2.9, 2.10 Psychosis, schizophrenia and management

Question 1

What elements of the mental state examination may be disturbed in schizophrenia?

Answer 1

1. Appearance
2. Behaviour **
3. Speech
4. Mood **
5. Affect **
6. Thoughts ** (CONTENT, FORM, FLOW)
7. Perceptions **
8. Cognition
9. Insight
   (Risk assessment)

Question 2

What are the positive symptoms of schizophrenia?

Answer 2

Delusions
Hallucinations
Thought disorder

Question 3

What are the negative symptoms of schizophrenia?

Answer 3

Apathy
Lack of volition
Social withdrawal
Cognitive impairment

Question 4

How long must symptoms persist for a diagnosis of schizophrenia in the ICD-10?

Answer 4

At least 1 month

Question 5

What are Schneider’s first rank symptoms?

Answer 5

1. Auditory hallucinations
   - Thoughts spoken out loud
   - Running commentary
   - Third person voices
2. Delusional perception
   - a delusional belief arising from normal perception
3. Delusions of control
   - made acts
   - impulses
   - volition
   - feelings
4. Delusions of thought interference:
   - Thought insertion
   - thought withdrawal
   - thought broadcasting

Any one of these symptoms lasting for 1 month or more indicates schizophrenia.

Question 6

What is the population lifetime risk of schizophrenia?

Answer 6

1%

Question 7

What is the peak incidence of schizophrenia in men and women?

Answer 7

Men: 15-25
Women: 25-35

Question 8

What is the rate of suicide in schizophrenia?

Answer 8

10-15%

Question 9

What factors are good prognostic indicators for schizophrenia?

Answer 9

• older age at onset
• female gender
• markred mood disturbance esp. elation
• FH of mood disorder

Question 10

What factors are bad prognostic indicators for schizophrenia?

Answer 10

• longer duration of untreated psychosis
• poor pre-morbid adjustment
• insidious onset
• early onset/childhood/adolescence

Question 11

What are 4 main groups of psychotic experiences?

Answer 11

Hallucinations
Delusions
Passivity
Formal thought disorder

Question 12

What is schizoaffective disorder?

Answer 12

Presence of both symptoms of schizophrenia and affective disorder
Episodes may be schizo-manic or schizo-depressed

Question 13

What are the main features of delirium?

Answer 13

A fluctuating state of clouded consciousness, and disorientation in person/place/time

• impaired concentration/memory
• visual/auditory hallucinations/illusions
• persecutory delusions
• psychomotor disturbance
• irritability
• insomnia