Schizophrenia

Question 1

Meaning of first rank symptoms

Answer 1

Symptoms SUGGESTIVE of schizophrenia in the absence of drug use or organic impairment but can occur in other manic epsiodes

Question 2

What are the first rank/ core symptoms of schizophrenia?

Answer 2

Delusions

Auditory hallucinations - 3rd person, or voices commenting on their behaviour

Thought interference - broadcasting, withdrawal, insertion

Passivity - acts are controlled by others

Question 3

Which diagnostic criteria commonly used in diagnosis?

Answer 3

ICD-10

Question 4

What is the diagnostic criteria of Schizophrenia?

Answer 4

At least one of the First Rank symptoms or two of the following:

a) Persistent hallucinations in any modality
b) Neologisms, breaks or interpolations of thought
c) Catatonic behaviour
d) Negative symptoms

Question 5

Sub types of schizophrenia

Answer 5

1. Paranoid
2. Hebephrenic - immaturity or silliness (pranks, animation)
3. Catatonic

Question 6

Which is the most common subtype?

Answer 6

Paranoid type - 1st rank symptoms predominate

Question 7

What is catatonic schizophrenia?

Answer 7

Movement disorder predominates

More rare - as responds to treatment

Periods of inactivity - may hold a convoluted posture for hours

Waxy flexibility - little or no resistance to passive movements, can move a patients arm and they will stay that way

Question 8

Other paranoid Psychoses

Answer 8

Persistent Delusional Disorder- fixed delusions the major or only feature

Schizotypal disorder - magical thinking, transient auditory hallucinations, social withdrawal and aloofness

Acute and Transient Psychotic Disorder

Schizoaffective Disorder - schizophrenia and bipolar disorder

Question 9

Positive symptoms (type 1, acute schizophrenia)

Answer 9

• Hallucinations
• Delusions
• Passivity Phenomena
• Disorder of the form of thought
• ideas of reference
• Persecutory ideas
• Poor insight

Question 10

Negative Syndromes (type 2, chronic)

Answer 10

Loss of normal functioning (hence called ‘negative’ symptoms)

4A’s:

• Reduced amount of speech - alogia
• Reduced motivation/drive - avolition
• Reduced energy - anhedonia
• Reduced interest/pleasure
• Reduced social interactions
• Blunting of affect - affective flattening

Question 11

Positive vs negative syndromes - which is more debilitating?

Answer 11

Negative syndromes

Question 12

Epidemiology of schizophrenia

Answer 12

1.4:1 male to female ratio

Onset in young adults

• peak incidence 15-25 years for men
• peak incidence 25-35 year for women

Higher incidence in lower socioeconomic class

Question 13

Risk factors of schizophrenia

Answer 13

Genetics

Birth complications - perinatal complications (prematurity, fetal distress), prenatal exposure to viral infections increases risk

Winter or spring birth - linked to viral exposure

Drug use - 2X in cannabis users

Urban dwelling - 2x increase

Neurodevelopmental and neurochemical changes

Question 14

What are the neurodevelopmental and neurochemical changes in schizophrenia?

Answer 14

Enlarged ventricles, thinner cortices

Altered dopamine signalling (excess D2)

Question 15

Course of schizophrenia

Answer 15

a) Premorbid

b) Prodromal

Question 16

Premorbid course of schizophrenia

Answer 16

subtle motor, cognitive and social deficits in childhood

that become greater with time (ex. delay in speech/walking)

Question 17

Prodromal course of schizophrenia

Answer 17

Gradual onset, non-specific symptoms

Odd ideas & experiences

Eccentricity

Altered affect

Odd behaviours

Question 18

Indicators of bad prognosis

Answer 18

Male gender 
Poor pre-morbid adjustment
Insidious onset
Early onset	-	childhood / adolescence
Long duration of untreated psychosis
Cognitive impairment
Enlarged ventricles
Comorbid substance abuse

Question 19

Good prognostic indicators

Answer 19

Older age of onset
Female gender
Marked mood disturbance especially elation
Family history of mood disorder