Schizophrenia and psychotic disorders

Question 1

What is the definition of psychosis?

Answer 1

Psychosis represents an inability to distinguish between symptoms of hallucination, delusion and disordered thinking from reality

Question 2

What are clinical presentations of psychosis?

Answer 2

Hallucinations

Delusional beliefs

Question 3

What are hallucinations like?

Answer 3

Have full force and clarity of true perception
Located in external space
No external stimulus
Not willed or controlled
Can be any of the senses

Question 4

What is a delusion?

Answer 4

An unshakeable idea or belief which is out of keeping with the person’s social and cultural background, it is held with extraordinary conviction

Question 5

What are types of delusion?

Answer 5

Grandiose
Paranoid
Hypochondriacal
Self referential

Question 6

What illnesses may have psychotic symptoms?

Answer 6

Schizophrenia
Delirium
Severe affective disorder - depressive episode or manic episode

Question 7

What is the most common illness associated with psychosis?

Answer 7

Schizophrenia

Question 8

What are the positive symptoms of schizophrenia?

Answer 8

Hallucinations
Delusions
Disordered thinking

Question 9

What are the negative symptoms of schizophrenia?

Answer 9

Apathy
Lack of interest
Lack of emotions

Question 10

What is the ICD-10 for a diagnosis of schizophrenia? (long answer)

Answer 10

For more than a month in absence of organic or affective disorder, at least one of following:
- alienation of thought as though echo, though insertion or withdrawal, or though broadcasting
- delusions of control, influence or passivity, clearly referred to body or limb movements, actions or sensations; delusional perception
- hallucinatory voices giving running commentary on patients behaviour or discussing him between themselves, other types of hallucinatory voices from sort part of body
- persistant delusions of other kinds that are completely impossible
And OR at least two of following:
- persistant hallucinations in any modality
- neologism, breaks or interpolations in train of thought resulting in incoherence or irrelevant speech
- catatonic behaviour, such as excitement, posturing or waxy flexibility, negativism, mutism and stupor
- ‘negative’ symptoms such as marked apathy, paucity of speech, blunting or incongruity of emotional responses

Question 11

What is the ICD-10 for a diagnosis of schizophrenia? (summary)

Answer 11

For more than a month in absence of organic or affective disorder, at least one of following:
- alienation of thought
- delusions of control, influence or passivity
- hallucinatory voices
- persistant delusions
And OR at least two of following:
- persistant hallucinations
- breaks or interpolations in train of thought
- catatonic behaviour
- ‘negative’ symptoms

Question 12

What is neologisms?

Answer 12

Making up new words

Question 13

What can the aetiologies of psychosis be considered as (3Ps)?

Answer 13

Possible predisposing factor
Precipitating factor
Perpetuating factor

Question 14

What are the possible aetiologies of psychosis?

Answer 14

Biological factors
Psychological factors
Social factors

Question 15

What can possible social and psychosocial factors influencing schizophrenia be?

Answer 15

Occupation
Social class
Migration
Social isolation
Life events as precipitants

Question 16

What are differentials for schizophrenia?

Answer 16

Delium

Acute organic brain syndrome

Question 17

What makes it appear more as delirium and not schizophrenia?

Answer 17

Visual hallucinations
Fluctuating, worse at night
Delusions are persecutor and evanescent

Question 18

What are persecutory delusions?

Answer 18

They feel harm is going to occur to them

Question 19

What type of symptoms typically occur with a depressive episode with psychotic symptoms?

Answer 19

Derogatory auditory hallucinations

Delusions of guilt, worthlessness, persecution

Question 20

What type of symptoms typically occur with a manic episode with psychotic symptoms?

Answer 20

Delusions of grandeur, special powers of messianic roles

Gross overactivity, irritability, behavioural disturbance, manic excitement

Question 21

What are good prognostic factors for schizophrenia?

Answer 21

Absence of FH
Good premorbid function
Clear precipitant
Acute onset
Mood disturbance
Prompt treatment
Maintenance of initiative/motivation

Question 22

What are poor prognostic factors for schizophrenia?

Answer 22

Slow, insidious onset

Prominent negative symptoms

Question 23

What is the treatment for schizophrenia?

Answer 23

Anti-psychotics

Psychological treatment e.g. CBT