Schizophrenia and Psychiatric Disorders

Question 1

What is psychosis?

Answer 1

Psychosis = disease of the mind, an inability to distinguish between symptoms of delusion, hallucination and disordered thinking from reality

Question 2

What are delusions?

Answer 2

Delusion = unshakable idea or belief which is out of keeping with person’s social and cultural background, it is held with extraordinary conviction

Question 3

What are examples of delusional beliefs?

Answer 3

• Granidiose
• Paranoid
• Hypochondriacal
• Self-referential

Question 4

Psychosis - presentation

Answer 4

• Hallucinations
  
  • Have full force and clarity of true perception
  • Located in external space
  • No external stimulus
  • Uses all 5 special senses

Question 5

Describe the hallucinations in psychosis?

Answer 5

• Hallucinations
  
  • Have full force and clarity of true perception
  • Located in external space
  • No external stimulus
  • Uses all 5 special senses

Question 6

What are some illnesses that can have psychosis?

Answer 6

• Schizophrenia
• Delirium
• Severe affective disorder
  
  • Depressive episode
  • Manic episode

Question 7

Schizophrenia - pathology

Answer 7

• Thinking
• Emotion
• Behaviour

Question 8

Schizophrenia - aetiology

Answer 8

• Biological factors
  
  • Genetics
    
    • Nruegulin (chromosome 8p)
    • Dysbindin (chromosome 6p)
    • Di George syndrome
  • Neurochemistry
    
    • Dopamine hypothesis – increased level of dopamine in brain
    • Revised dopamine hypothesis – mesolimbic hyperdopaminergia and mesocortical hypodopaminergia
    • Glutamate
    • GABA
    • Noradrenaline
    • Serotoninergic transmission
  • Neurological abnormalities
    
    • Ventricular enlargement
    • Reduced frontal lobe performance
    • Eye tracking abnormalities
    • EEG abnormalities
  • Obstetric complications
  • Maternal influenza
  • Malnutrition and famine
  • Substance misuse
• Psychological factors
• Social factors
  
  • Occupation and social class, “drift hypothesis”
  • Migration
  • Social isolation
  • Life events as precipitants

Question 9

What are some genetic causes of schizophrenia?

Answer 9

• Nruegulin (chromosome 8p)
• Dysbindin (chromosome 6p)
• Di George syndrome

Question 10

What are some neurological abnormalities linked to schizophrenia?

Answer 10

• Ventricular enlargement
• Reduced frontal lobe performance
• Eye tracking abnormalities
• EEG abnormalities

Question 11

What are some social factors linked to schizophrenia?

Answer 11

• Occupation and social class, “drift hypothesis”
• Migration
• Social isolation
• Life events as precipitants

Question 12

Schizophrenia - epidemiology

(how common as cause of psychosis, prevalence, sex)

Answer 12

• Most common cause of psychosis
• 1/100 prevalence
• M:F equally

Question 13

Presentation - schizophrenia

Answer 13

• Positive symptoms
  
  • Hallucinations
  • Delusions
  • Disordered thinking
• Negative symptoms (presence of these suggests poorer prognosis)
  
  • Apathy
  • Lack of interest
  • Lack of emotion

Question 14

What are the positive and negative symptoms for schizophrenia?

Answer 14

• Positive symptoms
  
  • Hallucinations
  • Delusions
  • Disordered thinking
• Negative symptoms (presence of these suggests poorer prognosis)
  
  • Apathy
  • Lack of interest
  • Lack of emotion

Question 15

Differential diagnosis - schizophrenia

Answer 15

• Delirium or acute organic brain syndrome
• Depressive episode with psychotic symptoms
  
  • Must be categorised as severe
• Mani episode with psychotic symptoms
• Schizoaffective disorder
  
  • Mix of affective and schizophrenia like features

Question 16

What is the diagnostic criteria for schizophrenia?

Answer 16

• More than a month in the absence of organic or affective disorder
• At least one of following
  
  • Alienation of thought
    
    • As thought echo, though insertion or withdrawal, or thought broadcasting
  • Delusions of control, influence or passivity
    
    • Referred to body or limb movements actions, or sensations, delusional perception
  • Hallucinatory voices
    
    • Typically giving running commentary on patients behaviour, or discussing them between themselves
  • Persistent delusions
    
    • Culturally inappropriate and completely impossible
• Or at least 2 of the following
  
  • Persistent hallucinations in any modality, when occurring every day for at least a month
  • Neologisms, breaks or interpolations in the train of through resulting in incoherence of irrelevant speech
  • Catatonic behaviour, such as excitement, posturing or waxy flexibility, negativism, mutism and stupor
  • “Negative” symptoms

Question 17

Management - schizophrenia

Answer 17

• Provision of information
• Pharmacological
  
  • Anti-psychotics – on first episode
    
    • Following remission continue maintenance treatment for at least 18 months
  • On acute exacerbation
    
    • Amisulpride, olanzapine or risperidone
  • To prevent relapse
    
    • Amisulpide, olanzapine or riperidone
  • Treatment resistant schizophrenia
    
    • Clozapine
• Psychological therapies
  
  • CBT
  • Family intervention

Question 18

Prognosis - schizophrenia

Answer 18

• 80% recover after first episode
• 50% have a moderate recovery
  
  • Some relapse
• Small group with chronic symptoms with little recovery
• Good prognostic factors
  
  • Absence FH
  • Good premorbid function – stable personality, stable relationships
  • Clear precipitant
  • Acute onset
  • Mood disturbance
  • Prompt treatment
  • Maintenance of initiative and motivation
• Poor prognostic factors
  
  • Slow, insidious onset and prominent negative symptoms
  • If starts in childhood

Question 19

What are some good and poor prognostic factors for schizophrenia?

Answer 19

• Good prognostic factors
  
  • Absence FH
  • Good premorbid function – stable personality, stable relationships
  • Clear precipitant
  • Acute onset
  • Mood disturbance
  • Prompt treatment
  • Maintenance of initiative and motivation
• Poor prognostic factors
  
  • Slow, insidious onset and prominent negative symptoms
  • If starts in childhood

Question 20

Complications - schizophrenia

Answer 20

• 9x risk of suicide
• 2x risk of death in violence
• Chronic schizophrenic patients should poorer cognition than first onset patients

Question 21

If you have psychosis, do you have schizophrenia?

Answer 21

If you have psychosis does not mean you have schizophrenia, however it is the most common cause