Psychotic Disorders

Question 1

Investigations for schizophrenia

Answer 1

Biological
- vitals, BMI, self-harm, physical abuse, PCOS, anemia, thyroid
- FBC UEC LFT FBG Lipid profile ECG urine drug screen
- hormone levels TFT CRP/ESR, EEG, bHCG, STD, hepatitis screen
Psychological
- MSE MMSE
- PANSS, BPRS
Social
- collaborative history

Question 2

Management for schizophrenia

Answer 2

Biological:
- antipsychotics
- if poor response after 6-8 weeks switch meds
- if 2nd med not responsive try clozapine
- if clozapine unresponsive augment with other antipsychotic/ECT
Psychological:
- psychoeducation
- CRT
- CBT
Social
- encourage academic and occupational attainment, peer support, social skill training
Lifestyle
- no substance use
- healthy diet and exercise

Question 3

Schizophrenia criteria

Answer 3

A. 2 or more of the following during a one month period, at least one must be 1-3
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized/catatonic behaviour
5. Negative symptoms
B. Level of functioning in one or more areas markedly impaired
C. Symptoms must be present at least for 6 months, must include A and maybe have prodromal/residual symptoms
D. Rule out schizoaffective/depressive/bipolar with psychotic features because no major depressive/manic episodes occurred or any mood episodes were only present for a minority of the time
E. not attributable to substance or other medical condition
F. if history of autism or communication disorder of childhood, this diagnosis is only valid if PROMINENT delusions or hallucinations and other negative symptoms

Question 4

Negative symptoms

Answer 4

affect, avolition, asociality, alogia, anhedonia

Question 5

Schizoaffective Disorder criteria

Answer 5

A. Uninterrupted period of illness during which there is a major mood episode concurrent with criteria A of schizophrenia
B. Delusions/hallucinations for 2 weeks or more in the absence of a major mood episode during the lifetime duration of the illness
C. Symptoms meeting criteria for major mood episode are present for the majority of the total duration of the active and residual portions of the illness
D. not attributable to physiological effects of a substance or other medical conditions

Question 6

Treatment of schizoaffective disorder

Answer 6

-Antidepressants/antimanics PLUS antipsychotics

Question 7

Schizophreniform disorder criteria

Answer 7

A. Same as schizophrenia
B. An episode of the disorder lasts at least 1 month but less than 6 months.
C. Schizoaffective/depressive/bipolar have been ruled out
D. not attributable to a substance or other med conditions