PBL ILO’s

Question 1

3 types of schizophrenic symptoms

Answer 1

Positive
Negative
Cognitive

Question 2

Types of positive schizophrenic symptoms

Answer 2

Positive Symptoms:
• Refers to symptoms that are new or increased experiences.
• Positive symptoms of schizophrenia may include:
○ Delusions (persecutory, referential, somatic, Eroto-manic, religious, grandiose
○ Hallucinations- a sensory change that no one else can experience (auditory, visual, olfactory, tactile).
○ Behavioral changes
○ Confusion and thought disorder

Question 3

Types of negative schizophrenic symptoms

Answer 3

Negative Symptoms:
• Refers to symptoms that represent a decrease in some factor.
• Negative symptoms and their impact may include:
○ Anhedonia- this refers to patients having little joy in doing anything anymore, especially things they may have previously enjoyed.
○ Alogia- refers to trouble with speech. Patients may not talk much or show any feelings.
○ Affective flattening- this refers to unusual facial expressions in the context of what they are saying. Patients may not smile normally or show happy facial expressions.
○ Apathy- this refers to withdrawal from social situations and relationships. The patient may no longer make plans with friends, talk easily, and make appointments. They may become a bit of a hermit.
○ Self-neglect- refers to patients being unable to complete their activities of daily life such as bathing, grooming, cooking, and eating. Their physical appearance and health may suffer as a result.
○ Avolition- this refers to patients being unable to complete or ‘follow through’ on tasks. Sometimes they may not be able to start tasks at all.

Question 4

Cognitive schizophrenic symptoms

Answer 4

Cognitive Symptoms:
• Refers to symptoms that affect patient’s thought processes and memory.
• Cognitive symptoms of schizophrenia may affect:
○ Processing speed
○ Working memory
○ Attention and vigilance
○ Verbal learning
○ Reasoning and problem solving
○ Social cognition

Question 5

Dopamine hypothesis of schizophrenia

Answer 5

Dopamine hypothesis of schizophrenia:

• The dopamine hypothesis of schizophrenia postulates that HYPERACTIVITY of dopamine D2 receptor neurotransmission in subcortical and limbic brain regions contributes to positive symptoms of schizophrenia.

Whereas negative and cognitive symptoms of the disorder can be attributed to HYPOFUNCTIONALITY of dopamine D1 receptor neurotransmission in the prefrontal cortex.

Question 6

Sections of the mental health act

Answer 6

You can be detained under the MHA if:
• you have a mental disorder
• you need to be detained for a short time for assessment and possibly medical treatment, and
• it is necessary for your own health or safety or for the protection of other people.

Section 2:
28 days

Section 3:
6 months

Section 5 (2):
Voluntary patient or inpatient
72 hours

Section 5 (4):
Voluntary inpatient receiving treatment for mental health
You can be kept under section 5(4) for up to 6 hours, or until a doctor or clinician with authority to detain you arrives. Whichever is earlier.

Question 7

Causes of secondary psychosis

Answer 7

Trauma
Autoimmune
Wilson’s disease
Lymes disease
Hypothyroidism
Toxic/substance induced
Infection
Degenerative diseases

Question 8

4 main dopamine pathways in the brain

Answer 8

There are four main dopamine pathways in the brain:

• Nigrostriatal 
• Mesolimbic 
• Mesocortical 
• Tuberoinfundibular

Question 9

What does the mental state exam assess?

Answer 9

The mental state examination (MSE) is a structured way of assessing a patient’s current state of mind. As with any clinical examination, it is split into several domains:
• Appearance and behaviour
• Speech
• Mood and affect
• Thoughts
• Perception
• Insight and judgement
• Risk

Question 10

Generalised anxiety disorder
Aetiology
Risk factors
Management

Answer 10

• Aetiology
1. Genetics
2. Brain chemistry
3. Environmental factors and life experiences

• Risk factors  1. Family history of anxiety  2. Experiencing traumatic events  3. History of physical/emotional abuse  4. Certain personality traits eg: being a perfectionist or worries a lot  

• Management  1. CBT  2. Medications: SSRI and SNRI   3. Mindfulness therapy

Question 11

Specific anxiety disorders
Aetiology
Risk factors
Management

Answer 11

• Specific anxiety disorders

• Aetiology  1. Genetic  2. Environmental  3. Psychological factors  

• Risk faactors  1. Family history  2. Traumatic experiences  3. Personality traits eg: highly sensitive or worrier 

• Management  1. CBT  2. Gradual exposure  3. Medications: SSRI and SNRI  4. Excercise and relaxation techniques  5. Stress management

Question 12

PTSD
Aetiology
Risk factors
Management

Answer 12

• Aetiology
1. Brain and body’s response to trauma
2. Triggered by experiencing or witnessing a traumatic event

• Risk factors  1. Severe or prolonged traumatic event  2. History of trauma  3. Previous mental health illness  4. Gender: affects women more than men  5. Age: younger individuals are more likely to be affected  6. Personality traits 

• Management  1. CBT  2. Eye movement desensitisation And reprocessing (EMDR)  3. Medications (SSRI)  4. Exercise and relaxation techniques  5. Having a support network