Schizophrenia

Question 1

What is schizophrenia

Answer 1

A group of mental disorders in which there is a range of problems with perception, cognition and behaviour

Question 2

What is the prevalence of schizphrenia

Answer 2

Worldwide prevalence of 0.5 percent

Genders equally affected

Question 3

What is the aetiology of schizophrenia

Answer 3

Unknown but thought to be a combination of genetic and environmental factors
Genetics- polygenic and non mendelian
Environment- daily cannabis usage(?)

Question 4

What is the likely pathology of schizophrenia

Answer 4

Neurodevelopmental disconnection
ie probems with brain connections
likely to be due to dopamine excess (still a theory as only explains the positive symptoms)

Question 5

What is seen on neuroimaging in schizophrenia

Answer 5

Alterations in prefrontal and less consistently temporal lobe function
Enlarged lateral ventricles
Disorganised cytoarchitecture in the hippo campus.

Question 6

When does schizophrenia usually present

Answer 6

early 20s

Question 7

What are the symptoms first rank of schizophrenia

Answer 7

Auditory, third person hallucinations
Though disorder eg withdrawal, insertion, broadcast
Delusions
Somatic passivity

Question 8

What is passivity?

Answer 8

the belief that your thoughts/actions/feelings are controlled by an external source

Question 9

describe what is meant by positive and negative symptoms

Answer 9

Positive- symptoms which are inherent to schizophrenia eg hallucinations, delusions, thought disorder ie psychotic symptoms
Negative- alteration to normal mood states eg lack of emiotion, poverty of thought ie. affective symptoms

Question 10

How is schizophrenia sometimes divided

Answer 10

Type 1 - positive - acute onset delusions and hallucinations, good prognosis
Type 2 - negative - insidious onset, absence of very acute symptoms, presents with apathy, social withdrawal etc

Question 11

What are the differentials in someone presenting with these symptomsq

Answer 11

Organic mental disorders eg temporal lobe seizures
Affective disorders eg bipolar, depression
Drug psychosis - amphetamines
Personality disorders eg schizotypal

Question 12

What is a delusion

Answer 12

a fixed belief, not amenable to logic or argument
did not come through logical means
not cultural or subculturally related

Question 13

what type of delusions occur in schizophrenia

Answer 13

any - usually bizarre

usually not mood congruent

Question 14

What is a ‘true’ hallucination

Answer 14

perceptual disturbance not based on an actual object
As vivid as a real perception
exist in external space
believed to be public

Question 15

what is the most common modality of hallucination in schizophrenia

Answer 15

third person , auditory

running commentary also common

Question 16

What is thought interferance

Answer 16

Disturbance of the experience of though

Question 17

What are examples of thought interferenct

Answer 17

though inserstion
withdrawl
broadcasting

Question 18

what is though insertion

Answer 18

thoughts being put into your head - not the same as obsession which are recognised as being your own thoughts

Question 19

Thought withdrawal

Answer 19

thoughts being taken out of your head -can be a delusional explanation for thought blocking

Question 20

thought broadcasting

Answer 20

thoughts being broadcast to other people/shared with others

Question 21

What emotional disorders occur in schizophrenia

Answer 21

blunted affect
incongruent affect eg laughing at a sad story
lack of motivation
anhedonia
lack of interest in social skills/relationships

Question 22

What motor/behavioural disorders occur in schizophrenia

Answer 22

catatonia
stereotypies
wavy flexibility
mutism

Question 23

What is the ICD- 10 criteria for schizophrenia

Answer 23

One of these symptoms:

• thought interference
• passivity phenomena
• hallucinatory voices giving running commentary, discussing patient of coming from a part of the patients body
• impossible persistent delusions

Two of these symptoms:

• formal thought disorder
• catatonic behaviour
• negative symptoms
• loss of interest, idleness, social withdrawal

For at least one month.

Question 24

What is neuroleptic malignant syndrome

Answer 24

A rare but potentially dangerous side effect of neuroleptic medications.
Presents with hyperthermia, muscle rigisity, tachy cardia, labile BP, pallor, raised CK, raised white cells and deranged LFTs.
Treatment is to stop medications and recusitate.

Question 25

What is the difference between the way that typical and atypical antipsychoitics work

Answer 25

Atypicals block the D2 receptors less than D1 receptors. As such they are less likely to result in extrapyramidal side effects and tardive dyskinesia.

Question 26

What are the down sides to chlorpromazine (typical)

Answer 26

sediation

Question 27

What is a common side effect of rispiradone (atypical

Answer 27

hyperprolactinaemia

Question 28

What is the main concern with olanzapine (atypical)

Answer 28

weight gain and metabolic syndrome

Question 29

What is used to treat intractable chronic schizophrenia

Answer 29

clozapine (a bibenzodiazepine)

Used in patients have failed on at least two conventional antipsychotics or as a first line therapy

Question 30

What is the risks of clozapine

Answer 30

can cause severe agranulocytosis