Schizophrenia

Question 1

What is schizophrenia classified as: a psychotic or neurotic disorder?

Answer 1

Schizophrenia is classified as a psychotic disorder.

Question 2

What is the origin of the term “schizophrenia”?

Answer 2

The term “schizophrenia” originates from the Greek words “schizein” (to split) and “phren” (mind).

Question 3

Under which classifications is schizophrenia listed in ICD-10 and ICD-11?

Answer 3

In ICD-10, schizophrenia is classified under “schizophrenia, schizotypal, and delusional disorders” (F20-F29), and in ICD-11, it is classified as “Schizophrenia or other primary psychotic disorders” (Block 6A2).

Question 4

What mental modalities are disturbed in schizophrenia?

Answer 4

Schizophrenia is characterised by disturbances in thinking, perception, self-experience, cognition, volition, affect, behaviour, and psychomotor disturbances.

Question 5

What are the core symptoms of schizophrenia?

Answer 5

The core symptoms include persistent delusions, persistent hallucinations, thought disorder, and experiences of influence, passivity, or control.

Question 6

Who were some of the early describers of schizophrenia, and what terms did they use?

Answer 6

Early describers include Morel (demence precoce), Kahlbaum (dementia paranoides, katatonia), and Hecker (hebephrenia).

Question 7

What are some early clinical concepts of schizophrenia?

Answer 7

Early clinical concepts include Greisinger’s ‘unitary psychosis’ and Kraepelin’s dementia praecox, which included four subtypes: hebephrenic, catatonic, paranoid, and simple.

Question 8

What was Bleuler’s contribution to understanding schizophrenia?

Answer 8

Bleuler (1911) introduced the concept of “the schizophrenias,” a collection of psychoses characterised by the ‘four As’: ambivalence, loosening of associations, affective incongruity and blunting, and autism.

Question 9

What are some early sociological concepts related to schizophrenia?

Answer 9

Some sociological concepts suggest schizophrenia is not an illness but a myth or a sane reaction to an insane world.

Question 10

What is the incidence of schizophrenia per year?

Answer 10

The incidence of schizophrenia is 15–20 per 100,000 per year.

Question 11

What is the lifetime risk of schizophrenia?

Answer 11

The lifetime risk of schizophrenia is approximately 0.9%.

Question 12

What genetic risk factors are associated with schizophrenia?

Answer 12

Genetic risk factors include family history, with higher risks for parents, siblings, and children of individuals with schizophrenia.

Question 13

What environmental risk factors are associated with schizophrenia?

Answer 13

Environmental risk factors include prenatal infection, birth complications, early cannabis use, and paternal age.

Question 14

What neurotransmitters are involved in schizophrenia?

Answer 14

Neurotransmitters involved in schizophrenia include dopamine, glutamate, serotonin, GABA, and noradrenaline.

Question 15

What neuropathological findings are associated with schizophrenia?

Answer 15

Neuropathological findings include a 6% decrease in brain weight, decreased synaptic markers, and non-specific ventricular enlargement.

Question 16

What are some physiological abnormalities in schizophrenia?

Answer 16

Physiological abnormalities include abnormal smooth-pursuit eye movements, EEG changes, and decreased sensory evoked potentials (P300).

Question 17

What psychological factors contribute to schizophrenia?

Answer 17

Psychological factors contributing to schizophrenia include personality traits and family dynamics like expressed emotion.

Question 18

What are the common clinical features of schizophrenia?

Answer 18

Common clinical features include lack of insight, hallucinations (especially auditory), delusions, apathy, avolition, social withdrawal, and affective blunting.

Question 19

What are the subtypes of schizophrenia based on symptom prominence?

Answer 19

Subtypes include paranoid, hebephrenic, catatonic, simple schizophrenia, undifferentiated, residual schizophrenia, and deficit syndrome.

Question 20

How is schizophrenia diagnosed?

Answer 20

Schizophrenia is diagnosed based on psychiatric history, mental state examination, and the exclusion of other disorders. First-rank symptoms, as per Schneider, include hearing thoughts spoken aloud and delusions of control.

Question 21

What are the DSM-V criteria for diagnosing schizophrenia?

Answer 21

DSM-V criteria require two or more symptoms, including delusions, hallucinations, or disorganised speech, present for a significant portion of time over a month.

