Schizophrenia

Question 1

what is the neurodevelopmental hypothesis?

Answer 1

people who experienced hypoxic brain injury at birth or were exposed to infetions in utero are at greater risk of developing schizophrenia

other examples
- temporal lobe epilepsy
- those who smoke cannabis

Question 2

how does neurodevelopmental damage present?

Answer 2

enlarged ventricles, small amounts of grey matter and smaller, lighter brains

Question 3

what is the NT hypothesis?

Answer 3

an excess of dopamine and overactivity in the mesocorticolimbic system is believed to cause the positive symptoms of schizophrenia

less dopamine activity in mesocortical tracts, which cause the negative symptoms in schizophrenia

Question 4

why do people with Parkinson’s experience psychotic symptoms in relevance to levodopa medication?

Answer 4

if they are overtreated w levodopa it increases the amount of dopamine in the brain

Question 5

what substancs can increase dopamine release and lead to psychosis?

Answer 5

amphetamines
cocaine
cannabis
novel psychoactive substances - ivory wave, spices
LSD

Question 6

other than dopamine what other NT’s are implicated in schizophrenia?

Answer 6

there is an increase in:
- serotonin activity
- glutamate activity

Question 7

what are the subtypes of schizophrenia

Answer 7

• paranoid schizophrenia
• hebephrenic schizophrenia
• catatonic schizophrenia
• undifferentiated schizophrenia
• residual schizophrenia
• simple schizophrenia

Question 8

what is paranoid schizophrenia?

Answer 8

most common type and is characterised by:
- paranoid delusions
- auditory hallucinations

Question 9

what is hebephrenic schizophrenia?

Answer 9

usually diagnosed in adolescents and young adults and is characterised by:
- mood changes
- unpredictable behaviour
- shallow affect
- fragmentary hallucinations

outlook is often poor as negative symptoms may develop rapidly

Question 10

simple schizophrenia?

Answer 10

similar to hebephrenic schizophrenia - characterised by negative symptoms:
- however in simple, patients have NEVER experienced positive symptoms

Question 11

catatonic schizophrenia?

Answer 11

characterised by:
- psychomotor features e.g. posturing, rigidity and stupor

Question 12

undifferentiated schizophrenia?

Answer 12

patients are designated as having undifferentiated schizophrenia when their symptoms do not fit neatly into one of the other categories of schizophrenia

Question 13

residual schizophrenia?

Answer 13

characterised again by negative symptoms:
- occurs when positive symptoms have burnt out

Question 14

are patients more likely to develop schizophrenia is there is a family history of it?

Answer 14

yes
- 50% monozygotic twin
- 15% if they are a dizygotic twin
- also if there father is aged over 55 when the child is conceived

Question 15

what are the risk factors during pregnancy?

Answer 15

• malnutrition
• viral infections
• other complications e.g. pre-eclampsia, emergency caesarean section also increase risk

Question 16

what is the neurodevelopmental hypothesis?

Answer 16

people who experienced hypoxic brain injury at birth or were exposed to infections in utero are at greater risk of developing schizophrenia

other examples
- temporal lobe epilepsy
- those who smoke cannabis

Question 17

which ethnicity is most at risk?

Answer 17

• afro-caribbean men

Question 18

clinical features are divided up into positive and negative symptoms - positive - change in behaviour or thought, whilst negative - decline in normal functioning… name some of these symptoms?

Answer 18

positive symptoms
- thought echo
- thought insertion or withdrawal
- thought broadcasting
- 3rd person auditory hallucinations
- delusional perception
- passivity and somatic passivity
- odd behaviour
- thought disorder
- lack of insight

negative symptoms
- blunted affect
- apathy
- social isolation
- poverty of speech
- poor self-care

Question 19

what are the investigation into schizophrenia?

Answer 19

• if a patient is suspected to have schiz they will be referred to local community mental health team - psychiatrist or specialist nurse carries out a detailed assessment
• lab IX - baseline blood tests, urine culture - rule out UTI causing delirium, urine drug screen, HIV testing, syphilis serology, serum lipids
• CT head - if organic neurological cause is suspected

Question 20

according to ICD-10 what does a dx of schizophrenia require:

Answer 20

first rank symptom or persistent delusion present for at least one month:
- delusional perception
- passivity
- delusions of thought interference - thought insertion, thought withdrawal and or/thought broadcasting
- auditory hallucinations - thought echo, third person voies, and or/running commentary

no other cause for psychosis - e.g. drug intoxication or withdrawal, brain disease (demetia/delirium/epilepsy) or extensive depressive or manic symptoms - unless its clear that schizophrenic symptoms antedate the affective disturbance