Schizophrenia

Question 1

Risk Factor

Answer 1

Family History

Question 2

Features

Answer 2

Schneider’s first rank symptoms may be divided into auditory hallucinations, thought disorders, passivity phenomena and delusional perceptions:

Auditory hallucinations of a specific type:
two or more voices discussing the patient in the third person
thought echo
voices commenting on the patient’s behaviour

Thought disorders
thought insertion
thought withdrawal
thought broadcasting

Passivity phenomena:
bodily sensations being controlled by external influence
actions/impulses/feelings - experiences which are imposed on the individual or influenced by others

Delusional perceptions
a two stage process) where first a normal object is perceived then secondly there is a sudden intense delusional insight into the objects meaning for the patient e.g. ‘The traffic light is green therefore I am the King’.

Other features of schizophrenia include
impaired insight
negative symptoms
incongruity/blunting of affect
anhedonia (inability to derive pleasure)
alogia (poverty of speech)
avolition (poor motivation)
social withdrawal
neologisms: made-up words
catatonia

Question 3

Prognostic Indicators

Answer 3

Factors associated with poor prognosis
strong family history
gradual onset
low IQ
prodromal phase of social withdrawal
lack of obvious precipitant

Question 4

Treatment

Answer 4

NICE published guidelines on the management of schizophrenia in 2009.

Key points:
oral atypical antipsychotics are first-line
cognitive behavioural therapy should be offered to all patients
close attention should be paid to cardiovascular risk-factor modification due to the high rates of cardiovascular disease in schizophrenic patients (linked to antipsychotic medication and high smoking rates)