Schizo

Question 1

Diagnosis incl ICD 10.

Change in thinking, perception, blunted or inappropriate affect, reduced social functioning.

Answer 1

-at least one of- (first rank)
Thought echo, insertion, withdrawal, or broadcasting.
Persistent delusions eg control, influence or passivity.
Auditory hallucinations. Eg commentary. Usually third person.
Made feelings impulses and actions.
Somatic passivity.
Delusional preception.
-or at least two of-
Persistent delusions.
Any persis hallucintion.
Incoherant or irrelevant speech. Breaks in train of thought.
Catatonic behaviour.
Negative symptoms eg paucity of speech, apathy, blunting.
Loss of interest and isolation etc.
Persistent over valued ideas.
-duration over 1 month.

Question 2

Differentials

Answer 2

Subsance induced psychotic disorder.
Psychosis due to a medical condition eg head injury, infection, tumour, post epileptic, CJD, high Na, low Ca, hyperthyroid, cushings. 
Mood disorder.
Sleep disorder.
Delusional disorder. 
Dementia and delerium. Delerium waxing and waning course. 
Body dysmorhpia.
PTSD.
OCD.
Hypochondriasis.
Paranoid or schizotypal personality disorder.
Anxiety disorder.

Question 3

Aetiology

Answer 3

Dopamine or serotonin or alpha adrenergic over activity.
Glutamine or GABA under activity.
Neurodevelopment.
Disconnection- reduced grey matter. 
-predisposing- genetic, pre and peri natal. 
-precipitating- psychosocial stresses.
-perpetuating- social.
-mediating- neurot's.

Question 4

Sub types

Answer 4

Paranoid
Hebephrenic- v unpredictable.
Catatonic
Simple- insidious LOF, lot neg symtpoms.
Residual- after one of above.
Can be congenital, adult onset, late onset after 60.

Question 5

Mx

Answer 5

Acute or relpase- admission.
Drugs- typical anti psychotics eg chlorpromazine good for pos symptoms. Clozapine better for chronic symps. Depot antipsychotics for maint. EPSE treated with anticholinergics eg procyclidine.
ECT for catatonic stupor.
Social skill straining, occ therapy, family therapy, psychoeducation, compliance therapy, CPN etc.
Pharm-
Option one- atypical eg olanzapine, amisulpride, risperidone, quetapine, clozapine, aripiprazole. Wth long acting BDZ eg diazepam.
Option two- low potency typical eg chlopromazide initially. LT non sedating eg trifluoperazine, haloperidol, sulpride.
-EPSE- dystonia, parkisonism, akathesia, tardive dyskinesia.
Also anti cholinergic effs- dry mouth, blurr vision, urinary retention, constipation, glaucoma.
Anti adrenergic- hypotension, tachyc, sexual dysfunction.
Anti histaminic- sedation, weight gain.
-clozapine if sequential use of adequate doses of at least two others.
Se-

Question 6

Prevalence

Answer 6

1% of popn
Onset typically 20s
Certain groups higher incidence

Question 7

Px

Answer 7

Psychotic symptoms:
-delusions- fixed, false, despite evidence, cant be reasoned, outside social and cultural norms. Grandiose, persecutory, hypochondriacal, reference, guilt, erotomanic. Need to test evidence.
-hallucination- perception without ext stim. Visual common in delerium. Olfactory in frontal lobe pathology. Pseudohallucinations are less clear and inside head.
-FTD- speech incoherant. Sentences dont follow but ideas ARE related.
-disorders of self- self vs other, continuity in time, self as agent, self as unity of experience, self as private space. Eg thought interference.
Schizo:
-positive- delusions and hallucination.
-negative- lack of will and interest, isolation, in own world.
May be separate of together.

Question 8

Investigation

Answer 8

• bio- drug screen, CT head, bloods, sensory function.
• psycho- family, hx, MSE.
• social- information, housing.

Question 9

Mx

Answer 9

• place and formality depends on risk, insight, compliance, condition.
• bio- antipsychotic, ?depot.
• psycho- supportive conselling, family intervention.
• social- hosuing, activities.

Question 10

Causes

Answer 10

• bio- genetic, drug use, poor compliance.
• psycho- family, stress, rels.
• social- immigration, role in society.

Question 11

Psychosis defin

Answer 11

Out of touch with reality or expriencing a different reality.
They dont realise.
Eg schizo, mania, dep, AD, EUPD.
Schizo vs psychosis- psychosis us few weeks. Schizo recurrent or followed by other symptoms.

Question 12

Prognosis

Answer 12

20% first episodes dont recur.
Few stay employed.
55% good social func LT.
Poor prognostic facs- poor premorbid adjutment, insidious onset, yng onset, cog impair, enlarged ventricles.
Good facs- mood disturbance intially, family hx of mood disorder, female, developing country.