Clinical Features of Schizophrenia Flashcards

Describe the clinical presentation of schizophrenia, including the nature of the symptom domains of the illness, positive symptoms, negative symptoms, affective symptoms, neurocognitive deficits, and impaired social cognition Understand the aetiological theories of schizophrenia, considering particularly the heritable genetic component, environmental risk factors, and interactions between the two Describe the neurodevelopmental model of schizophrenia

1
Q

Define psychosis

A

A loss of contact with reality - the presence of hallucinations, delusions, or a limited number of severe abnormalities of behaviour, such as gross excitement and overactivity, marked psychomotor retardation, and catatonic behaviour

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2
Q

Name the 2 main psychotic illnesses

A

Schizophrenia, bipolar disorder

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3
Q

State the disorders encompassed by schizophrenia

A

Brief reaxtive psychosis, organic psychosis, delusional disorder, psychotic depression, schizoaffective disorder

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4
Q

Give the 3 main comorbidities of bipolar disorder

A

Anxiety, substance misuse, borderline personality disorder

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5
Q

Name the symptom domains of schizophrenia

A

Positive, negative, neurocognitive, disorganisation, affective dusturbance, disturbed behaviour, social cognition

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6
Q

Describe the neurocognitive symptoms of schizophrenia

A

Dysfunction in attention, memory, and executive function

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7
Q

Describe the positive symptoms of schizophrenia

A

Delusions, hallucinations

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8
Q

Describe the negative symptoms of schizophrenia

A

Affective flattening, alogia, avolition, anhedonia

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9
Q

Describe the disorganised symptoms of schizophrenia

A

Formal thought disorder

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10
Q

Describe the affective disturbance symptoms of schizophrenia

A

Suicidal ideation, hopelessness, excitement, hypomania

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11
Q

Describe the behavioural symptoms of schizophrenia

A

Social withdrawal, thought disturbance, anti-social behaviour, depressed behaviour

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12
Q

Describe the social cognition symptoms of schizophrenia

A

Impaired emotion processing, theory of mind, and social relationship perception

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13
Q

Name the 4 classic schizophrenia subtypes

A

Paranoid, hebephrenic, catatonic, simple

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14
Q

Describe paranoid schizophrenia

A

Characterised by persecutory or grandiose delusions and derogatory auditory hallucinations

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15
Q

Describe hebephrenic schizophrenia

A

A disorganisation syndrome, characterised by formal thought disorder, affective flattening, and bizarre behaviour

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16
Q

Describe catatonic schizophrenia

A

Multiple motor, volitional, and behavioural disorders, accompanied by stupor and excitement

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17
Q

Describe simple schizophrenia

A

Insidious but progressive impoverishment of mental life, without development of florid symptoms

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18
Q

Describe Crow’s 1985 two-syndrome model of schizophrenia

A

Type 1 schizophrenia was an acute illness featuring positive symptoms - hallucinations, delusions, and thought disorder - with a good response to medication and no intellectual impairment. Type 2 schizophrenia was a chronic illness featuring negative symptoms - affective flattening, speech poverty, loss of drive - with a poor response to medication and some intellectual impairment

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19
Q

State the problems with the four-subtype model of schizophrenia

A

The subtypes are temporally unstable, overlapping, and of questionable validity and clinical relevance

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20
Q

Name the 3 schizophrenia syndromes proposed by Liddle & Barnes in 1990

A

Psychomotor poverty, disorganisation syndrome, reality distortion

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21
Q

Describe the psychomotor poverty subtype defined by Liddle in 1990

A

Poverty of speech, decreased spontaneous movement, unchanging facial expressure, affective non-response, lack of vocal inflections

22
Q

Describe the disorganisation syndrome subtype defined by Liddle in 1990

A

Inappropriate affect, poverty of content of speech, tangentiality, derailment, distractibility

23
Q

Describe the reality distortion subtype defined by Liddle in 1990

A

Auditory hallucinations, delusions of persecution, delusions of reference

24
Q

When is the typical onset of schizophrenia?

A

Middle to late adolescence, with age of onset often earlier in males (Castle et al, 1998)

25
Q

Describe the typical initial symptoms of schizophrenia

A

Change in personality, decrease in academic, social, and interpersonal functioning

26
Q

What is the male to female ratio of schizophrenia?

A

1.4:1

27
Q

Which physical health problems are more common in schizophrenia?

