Schizophrenia and related disorders

Question 1

What conditions can psychosis present in?

Answer 1

• Organic states & disorders (delirium, dementia, DT’s, other brain disorders, metabolic disorders e.g. porphyria etc.)
• Psychoactive substance misuse (intoxication and
withdrawal states, DTs)
• Schizophrenia
• Affective disorders
• Sleep or sensory deprivation
• Bereavement

Question 2

What are the five types of these disorders?

Answer 2

Schizophrenia, schizoaffective disorder, delusional disorder, acute & transient psychotic disorder, schizotypal disorder.

Question 3

Schizophrenia epidemiology?

Answer 3

Up to 1% of the population.
M>F
Symyptoms >6/12 (>1/12 for diagnosis)

Question 4

What are the positive symptoms in schizophrenia?

Answer 4

Hallucinations (esp auditory)
Delusions
Thought disorders

These are the focus of drug treatment and have a good prognosis.

Question 5

What are the negative symptoms in schizophrenia?

Answer 5

Avolition: lack of motivation
Anhedonia: unable to experience pleasure
Alogia: poverty of speech
Asociality: lack of desire for relationships
Affect Blunt

Less responsive to treatment

Question 6

What is schizophrenia characterised by (in general) in the ICD-10?

Answer 6

• fundamental and characteristic distortions of thinking and perception
• affects that are inappropriate or blunted.

Question 7

What are the most important psychopathological phenomena of schizophrenia?

Answer 7

Thought broadcast
Thought withdrawal or insertion
Thought echo
Delusional perception
Delusions of control/passivity/influence
3rd person hallucinatory voices
Thought disorders
Negative symptoms

Question 8

When should schizophrenia not be diagnosed?

Answer 8

Overt brain disease (including epilepsy)

States of intoxication or withdrawal

Question 9

What is schizoaffective disorder?

Answer 9

This is when symptoms of schizophrenia and affect are prominent at the same time.

Question 10

5 types of schizophrenia

Answer 10

Paranoid (most common)
Hebenephric
Catatonic
Simple 
Undifferentiated

Question 11

What are Schneiders first-rank symptoms of schizophrenia?

Answer 11

• Delusional perception
• 3rd person auditory hallucinations
• Thought Echo, Insertion, Withdrawal, Broadcast
• Passivity
  * Somatic (experiences of bodily influence)
  * Made (Acts, Impulses, Affects (emotions))

Question 12

What neurotransmitter is thought to be the cause of schizophrenic disorders?

Answer 12

Dopamine

Question 13

What receptors do most antipsychotics act upon?

Answer 13

Dopamine receptors (all 5 but mostly D2)

Question 14

What brain system causes positive symptoms, and which one causes negative symptoms?

Answer 14

Positive > mesolimbic

Negative > mesocortical

Question 15

What risk factors are there for schizophrenia?

Answer 15

Environmental:
• Winter births, viral infections
• Association with other CNS pathologies
• Neurosyphyllis, Encephalitis, Temporal Lobe Epilepsy
Life events:
• Social exclusion, economic adversity
• Childhood trauma/abuse
• Migration (higher rates in migrants)
• Urban environment (higher rates)
• Negative attitudes/ high expressed emotion
Substance misuse:
• Cannabis, amphetamines
Peri-natal trauma:
• Hypoxia, maternal stress

Question 16

What is De Clerambault’s syndrome?

Answer 16

•Erotomania -Delusional belief another (famous, higher social status) is in love with them
•Can’t declare love so via secret signs/
communication

Question 17

What is Capgras syndrome?

Answer 17

• Delusional misidentification
• Relative/ spouse/ close relation/ friend replaced by identical looking double or impostor
• M:F = 2:3

Question 18

What is Othello syndrome?

Answer 18

• Delusional belief that partner having
affair/sex with others
• No evidence/ misinterprets minor
evidence
• Associated with alcohol dependence/
sexual dysfunction
• Risk of stalking and/or violence to
partner

Question 19

What is Fregoli’s syndrome?

Answer 19

• Different people are a single person
who changes appearance or is in
disguise
• Often believe they are being
persecuted by that person

Question 20

What is Cotard’s syndrome?

Answer 20

•Delusion of being dead, dying, nonexistent,
rotting, lost parts of body/organs
•Associated with depression

Question 21

What is Folie a Deux?

Answer 21

• Induced delusional disorder

* Psychosis shared by two people

Question 22

What is Ekboms syndrome?

Answer 22

•Delusional parasitosis
•infested with parasites
•No evidence (only little marks/
freckles/spots)
•Associated with formication
•Risk of self harm trying to get rid of
parasites
•Presents to dermatologists
•House or home infested: delusional
cleptoparasitosis

Question 23

What is catatonic schizophrenia?

Answer 23

• prominent psychomotor disturbances that may alternate between extremes such as hyperkinesis
and stupor, or automatic obedience and negativism.
• Constrained attitudes and postures may be maintained for long periods.
• Episodes of violent excitement may be a striking feature of the condition.
• The catatonic phenomena may be combined with a dream-like (oneiroid) state with vivid scenic
hallucinations.

Question 24

What is simple schizophrenia?

Answer 24

• insidious but progressive development of oddities of conduct, inability to meet the demands of
society, and decline in total performance.
• The characteristic negative features of residual schizophrenia (e.g. blunting of affect and loss of
volition) develop without being preceded by any overt psychotic symptoms.

Question 25

What is undifferentiated schizophrenia?

Answer 25

• Psychotic conditions meeting the general diagnostic criteria for schizophrenia but not conforming
to any of the subtypes or exhibiting the features of more than one of them without a clear
predominance of a particular set of diagnostic characteristics

Question 26

What short-term (acute) medication can you use to treat schizophrenia?

Answer 26

Antipsychotics

Question 27

What long-term (maintenance) medication can you use to treat schizophrenia?

Answer 27

Antipsychotics (oral/depot)
Antidepressants
Lithium

Question 28

What psycho-social short-term (acute) treatment can you use to treat schizophrenia?

Answer 28

Psychoeducation (CBT/family Interventions)

Question 29

What psycho-social long-term (maintenance) treatment can you use to treat schizophrenia?

Answer 29

CBT
Supported employment
Family interventions
Reduce expressed emotion
Relapse signature
Art therapy

Question 30

What side effects are you more at risk of in 1st generation antipsychotics and what are you more at risk on in 2nd generation antipsychotics?

Answer 30

FGA - Neurological side effects
Tardive dyskinesia, extrapyramidal symptoms, D2 antagonists
SGA - Metabolic side effects
Weight gain, hyperglycaemia, dyslipidaemia, 5HT2A/D2 antagonists

Question 31

What is the main risk of Clozapine?

When do you offer it?

Answer 31

Agranulocytosis, also myocarditis, weight gain, salivation, seizures, sedation.

NICE: Offer clozapine to people with schizophrenia whose illness has not responded adequately to treatment despite the sequential use of adequate doses of at least two different antipsychotic drugs.

Question 32

What is tardive dyskinesia?

Answer 32

Tardive – delayed or appearing late (because it’s a side effect that usually doesn’t appear until after you’ve been taking medication for a while)
Dyskinesia – abnormal or unusual movements

Question 33

What are extrapyramidal symptoms?

Answer 33

These symptoms include:
dystonia (continuous spasms and muscle contractions), akathisia (motor restlessness),
parkinsonism (characteristic symptoms such as rigidity), bradykinesia (slowness of movement), tremor, and tardive dyskinesia (irregular, jerky movements).