4. Schizophrenia

Question 1

What psychological therapy should all people with schizophrenia be offered?

Answer 1

CBT
Family intervention - should be offered to the family
Consider art therapy

Question 2

What are the differential diagnoses of early onset psychosis?

Answer 2

Depression
Chronic anxiety
Stress reaction
Autism
Substance misuse

Later typical symptoms are: delusions, thought disorder, hallucinations.

Question 3

How long should family therapy continue for children with schizophrenia?

Answer 3

3 months- 1 year

Should involve the child, and be about problem solving/crisis management.

Question 4

What is schizoaffective disorder?

Answer 4

where symptoms of schizophrenia and a mood disorder (depressed or manic) are equally prominent.

Question 5

What is drug induced psychosis?

Answer 5

substance-induced and usually remits within a month of cessation of use.

Question 6

What is persistent delusional disorder?

Answer 6

Persistent delusional disorder — where the most pervasive symptom is delusion

Question 7

How long must psychotic symptoms be present to diagnose schizophrenia?

Answer 7

At least 1 month.

Question 8

What are positive symptoms of psychosis?

Answer 8

hallucinations - auditory most common.
Delusions - of reference, of control, persecution
Disorganised thoughts (thought disorder), behaviour or speech

Question 9

What are negative psychotic symptoms?

Answer 9

Emotional blunting.
Reduced speech.
Loss of motivation.
Self-neglect.
Social withdrawal.

Question 10

For those at risk of psychosis/in prodromal phase, what do EIP offer?

Answer 10

Individual CBT
Family intervention
Treatment of co-existing depression/anxiety/substance misuse

Question 11

What do EIP offer those with confirmed diagnosis psychosis (schizophrenia)?

Answer 11

• Trial oral antipsychotic (first or second gen) plus any/all of:
• individual CBT
• Family intervention for the relatives (3mths-1yr)
• arts therapies
• Monitor for 12 months at least/until stable (monitor for 3 years if no clear diagnosis)

Question 12

What should the annual primary care review include for schizophrenia?

Answer 12

• screen for psychotic symptoms
• symptoms of raised prolactin/treatment side effects
• weight/wast circumference
• HR and BP
• Fasting glucose, HbA1c.
• Lipid profile.
• Urea and electrolytes.
• Full blood count.
• Liver function tests.
• Prolactin (not needed for aripiprazole,clozapine, quetiapine, olanzapine)
• ECG if on other meds causing prolonged QTC, or on halopreidol

Question 13

When is clozapine indicated?

Answer 13

For schizophrenia not controlled by trial of 2 or more antipsychotic drugs (one must have been 2nd gen) - each for at least 6 weeks.

Question 14

What are the adverse effects of clozapine?

Answer 14

• agranulocytosis (1%), neutropaenia (3%)
• reduced seizure threshold - can induce seizures in up to 3% of patients
• constipation
• myocarditis: a baseline ECG should be taken before starting treatment
• hypersalivation

adjust dose if start/stop smoking (smoking increases metabolism of clozapine)