Schizophrenia

Question 1

What are delusions

Answer 1

Belief held in spite of superior evidence to the contrary.

Question 2

What conditions are deusions seen in

Answer 2

Schizophrenia, bipolar disorder, psychotic depression

Question 3

What are nihilistic delusions

Answer 3

Negative delusions that are typically mood-congruent and seen in depressed patients

Question 4

What are delusions of grandeur/grandiose delusions

Answer 4

delusions with strong positive affect where patients believe they have highly positive traits such as ‘I’m rich’ ‘I’m the prime minister’. Associated with mania.

Question 5

What are delusions of control

Answer 5

To a sensation that an external party is controlling an individuals thoughts or actions. Seen in psychosis.

Question 6

What are persecutory delusions

Answer 6

Set of delusional conditions in which the patient believes they are being persecuted. Seen in psychosis

Question 7

Biological risk factors for Schizophrenia

Answer 7

Genetics - family history
Problems during pregnancy and birth
Brain structure abnormalities
Neurochemical abnormalities
Ilicit drug use

Question 8

Problems during pregnancy and birth which are associated with Sz

Answer 8

2nd trimester viral illnesses
Pre-eclampsia, foetal hypoxia, emergency CS
CNS viral infections such as mumps and CMV

Question 9

Brain structure abnormalities seen in schizophrenia

Answer 9

Factors during foetal and childhood development of brain
Enlarged lateral ventricles
Thinning of superior temporal gyrus
Thinner medial temporal structures such as hippocampus

Question 10

Neurochemical abnormalities in Schizophrenia

Answer 10

Increased dopamine activity in mesolimbic area
Changes in dopamine activity in frontotemporal region
Glutamate receptor blocking
Excess seratonin

Question 11

Implication of cannabis in schizophrenic patients

Answer 11

Type, content (9-tetrahydrocannabinol) and frequency important.
Increases risk of Sz developing.
Also makes course and prognosis worse

Question 12

Social and psychological risk factors for schizophrenia

Answer 12

Migration
Urban upbringing
Childhood trauma and other adverse life events
Social defeat hypothesis

Question 13

Four categories of schizophrenia symptoms

Answer 13

Positive symptoms
Negative symptoms
Thought disorder
Movement disorder

Question 14

What are positive symptoms

Answer 14

Hallucinations and delusions. These can be:
Thought echo, insertion, withdrawal and broadcasting
Delusions of control influence, passivity, delusional perception
Hallucinatory voices giving commentary, third person dicussion
Persistent delusions of other kinds which are culturally inappropriate or completely impossible

Question 15

What are negative symptoms

Answer 15

Flattened affect, apathy, avolition, alogia

Question 16

What is thought disorder

Answer 16

Thinking can be jumbled, or otherwise slow or disorganised

Question 17

What are catonic symptoms

Answer 17

Abnormalities in movement and muscle tone

Question 18

Insight in someone with schizophrenia

Answer 18

Often lack insight, meaning they do not understand that their symptoms or problems could be caused by an illess, therefore do not ask for help or treatment

Question 19

Onset on schizophrenia

Answer 19

Often preceded by prodromal phase, insidious onset with mainly negative and cognitive symptoms whic can take up to years before positive symptoms present

Question 20

ICD-10 daignosis of schizophrenia

Answer 20

One positive symptom and at least 2 symptoms of negative symptoms, change in personality and behaviour, catatonic behaviour, thought disorder.

Question 21

Differentials of schizophrenia

Answer 21

Substance induced psychotic disorder
Organic psychosis caused by infection, brain injury
Metabolic disorder such as hyperthyroidism and hyperparathyroidism
Dementia and depression psychosis

Question 22

Management of schizophrenia

Answer 22

Care programme approach, CBT, family therapy alongside an oral antipsychotic

Question 23

First line drug for sz

Answer 23

Risperidone

Question 24

First line drug for child with Sz

Answer 24

Clozapine

Question 25

Other drug options

Answer 25

Lorazepam if there is acute behaviour disturbance