Clinical Topic 3: Psychotic Symptoms

Question 1

Give some examples of Positive Symptoms seen in Schizophrenia

Answer 1

Hallucinations
Delusions
Behaviour disturbances

Question 2

Give some examples of Negative Symptoms seen in Schizophrenia

Answer 2

Lack of motivation
Underactivity
Reduced speech
Reduced emotion
Social withdrawal
Thought disorder

Question 3

When do men and women typically develop Schizophrenia? In which is it more common?

Answer 3

Men: 15-30
Women: 25-35
More common in males

Question 4

Being born in which seasons increases your risk of schizophrenia development?

Answer 4

Winter and early Spring (virus exposure)

Question 5

Which type of hallucination is most likely to occur in delirium and substance misuse?

Answer 5

Visual

Question 6

In schizophrenia, there is often a reduction in the amount of grey matter seen on imaging. What lobes of the brain is this most likely to affect?

Answer 6

Temporal and Frontal

Question 7

When is suicide most likely to be attempted in patients with schizophrenia? When insight is lost or preserved?

Answer 7

Commonly after discharge from hospital, when insight is preserved

Question 8

How long must symptoms be present for before a diagnosis of Schizophrenia can be made? If symptoms are less than this, what can be an alternative diagnosis?

Answer 8

> 1 month

If < 1 month, Acute Psychotic Disorder

Question 9

Acute and Chronic Schizophrenia are associated with what kinds of symptoms?

Answer 9

Acute: Positive
Chronic: Negative

Question 10

What are the first rank symptoms of Schizophrenia?

Answer 10

Auditory hallucinations, Delusions, Thought disorder, Passivity Phenoma

Question 11

What is Passivity phenomena?

Answer 11

Bodily sensations being controlled by external influence

Actions/impulses/feelings - experiences which are imposed on the individual or influenced by others

Question 12

What are the specific auditory hallucinations characteristically found in Schizophrenia?

Answer 12

• Two or more voices discussing the patient in the third person
• Voices commenting on the patient’s behaviour
• Thought echo

Question 13

What is the strongest risk factor associated with Schizophrenia? What are other risk factors?

Answer 13

Family history

Being black, migration, urban environment, cannabis use

Question 14

What factors are associated with poor prognosis in patients with Schizophrenia?

Answer 14

Strong family history, gradual onset, low IQ, premorbid history of social withdrawal, lack of obvious precipitant

Question 15

What is first-line treatment of patients with Schizophrenia?

Answer 15

Oral atypical antipsychotics

All patients should be offered CBT also

Question 16

What is a “Delusion”?

Answer 16

A false, firm, fixed belief

Question 17

What is “Delusions of control”?

Answer 17

False belief that another person, group of people, or external force controls one’s general thoughts, feelings, impulses, or behavior

Question 18

What is the “Cotard delusion”?

Answer 18

False belief that one does not exist or has died

Question 19

What is “Othello syndrome”?

Answer 19

A person believes that their spouse or sexual partner is being unfaithful without having any real proof

Question 20

What is a “Delusion of reference”?

Answer 20

False belief that insignificant remarks, events, or objects in one’s environment have personal meaning or significance

Question 21

What are the three phases of Schizophrenia?

Answer 21

Prodromal
Active
Residual

Question 22

What is the mechanism of Clozapine?

Answer 22

5-HT2A antagonist
D2 antagonist (weak)

Question 23

What is “Waxy flexibility”?

Answer 23

A type of symptom of Catatonia associated with Schizophrenia. Patients are unresponsive to stimuli and tend to be remain still. Attempts at moving / repositioning them and patient will remain in new position

Question 24

What is “Schizoaffective disorder”?

Answer 24

Patients present with delusions and hallucinations and symptoms of a mood disorder, i.e. accompanied by either a depressive or a manic mood state