Schizophrenia and related disorders

Question 1

schizophrenia features (first rank symptoms)

Answer 1

Schneider’s first rank symptoms may be divided into auditory hallucinations, thought disorders, passivity phenomena and delusional perceptions:

Auditory hallucinations of a specific type:
two or more voices discussing the patient in the third person
thought echo
voices commenting on the patient’s behaviour

Thought disorders
thought insertion
thought withdrawal
thought broadcasting

Passivity phenomena:
bodily sensations being controlled by external influence
actions/impulses/feelings - experiences which are imposed on the individual or influenced by others

Delusional perceptions
a two stage process) where first a normal object is perceived then secondly there is a sudden intense delusional insight into the objects meaning for the patient e.g. ‘The traffic light is green therefore I am the King’.

Other features of schizophrenia include
impaired insight
negative symptoms:
- incongruity/blunting of affect
- anhedonia (inability to derive pleasure)
- alogia (poverty of speech)
- avolition (poor motivation)
- social withdrawal

neologisms: made-up words
catatonia

Question 2

Schizophrenia risk factors

Answer 2

Question 3

schizophrenia poor prognostic indicators

Answer 3

Factors associated with poor prognosis
strong family history
gradual onset
low IQ
prodromal phase of social withdrawal
lack of obvious precipitant

Question 4

schizophrenia definition

Answer 4

ICD-11 Criteria: Symptoms present for at least 1 month, causing significant impairment.

DSM-5 Criteria: Symptoms persist for at least 6 months, encompassing at least one month of active-phase symptoms (must include one prominent ‘ABCD’ symptom).

Question 5

schizophrenia subtypes

Answer 5

Paranoid Schizophrenia: Characterized by delusions and hallucinations, often with a persecutory theme.
Catatonic Schizophrenia: Features motor disturbances and waxy flexibility.
Hebephrenic Schizophrenia: Marked by disorganized thinking, emotions, and behavior.
Residual Schizophrenia: Residual symptoms persist after a major episode.
Simple Schizophrenia: Characterized by a gradual decline in functioning without prominent positive symptoms.

Question 6

Schizophrenia investigations

Answer 6

While schizophrenia is primarily a clinical diagnosis based on history and examination, investigations can help exclude organic causes of psychosis. This includes:

• Brain imaging (CT/MRI) to rule out structural abnormalities
• Blood tests to exclude infectious (e.g.,HIV, syphilis) or metabolic causes (e.g., thyroid function tests)
• Drug screening to identify substance misuse

Question 7

Management of Schizophrenia

Answer 7

Question 8

delusions definition

Answer 8

Delusions are fixed, false beliefs that are maintained despite contradictory evidence. They are a prominent feature of numerous psychiatric conditions, including but not limited to schizophrenia, bipolar disorder, and psychotic depression. Delusions can be classified as bizarre (very strange or highly unusual) or non-bizarre (plausible but incorrect), and mood-congruent (consistent with the individual’s emotional state) or mood-neutral
hallmark of psychosis

Question 9

Delusions subtypes and their meaning
* Nihilistic delusions
* Delusions of grandeur/grandiose delusions
* Delusions of control
* Persecutory delusions
* Somatic delusions
* Delusional perceptions
* Delusions of reference

Answer 9

Question 10

Delusions differentials

Answer 10

Question 11

delusions management

Answer 11

Question 12

should be considered in elderly patients with new sudden onset psychosis to rule out an organic cause for their presentation

Answer 12

CT head

Question 13

Psychosis definition

Answer 13

Psychosis is a term used to describe a person experiencing things differently from those around them.

Question 14

Psychotic features in psychosis

Answer 14

hallucinations (e.g. auditory)
delusions
thought disorganisation
* alogia: little information conveyed by speech
* tangentiality: answers diverge from topic
* clanging
* word salad: linking real words incoherently → nonsensical content

Question 15

Associated features in psychosis:

Answer 15

• agitation/aggression
• neurocognitive impairment (e.g. in memory, attention or executive function)
• depression
• thoughts of self-harm

Question 16

Psychotic symptoms may occur in a number of conditions:

Answer 16

• schizophrenia: the most common psychotic disorder
• depression (psychotic depression, a subtype more common in elderly patients)
• bipolar disorder
• puerperal psychosis
• brief psychotic disorder: where symptoms last less than a month
• neurological conditions e.g. Parkinson’s disease, Huntington’s disease
• prescribed drugs e.g. corticosteroids
• certain illicit drugs e.g. cannabis, phencyclidine

Question 17

The peak age of first-episode psychosis is

Answer 17

around 15-30 years old

Question 18

what is cotard syndrome?

Answer 18

Cotard syndrome is a rare mental disorder where the affected patient believes that they (or in some cases just a part of their body) is either dead or non-existent. This delusion is often difficult to treat and can result in significant problems due to patients stopping eating or drinking as they deem it not necessary.

Cotard syndrome is associated with severe depression and psychotic disorders.

Question 19

catatonia definition

Answer 19

Stopping of voluntary movement or staying still in an unusual position = catatonia

Question 20

rapid tranquillazation pathway (if someone presents very agitated)

Answer 20

Question 21

antipsychotics act on which pathways in the brain

Answer 21

Question 22

extra pyramidal SE of antipsychotics and management

Answer 22

procyclidine is the anti-cholinergic medication of choice usually

Question 23

one of most serious and rare SE of antipsychotics

Answer 23

• Very old, dehydrated, or started on high dose
• emergency

Question 24

Antispychotics routes

Answer 24

• oral
• orodispersible
• IM short acting
• IM depot

Question 25

clozapine common and serious side effects

Answer 25

Question 26

Clozapine monitoring

Answer 26

Smoking increases metabolism of clozapine: if the stop smoking, levels go up