Clinical Features of Schizophrenia

Question 1

Define psychosis

Answer 1

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

Question 2

Name the 2 main psychotic illnesses

Answer 2

Schizophrenia, bipolar disorder

Question 3

State the disorders encompassed by schizophrenia

Answer 3

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

Question 4

Give the 3 main comorbidities of bipolar disorder

Answer 4

Anxiety, substance misuse, borderline personality disorder

Question 5

Name the symptom domains of schizophrenia

Answer 5

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

Question 6

Describe the neurocognitive symptoms of schizophrenia

Answer 6

Dysfunction in attention, memory, and executive function

Question 7

Describe the positive symptoms of schizophrenia

Answer 7

Delusions, hallucinations

Question 8

Describe the negative symptoms of schizophrenia

Answer 8

Affective flattening, alogia, avolition, anhedonia

Question 9

Describe the disorganised symptoms of schizophrenia

Answer 9

Formal thought disorder

Question 10

Describe the affective disturbance symptoms of schizophrenia

Answer 10

Suicidal ideation, hopelessness, excitement, hypomania

Question 11

Describe the behavioural symptoms of schizophrenia

Answer 11

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

Question 12

Describe the social cognition symptoms of schizophrenia

Answer 12

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

Question 13

Name the 4 classic schizophrenia subtypes

Answer 13

Paranoid, hebephrenic, catatonic, simple

Question 14

Describe paranoid schizophrenia

Answer 14

Characterised by persecutory or grandiose delusions and derogatory auditory hallucinations

Question 15

Describe hebephrenic schizophrenia

Answer 15

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

Question 16

Describe catatonic schizophrenia

Answer 16

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

Question 17

Describe simple schizophrenia

Answer 17

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

Question 18

Describe Crow’s 1985 two-syndrome model of schizophrenia

Answer 18

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

Question 19

State the problems with the four-subtype model of schizophrenia

Answer 19

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

Question 20

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

Answer 20

Psychomotor poverty, disorganisation syndrome, reality distortion

Question 21

Describe the psychomotor poverty subtype defined by Liddle in 1990

Answer 21

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

Question 22

Describe the disorganisation syndrome subtype defined by Liddle in 1990

Answer 22

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

Question 23

Describe the reality distortion subtype defined by Liddle in 1990

Answer 23

Auditory hallucinations, delusions of persecution, delusions of reference

Question 24

When is the typical onset of schizophrenia?

Answer 24

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

Question 25

Describe the typical initial symptoms of schizophrenia

Answer 25

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

Question 26

What is the male to female ratio of schizophrenia?

Answer 26

1.4:1

Question 27

Which physical health problems are more common in schizophrenia?

Answer 27

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

Question 28

Why is the risk of cardiovascular disease increased in schizophrenia?

Answer 28

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

Question 29

State some reasons why schizophrenia increased morbidity and mortality

Answer 29

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

Question 30

Name 3 genes associated with schizophrenia

Answer 30

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

Question 31

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

Answer 31

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

Question 32

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

Answer 32

Accumulation of de novo mutations in paternal sperm

Question 33

Describe the relationship between cannabis use and schizophrenia

Answer 33

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

Question 34

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

Answer 34

The val/val COMT gene mutation on chromosome 22q11

Question 35

State some prodromal symptoms of schizophrenia

Answer 35

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

Question 36

Why are patients with prodromal symptoms of schizophrenia not treated?

Answer 36

Many of them will never develop any psychiatric illness

Question 37

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

Answer 37

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

Question 38

Define alogia

Answer 38

Decrease in verbal output or verbal expressiveness

Question 39

Define affective blunting

Answer 39

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

Question 40

Define avolition

Answer 40

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

Question 41

Define anhedonia

Answer 41

Loss of ability to experience pleasure for positive stimuli

Question 42

Describe 2 forms of abnormal affect

Answer 42

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

Question 43

State 2 reasons why negative symptoms are difficult to identify

Answer 43

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

Question 44

What percentage of people with schizophrenia exhibit some negative symptoms?

Answer 44

50-70%

Question 45

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

Answer 45

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

Question 46

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

Answer 46

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

Question 47

Give some risk factors for suicide in schizophrenia

Answer 47

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

Question 48

What is the only protective factor for suicide in schizophrenia?

Answer 48

Adherence to effective treatment

Question 49

Define thought blocking

Answer 49

A disorder of the stream of thought

Question 50

Define thought insertion

Answer 50

A disorder in control of thought