Schizophrenia

Question 1

What is the most common cause of psychosis?

Answer 1

Schizophrenia

Question 2

What is psychosis?

Answer 2

Delusions, hallucinations and or a thought disorder without insight

Question 3

Epidemiology of schizophrenia
Prevalence?
When does it commonly present?

Answer 3

720/100000
Commonly presents in teens/20s
But can present at any time

Question 4

Risk factors for schizophrenia

Answer 4

FHx of schizophrenia
premature birth
Abnormal development
Social isolation/migrant

Question 5

Illicit drugs which can cause psychosis?

Answer 5

Cannabis - short/long term

Cocaine/amphetamines also risk

Question 6

schizophrenia patients die earlier than average. By how many years?

Answer 6

25

Question 7

Organic differential diagnoses for psychosis

Answer 7

Drug induced psychosis
Temporal lobe epilepsy
Encephalitis 
Alcoholic hallucinations
Dementia
Delirium (2y to infection etc)
Cerebral syphilis [rare]

Question 8

Psychiatric differential diagnoses for psychosis

Answer 8

Mania
Psychotic depression
Some personality disorders
Panic disorder
Dissociative identity disorder

Question 9

Outline the 3 phases of schizophrenia

Answer 9

1) prodrome - a bit withdrawn etc
2) active - symptoms [delusions, hallucinations etc]
3) residual - cognitive symptoms

Question 10

First rank symptoms of schizophrenia

Answer 10

• strongly suggest schizophrenia - acute -
  Auditory hallucinations (thought echo, 3rd person)
  Thought insertion, withdrawal, blocking
  Delusional perceptions
  Somatic passivity

Question 11

Secondary symptoms of schizophrenia (the chronic ones)

Answer 11

- chronic -
Delusions
2nd person auditory hallucinations
hallucinations in other senses
thought disorder
catatonic behaviour
negative symptoms

Question 12

What’s the difference between positive and negative symptoms?

Answer 12

Positive - add to normal experience, ie hallucinations

Negative - ‘less’ than normal ie flat affect - not interested that theres a monkey dancing in front of you

Question 13

Give examples of some positive symptoms (for schizophrenia)

Answer 13

Hallucinations
Delusions (control, reference)
Passivity phenomena
Thought alienation
Change in mood
(lack of insight)

Question 14

Give some examples of negative symptoms (for schizophrenia)

Answer 14

Blunting of affect
Amotivation 
Poverty of speech/thought
Reduced non verbal communication 
Reduced functioning/self neglect
(lack of insight)

Question 15

Signs of schizophrenia in mental state examination

ASEPTIC

Answer 15

A/B - Withdrawn, suspicious
S - thought blocking, loosening of association
E - flattened/incongruous/odd mood
P - delusions
T - Thought control, passivity
I - no insight
C - cognition subtly different

Question 16

Investigations for schizophrenia to rule out other causes

Answer 16

LFTs, FBC - for alcohol abuse (deranged LFTs and MCV up)
Serology for syphilis
Urine toxicology

Question 17

Treatment for schizophrenia

Answer 17

Psychological and pharmacological, MDTs etc

Risperidone/olanzapine - first line - atypical antipsychotics
Clozapine next in line
ECT - brief improvements

Question 18

DSM-5 criteria for diagnosis of schizophrenia

Answer 18

Must have one of:
Delusions
Hallucinations
Disorganised speech
and a second symptom from those 3 or these 2:
Disorganised/catatonic behaviour
Negative symptoms

These are required for 6 months of which one month has active symptoms

Question 19

What is Hebephrenic schizophrenia

Answer 19

• Disorganised behaviour without purpose.
• Disorganised thoughts: other people may find it difficult to understand you.
• Pranks, giggling, health complaints and grimacing.
• Short-lasting delusions and hallucinations.
• Usually develops between 15 and 25 years old

Question 20

Postpartum Psychosis

puerperal psychosis

Answer 20

Postpartum psychosis is a severe mental illness which develops acutely in the early postnatal period, usually within the first month following delivery

Symptoms can be 
depressive - withdrawal, confusion etc
manic - elated, gambling etc
delusions - paranoia, jealousy, persecutory, grandiose
hallucinations 
odd beliefs about the baby

Question 21

Organic differentials for psychosis

Answer 21

Endocrine (thyroid ^/v, steroid producing tumour (adrenal gland - cushings, or ectopic SCLC))
Metabolic diseases
Autoimmune (SLE etc)
Infections (neurosyphilis, HIV, cerebral malaria and other ‘tropical’ diseases)
Narcolepsy
Seizures
Space-occupying lesions, stroke, head injury
Demyelinating diseases (multiple sclerosis)
Nutritional deficiencies (B12, thiamine)
Substances