Psychotic disorders

Question 1

Name 3 predisposing factors for developing schizophrenia. (3)

Answer 1

Periods of high stress
Periods of extreme emotions (high or low)
Increased levels of criticism from family or friends
Drugs: cannabis, alcohol, hallucinogens
Family history
Previous mental health disease

Question 2

What are the positive symptoms of schizophrenia? (4)

Answer 2

Delusions of control, influence or passivity
Hallucinations: 3rd party auditory, running commentary
Thought disorders: Echo, insertion, Withdrawal, Broadcast
Catatonic symptoms: posturing or waxy flexibility

Question 3

What are the negative symptoms of schizophrenia? (3)

Answer 3

Blunting of affect: lack of emotional reactivity
Avolition: general lack of drive
Alogia: poverty of speech
Anhedonia (??)

Question 4

In ICD-10 criteria, how is schizophrenia diagnosed? (2)

Answer 4

Duration over 1 month

At least one positive symptom of
- persistent delusions, delusion of control, auditory hallucinations eg running commentary, thought disorders eg echo, insertion, withdrawal.
OR
At least 2 of:
- persistent hallucinations of any modality
- catatonic behaviour
- Breaks in train of thought
- Negative symptoms
- Significant and consistent change in aspects of personal behaviour e.g. loss of interest, self-absorbed, social withdrawal.

Question 5

Name 2 differentials for schizophrenia. (2)

Answer 5

Schizoaffective disorder (mixed schizophrenia and affective disorder)
Schizotypal disorder (social and interpersonal difficulties associated with unusual interest and beliefs)

Question 6

Define schizophrenia. (2)

Answer 6

Psychotic disorder in absence of organic disease, alcohol or drug-related withdrawal or dependence. Not secondary to elevation or depression of mood.

Question 7

Name 3 sub-types of schizophrenia. (3)

Answer 7

Paranoid, Hebephrenic, Catatonic, Simple, Residual

Question 8

What is the lifetime risk of developing schizophrenia? (1)

Answer 8

1%

Question 9

What are Schneider’s first rank symptoms? (3)

Answer 9

1. Auditory hallucinations
   - third person
   - running commentary
   - hearing thoughts spoken aloud
2. Passivity phenomenon
   - somatic passivity
   - actions influenced by external agents
   - thought withdrawal
   - thought insertion
   - thought broadcast
3. Delusional perception

Question 10

What is the management of schizophrenia? (3)

Answer 10

• Risk assessment: self, others, self-neglect
• Anti-psychotics dependent on response and side-effects. Consider depot if compliance an issue.
• Clozapine for treatment resistant: two trials of different anti-psychotics (one to be atypical)
• CBT for persistent delusions/hallucinations
• Behavioural family therapy
• Social rehabilitation
• Community care

Question 11

Name 3 factors that indicate a positive outcome for schizophrenia. (3)

Answer 11

Old age of onset
Female
Married
No FH
No personality problems
High IQ
Precipitants
Positive symptoms
Treatment compliance
Low expressed emotion
Acute onset
Presence of mood component

Question 12

Name 3 factors that may indicate a negative outcome in schizophrenia. (3)

Answer 12

Young age at onset
Male
Unmarried
FH
Personality problems
Low IQ
No obvious precipitants
Negative symptoms
Poor treatment compliance
High expressed emotion
Insidious onset
No mood component

Question 13

Define schizoaffective disorder. (2)

Answer 13

Must satisfy criteria for both schizophrenia and a mood disorder within same episode where psychosis is not secondary to mood disorder.