Schizophrenia

Question 1

Risk factors

Answer 1

Family history is strongest risk factor

Black Caribbean ethnicity

Migration

Urban environment

Cannabis use

Question 2

Features

Answer 2

Auditory hallucinations

Thought disorders

Passivity phenomena

Delusional perceptions

Question 3

Auditory hallucinations

Answer 3

Two ore more voices discussing the patient in third person

Thought echo

Voices commenting on the patient’s behaviour

Question 4

Thought disorders

Answer 4

Though insertion

Thought withdrawal

Thought broadcasting

Question 5

Passivity phenomena

Answer 5

Bodily sensations being controlled by external influence

Actions/ impulses/ feelings- imposed in individual or influenced by others

Question 6

Delusional perceptions

Answer 6

Normal object is perceived then secondly there is a sudden intense delusional insight into the objects meaning for the patient

Question 7

Other features

Answer 7

Impaired insight

Incongruity/ blunting of affect

Decreased speech

Neologisms (made up words)

Catatonia

Negative symptoms (blunting of affect, anhedonia, alogia, avolition)

Question 8

Management

Answer 8

Oral atypical antipsychotics first line

CBT

Pay attention to CVD risk factors

Question 9

Factors associated with poor prognosis

Answer 9

Strong family history

Gradual onset

Low IQ

Prodromal phase of social withdrawal

Lack of obvious precipitant

Question 10

Atypical antipsychotics

Answer 10

Act on variety of receptors (D2/3/4 5-HT)

Extrapyramidal side effects and hyperprolactinaemia less common than typical

Metabolic effects

e.g. clozapine, risperidone, olanzapine