L3 Schizophrenia: Clinical aspects.

Question 1

Neurosis

Answer 1

Mental disorder not caused by an organic disease

Includes:
-Anxiety
-Depression
-OCD
-Adjustment disorders
-Somatisation disorders 
(somatic symptoms with no diagnosis)

Question 2

Psychosis

Answer 2

• Organic disease
• Loss of boundaries with reality
• Loss of insight
• Delusions and hallucinations

Includes

• Schizophrenia
• Bipolar
• Depressive psychosis

Question 3

Delusion

Answer 3

• Belief held firmly but on inadequate grounds
• not affected by rational argument or evidence
• not shared by similar person

Question 4

Hallucination

Answer 4

perception experienced in the absence of an external stimulus.

auditory hallucination most common

due to internal perception attribution error

Question 5

Schneider’s First Rank Symptoms [5]

Answer 5

1) Auditory Hallucinations:
- Thoughts spoken aloud
- Third person hallucinations
- Running commentary

2) Somatic hallucinations
3) Passivity phenomena- feeling like they are no longer in control of their body
4) Thought insertion, withdrawal or broadcast
5) Delusional perception

Question 6

ICD 10 Diagnosis of schizophrenia

Answer 6

Requires

• one of a-d or
• two of e-h for at least 1 month:
  a) Thought echo, insertion, withdrawal or broadcast

b) Delusion of passivity or delusional perception (e.g. the toilet flushed and then I knew)
c) Running commentary hallucination or 2 voices discussing the patient
d) Persistent delusions of other kinds
e) Persistent hallucinations in any modality with accompanying brief delusions
f) Breaks in thought resulting in abnormal speech
g) Catatonic behaviour
h) Negative symptoms not due to depression or medication

Question 7

Affective psychosis [3]

Answer 7

Mood disorders, differential diagnosis of schizophrenia.

• Bipolar disorder
• Depressive psychosis
• Schizoaffective disorder

Question 8

Examples of organic diseases the doctor must rule out

Answer 8

• temporal lobe epilepsy
• infections
• cerebral trauma
• MS
• toxins e.g lead

Question 9

Signs of schizophrenia

Answer 9

No specific signs but commonly include

• self-neglect
• talking to themselves
• clothing
• posturing

Question 10

Mental state examination of acute syndrome (positive symptoms/ type I)

• Appearance
• Mood
• Thinking
• Delusions
• Hallucinations
• Insight
• Cognition

Answer 10

Appearance
-Restless, unpredictable

Mood
-Blunting, disinhibited, perplexed, anxious

Thinking
-Disordered, vague, thought blocks, loosening of associations

Delusions
-primary and secondary

Hallucinations
-all senses

Insight impaired

Cognition
-Orientation and memory normal initially

Question 11

Mental state examination of chronic syndrome (negative symptoms/ type II)

• Appearance
• Movement
• Mood
• Delusions
• Hallucinations
• Insight
• Cognition

Answer 11

Appearance
-lack of drive and activity, social withdrawal, self neglect

Movement(abnormal)
-Stupor, Catatonia,

Mood
-Depression, blunted

Delusions
-Primary and secondary

Hallucinations
-All senses

Insight impaired

Cognition
-normal orientation but can decline

Question 12

Epidemiology

Answer 12

Men have earlier onset and more negative symptoms
Increased rate in migrants
refer to slides

Question 13

Cannabis and schizophrenia

Answer 13

increases vulnerability to psychosis

chronic uses sensitizes and increases vulnerability

possible familial connection

Impact of cannabis on developing brain is more potent (<14 years)