A

Diabetes mellitus (due to schizophrenia and the effects of antipsychotics), cardiovascular disease

28
Q

Why is the risk of cardiovascular disease increased in schizophrenia?

A

HPA and mitochondrial dysfunction, peripheral and CNS inflammation, oxidative and nitrosative stress, common genetic links, epigenetic interactions

29
Q

State some reasons why schizophrenia increased morbidity and mortality

A

Lack of access to and uptake of preventative care, social deprivation, under-diagnosis and treatment of physical illness, poor compliance with medical treatment, unhealthy lifestyle (higher incidence of smoking and substance use), sleep and circadian disorders

30
Q

Name 3 genes associated with schizophrenia

A

Neuregulin 1, dysbindin, disrupted in schizophrenia 1 (DISC1)

31
Q

Describe the synaptic pruning hypothesis of schizophrenia (Sekar et al, 2016)

A

The risk of schizophrenia is greater in those with complement C4 alleles which produce more C4A protein - involved in marking synapses for destruction by microglia. Excessive or inappropriate pruning of neural connections could lead to schizophrenia

32
Q

Why is advancing paternal age a risk factor for schizophrenia? (Sipos et al, 2004)

A

Accumulation of de novo mutations in paternal sperm

33
Q

Describe the relationship between cannabis use and schizophrenia

A

Cannabis use is a risk factor for psychosis - the Dunedin cohort study found a 40% increased risk of psychosis in cannabis users compared to non-users, with the risk greater in the most frequent users (Moore et al, 2007). However, it is unclear if this is causal - individuals with early schizophrenia symptoms may be more likely to try cannabis or use it to self-medicate or normalise their symptoms

34
Q

Which genotype produces the greatest risk of schizophrenia following adolescent cannabis use?

A

The val/val COMT gene mutation on chromosome 22q11

35
Q

State some prodromal symptoms of schizophrenia

A

Dysphoria, suspicion, perceptual distortion, poor concentration, sleep disturbance, paranoid notions, functional deterioration, social withdrawal, emotional withdrawal, academic decline, ritualistic behaviour, lack of drive

36
Q

Why are patients with prodromal symptoms of schizophrenia not treated?

A

Many of them will never develop any psychiatric illness

37
Q

How does a delay in treating psychosis affect outcomes? (McGlashan & Johannessen, 1996)

A

A longer duration of untreated psychosis correlates with poorer medication response and worse symptomatic and functional outcomes

38
Q

Define alogia

A

Decrease in verbal output or verbal expressiveness

39
Q

Define affective blunting

A

Diminished facial emotional expression, poor eye contact, and decreased sponatenous movement

40
Q

Define avolition

A

A subjective reduction in interests, desires, and goals, and behavioural reduction in self-initiated and purposeful acts

41
Q

Define anhedonia

A

Loss of ability to experience pleasure for positive stimuli

42
Q

Describe 2 forms of abnormal affect

A

1) Blunted affect - reduction in emotional intensity and variation
2) Incongruous affect - affective response incompatible with thoughts or ideas expressed, e.g. laughing at bad news

43
Q

State 2 reasons why negative symptoms are difficult to identify

A

1) Antipsychotic medication side effects are similar to negative symptoms
2) Apparent negative symptoms can be due to positive symptoms - e.g. social withdrawal due to paranoid delusions or to avoid distracting psychotic experiences

44
Q

What percentage of people with schizophrenia exhibit some negative symptoms?

A

50-70%

45
Q

Describe the relationship between schizophrenia and suicide (Carlborg et al, 2010)

A

Schizophrenia patients are 12x more likely to commit suicide than the general population, with 4-5% of patients dying by suicide. Rates are highest in younger patients at an early stage of their illness and immediately after a psychotic episode

46
Q

At what point would an SSRI be considered to treat depressive symptoms in schizophrenia?

A

If severe, within 6 months of a psychotic episode - otherwise only if more than 6 months after a psychotic episode

47
Q

Give some risk factors for suicide in schizophrenia

A

Young patient, male, high level of education, fear of mental disintegration, prior suicide attempts, depressive symptoms, active hallucinations and delusions, agitation, presence of insight, comorbid PTSD or substance abuse

48
Q

What is the only protective factor for suicide in schizophrenia?

A

Adherence to effective treatment

49
Q

Define thought blocking

A

A disorder of the stream of thought

50
Q

Define thought insertion

A

A disorder in control of thought