Question 22

What are some differential diagnoses for schizophrenia?

Answer 22

Differential diagnoses include delusional disorders, schizoaffective disorders, acute and transient psychotic disorders, and drug-induced states.

Question 23

What investigations are used in the diagnosis of schizophrenia?

Answer 23

Investigations for schizophrenia include biological, psychological, and social assessments.

Question 24

What are the main treatment approaches for schizophrenia?

Answer 24

Treatment approaches include typical/atypical antipsychotics, cognitive retraining, crisis management, education, vocational rehabilitation, and supportive therapy.

Question 25

What are predictors of poor outcomes in schizophrenia?

Answer 25

Predictors of poor outcomes include male gender, early age of onset, insidious onset, substance abuse, and family history of schizophrenia.

Question 26

What are the core symptoms of schizophrenia?

Answer 26

Core symptoms: Persistent delusions, persistent hallucinations, thought disorder, experiences of influence, passivity, or control.

Question 27

What is the significance of “schizophrenia” in ICD-10 and ICD-11?

Answer 27

ICD-10: “Schizophrenia, schizotypal and delusional disorders” (F20-F29). ICD-11: “Schizophrenia or other primary psychotic disorders” (Block 6A2).

Question 28

What are the disturbances in mental modalities seen in schizophrenia?

Answer 28

Disturbances in mental modalities: Thinking (delusions, disorganisation), perception (hallucinations), self-experience (control by external force), cognition (impaired attention, memory, social cognition), volition (loss of motivation), affect (blunted emotional expression), behaviour (bizarre or purposeless behaviour), psychomotor disturbances (catatonia).

Question 29

What are the early clinical concepts of schizophrenia according to Kraepelin?

Answer 29

Kraepelin’s early clinical concepts: Schizophrenia as dementia praecox, a chronic disorder with onset in adolescence and progressive deterioration in mental function.

Question 30

What are Bleuler’s fundamental symptoms of schizophrenia?

Answer 30

Bleuler’s fundamental symptoms: Ambivalence, loosening of associations, affective incongruity and blunting, autism (withdrawal).

Question 31

What are the environmental risk factors for schizophrenia?

Answer 31

Environmental risk factors: Prenatal infection, birth complications, maternal malnutrition, early cannabis use, paternal age, winter birth.

Question 32

What neurotransmitters are involved in the neurochemistry of schizophrenia?

Answer 32

Neurotransmitters: Dopamine, glutamate, serotonin, GABA, noradrenaline, CCK, neurotensin.

Question 33

What are the key features of the dopamine hypothesis in schizophrenia?

Answer 33

Dopamine hypothesis: Postulates dopamine overactivity; supported by amphetamine-induced psychosis and the effectiveness of antipsychotics that block D2 receptors.

Question 34

What are the gender differences in the incidence of schizophrenia?

Answer 34

Gender differences: Schizophrenia is more common in males than females, with different age-onset patterns.

Question 35

What social factors are associated with schizophrenia?

Answer 35

Social factors: Migration, urban birth and upbringing, recent life events, ethnicity, place of residence, occupation, social isolation.

Question 36

What are the subtypes of schizophrenia based on symptom prominence?

Answer 36

Subtypes of schizophrenia: Paranoid (persecutory delusions, auditory hallucinations), hebephrenic (thought disorder, affective symptoms), catatonic (motor symptoms), simple schizophrenia (insidious onset, social withdrawal), undifferentiated, residual schizophrenia, deficit syndrome.

Question 37

What are the common investigations for diagnosing schizophrenia?

Answer 37

Common investigations: History and mental state examination, physical exam, investigations (biological, psychological, social).

Question 38

What are the predictors of poor outcomes in schizophrenia?

Answer 38

Predictors of poor outcomes: Male gender, history of obstetric complications, abnormal premorbid personality, low IQ, single status, early age at onset, insidious onset, substance abuse, family history.

Question 39

What are the lifetime risks for relatives of probands with schizophrenia?

Answer 39

Lifetime risks: Parent (4.4–5.5%), all siblings (8.5–10.2%), children (12.3–13.9%), child of 2 parents (36.6–46.3%), sibling with one parent having schizophrenia (13.8–17.2%), MZ twins (40–50%) vs DZ twins (10%).