed

Question 11

Schizophrenia pathophysiology

Answer 11

Affected dopamine pathways:
Mesolimbic
- Involved in reward pathway
- Excessive dopamine causes delusions/hallucinations
Mesocortical
- Important for executive function, emotion, speech
- Less dopamine here gives negative sx
Nigrostriatal
- Dopamine increases voluntary movements
- Anti-psychotics (D2 blockers) lead to extrapyramidal side effects

Question 12

Schizophrenia risk factors
- biological
- psychological
- social

Answer 12

Biological
* Genetics - family history
* Brain maturation/injury
* Precocious drug use esp cannabis

Psychological
* Stress
* Adversity in childhood, trauma, neglect and abuse

Social
* Population density
* Family separation
* Migrant effect
* Social isolation

Question 13

Schizophrenia
- positive Symptoms

Answer 13

• Hallucinations - usually 3rd person auditory/running commentary
• Delusions - most commonly persecutory
• Thought disorder - insertion, withdrawal, broadcasting
• Passivity phenomena/somatic passivity - belief thoughts/actions aren’t their own
• Catatonia - abnormal movements inc. waxy flexibility (move patient into position and they will remain frozen there), catatonic stupor (patient suddenly stops and stays there

Question 14

Schizophrenia
- negative Symptoms

Answer 14

• Affective flattening - minimal emotional reaction to emotive subjects/events
• Alogia - poverty of speech
• Anhedonia - lack of interest in activities
• Avolition - lack of motivation
• Reduced level of functioning - social engagement, productivity at work/school, self-care

Question 15

Schizophrenia
- Prevalence
- Mortality

Answer 15

Schizophrenia

• Prevalence
  1%
• life expectancy 10-20 years less

Question 16

Schizophrenia DSM-5 criteria

Answer 16

At least 2 for 1 month, and at least 1 of the first 3:
1. Delusions
2. Hallucinations
3. Disorganised speech
4. Catatonic behaviour
5. Negative symptoms

ICD-10 used to differentiate between subtypes by features

Question 17

Schizophrenia/psychosis
- Biological Mx

Answer 17

Antipsychotics (D2 receptor blockers)

• 1st line: oral atypical anti-psychotics (quetiapine, olanzapine, risperidone)
• 2nd line: oral typical anti-psychotics (Haloperidol, chlorpromazine)
• 3rd line: Clozapine PO - only used for psychosis refractory to other tx

Question 18

Schizophrenia/psychosis
- Psycho Mx

Answer 18

CBT for psychosis
- helps individuals understand and manage their experiences of psychosis

Question 19

Schizophrenia/psychosis
- Social Mx

Answer 19

• Support for housing, finances etc
• Crisis teams
• community mental health team
• early intervention team (1st episode)

Question 20

Schizophrenia Hx questions
1. delusions
2. hallucinations

Answer 20

1. Delusions
   - Is there any thing heavily on your mind?
   - Do other people seem to try to disagree with you about what you’re saying?
2. Hallucinations
   - Do you ever hear someone speaking when there doesn’t seem to be anyone there?
   - Do you ever talk to people that other people don’t seem to see?