Psychiatry

Question 1

What is the background risk of developing schizophrenia in the general population?

Answer 1

1%

Question 2

What are the risk factors for schizophrenia?

Answer 2

1) Family history - the more closely related, the greater the risk
Environmental risk factors:
2) Traumatic events in childhood
3) Heavy cannabis use in childhood
4) Maternal poor health incl. malnutrition and infections e.g. rubella and CMV
5) Birth trauma esp. hypoxia and blood loss
6) Living in the city
7) Living in/emigrating to more developed countries
8) Being born in winter months (v small increase in risk maybe due to increased rates of maternal flu)

Question 3

What are four first rank features of schizophrenia?

Answer 3

1) Auditory hallucinations
2) Thought disorders
3) Delusional perceptions
4) Passivity phenomena

Question 4

What is the classic auditory hallucination in schizophrenia?

Answer 4

Third person running commentary

Question 5

What are the two less common types of auditory hallucinations in schizophrenia?

Answer 5

1) Thought echo
2) Command hallucinations

Question 6

What are the three types of thought disorders?

Answer 6

1) Thought insertion - thoughts implanted into the patient
2) Thought withdrawal - thoughts being removed from the patient
3) Thought broadcasting - others can hear my thoughts

Question 7

What is the 2 stage process of delusional perceptions?

Answer 7

1) A normal object is perceived
2) There is a delusional insight into its meaning

Question 8

What is passivity phenomena?

Answer 8

The sensation of an external influence controlling the thoughts or actions of the sufferer

Question 9

What are the negative symptoms of schizophrenia?

Answer 9

1) Alogia (poverty of speech)
2) Anhedonia (inability to derive pleasure)
3) Incongruity/blunting of affect
4) Avolition (poor motivation)

Question 10

The ICD-11 diagnosis of paranoid schizophrenia requires at least one symptom of:

Answer 10

1) Thought echo, insertion, withdrawal or broadcasting
2) Delusions of control, influence or passivity
3) Hallucinatory voices giving a running commentary on the patient’s behaviour, or discussing the patient among themselves
4) Persistent delusions of other kinds that are culturally inappropriate and completely impossible

Question 11

The ICD-11 diagnosis of paranoid schizophrenia requires at least two symptoms of:

Answer 11

1) Persistent hallucinations in any modality, when accompanied by fleeting delusions or over-valued ideas
2) Breaks in the train of thought
3) Catatonic behaviour
4) ‘Negative’ symptoms e.g. marked apathy, paucity of speech, blunting, incongruity of emotional responses
5) Significant and consistent change in the overall quality of personal behaviour

Question 12

How long should schizophrenia symptoms have been present before diagnosis?

Answer 12

Most of the time during a period of at least one month

Question 13

How is schizophrenia diagnosed?

Answer 13

Clinical diagnosis

Question 14

Which investigations can be considered in schizophrenia based on the history and examination to rule out other potential causes?

Answer 14

1) CT/MRI head
2) HIV and syphilis screen
3) Drug testing
4) Routine bloods incl. FBC and TFTs

Question 15

Which factors are associated with a better prognosis in schizophrenia?

Answer 15

1) High IQ/education level
2) Sudden onset
3) Obvious precipitating factors e.g. traumatic life event
4) Strong support network
5) Positive symptoms predominant

Question 16

What is the rule of quarters in the prognosis of schizophrenia?

Answer 16

1) 25% never have another episode
2) 25% improve substantially on treatment
3) 25% have some improvement on treatment
4) 25% are resistant to treatment

Question 17

What are differentials of schizophrenia that can mimic schizophrenia?

Answer 17

1) Substance induced psychotic disorder (commonly drugs of abuse, but can be iatrogenic e.g. steroids)
2) Organic psychosis caused by infection, brain injury and CNS diseases e.g. Wilson’s disease
3) Metabolic disorder e.g. hyperthyroidism, hyperparathyroidism
4) Dementia and depression can also co-occur with psychosis

Question 18

What is first line treatment for paranoid schizophrenia as with any psychotic disorder?

Answer 18

Atypical antipsychotics e.g. risperidone

Question 19

Why are atypical antipsychotics preferred to typical antipsychotics e.g. haloperidol?

Answer 19

Due to the reduced risk of extra-pyramidal symptoms

Question 20

Which drugs can be used if there is acute behavioural disturbance in the presentation of paranoid schizophrenia?

Answer 20

Sedative drugs e.g. lorazepam (but not first line and will not improve psychotic symptoms)

Question 21

When does NICE recommend clozapine for children and young people with schizophrenia?

Answer 21

When the schizophrenia has not responded to adequate doses of at least two different antipsychotics used sequentially for 6-8 weeks