Schizophrenia

Question 1

What are 1st rank Schneider symptoms?

Answer 1

Delusion
Delusional percept
Auditory hallucinations
Audible thoughts
Voices arguing or discussing
Voices commenting on the patient’s action
Thought disorder; passivity of thought
Thought withdrawal/ insertion/ broadcasting
Passivity of affect, impulse, volition, somatic
Delusion of control

Question 2

What type of hallucinations are almost pathognomonic of schizophrenia?

Answer 2

3rd person

Question 3

Diagnosis of schozphrenia according to ICD-10?

Answer 3

At least one of:
Thought echo; thought inserion or withdrawal or thought broadcasting
Delusions of control, influence of passivity, body or limb movement, actions, sensations, delusional perception
Hallucinatory voices giving a running commentary on behaviour, discussing him between themselves
Persistent delusions that are culturally inappropriate or completely impossible
OR
2 of the following:
Persistent hallucinations in any modality, when occurring every day for at least 1 month, when accompanied by delusions without clear affective content
Neologisms, breaks or interpolations in train of thought
Catatonic behaviour; excitement, posturing, waxy flexibility, negativism, mutism and stupor
Negative symptoms;

Question 4

Negative symptoms in schizophrenia?

Answer 4

Marked apathy
Paucity of speech - reduced speech 
Reducing motivation 
Reduced interest/ drive
Reduced social interaction 
Blunting of affect
Incongruity of emotional responses

Question 5

Subtypes of schizophrenia?

Answer 5

Paranoid
Hebephrenic
Catatonic

Question 6

What is paranoid schizophrenia?

Answer 6

Most common

1st rank symptoms predominate

Question 7

What is hebephrenic schizophrenia?

Answer 7

Immaturity
Silliness
Animation
Giggly

Question 8

What is catatonic schizophrenia?

Answer 8

Movement disorder predominate;

excitability, posturing, waxy flexibility, negativism, mutism, supor

Question 9

What is persistent delusional disorder?

Answer 9

Systematised, fixed delusions are the major or only features

Question 10

What is schizotypal disorder?

Answer 10

Eccentriticy and aloofness
Social withdrawal
Paranoid quasi-delusional ideas
Magical thinking
Transient auditory hallucinations

Question 11

What is acute/ transient psychotic disorder?

Answer 11

Schizophrenia like symptoms

Last <1 month

Question 12

What is schizoaffective disorder?

Answer 12

First rank symptoms + depression or mania

Question 13

Positive symptoms in schizophrenia?

Answer 13

Hallucinations
Delusions
Passivity phenomena
Disorder of form of thought

Question 14

Peak incidence of schizophrenia in men?

Answer 14

15-25

Question 15

Peak incidence of schizophrenia in females?

Answer 15

25-35

Question 16

Risk factors for development of schizophrenia?

Answer 16

Genetics; MZ twins have 40-60% concordance
Birth complications; prematurity, prolonged labour, foetal distress, hypoxial
Prenatal exposure to viral infections; toxoplasmosis, chlamydia, maternal stress and malnutrition
Heavy cannabis use
Urban dwelling
Social adversity or deprivation
Neurodevelopmental changes
Neurochemical changes

Question 17

What neurodevelopmental changes are seen in schizophrenia?

Answer 17

Enlarged ventricles

Thinner cortices

Question 18

What neurochemical changes are seen in schizophrenia?

Answer 18

Altered dopamine (D2) signalling
Hyperdominargia in basal ganglia and reduced in prefrontal cortex

EXCESS DOPAMINE IN MESOLIMBIC = POSITIVE SYMPTOMS (Hallucinations, delusions, passivity, disorder of form of thought)
REDUCED DOPAMINE IN MESOCORTICAL = NEGATIVE SYMPTOMS (poverty of speech, flattening and blunting of affect, anhedonia, anergie, reduced social interaction)

Question 19

What symptoms in schizophrenia are DANGEROUS IN TERMS OF HOMICIDE?

Answer 19

Command hallucinations

Othello syndrome

Question 20

Are those with schizophrenia more likely to commit suicide?

Answer 20

Yes; 10-15%

Highest in 1st week following discharge from hospital

Question 21

Bad prognostic indicators in schizophrenia?

Answer 21

Poor premorbid adjustment
Insidious onset
Early onset; childhood/ adolescence
Long duration of untreated psychosis
Cognitive impairment
Enlarged lateral ventricles

Question 22

Good prognostic indicators in schizophrenia?

Answer 22

Older age of onset
Shorter time of untreated psychosis 
Female gender
Marked mood disturbance especially elation (more likely to be schizoaffective_ 
Family history of mood disorder