Schizophrenia

Question 1

What is schizophrenia?

Answer 1

Mental disorder inn which the thoughts, affective response or ability to recognise reality, and ability to communicate and relate to others, are sufficiently impaired to interfere grossly with the capacity to deal with reality

Question 2

What are the classic characteristics of schizophrenia?

Answer 2

Lack of insight, hallucinations, delusions, disorder of form of thought

Question 3

What are the types of schizophrenia?

Answer 3

Organic conditions = delirium, dementia, stroke, brain injury
Substance use = acute intoxication, withdrawl, delerium tremens
Manic depressive psychosis = unipolar depression, bipolar disorder
Dementia praecox = schizophrenia and other paranoid illnesses
Schizoaffective disorder

Question 4

What does schizophrenia involve?

Answer 4

Inability to distinguish between subjective experience and objective reality = qualitatively different from normal experience

Question 5

What are some examples of psychotic experiences?

Answer 5

Hallucinations, ideas of reference, delusions, thought disorder, thought interference, passivity phenomena, loss of insight

Question 6

What is a hallucination?

Answer 6

Perception which occurs in absence of an external stimulus

Question 7

What are some features of a hallucination?

Answer 7

Experienced as originating in real space (not just in thoughts)
Has same qualities as normal perception
Not subject to conscious manipulation

Question 8

What are the different types of hallucination?

Answer 8

can occur in any sensory modality = auditory, visual, olfactory, gustatory, tactile, haptic

Question 9

What is idea of reference?

Answer 9

Innocuous or coincidental events will be ascribed significant meaning by the person

Question 10

What are some examples of idea of reference?

Answer 10

Thinking there are messages in the newspaper about them

Believing objects have been arranged so as to convey a hidden message to them

Question 11

What are self-referential experiences?

Answer 11

Belief that external events are related to oneself = can vary in intensity from brief though to frequent and intrusive thought to delusional intensity

Question 12

What are some examples of self-referential experiences?

Answer 12

Feeling that others are speaking about them

Believing they are the second coming of Christ

Question 13

What are delusions?

Answer 13

Fixed falsely held belief = held with unshakeable conviction, may be bizarre or impossible, impervious to logical arguments or evidence

Question 14

What are the origins of delusions?

Answer 14

Primary = arrive fully formed in the consciousness without need for explanation
Secondary = often attempts to explain anomalous experiences

Question 15

What are some types of delusion?

Answer 15

Paranoid, sin, persecutory, poverty, grandoise, nihilistic, religious, erotomantic, misidentification, jealousy, guilt

Question 16

How are though disorders identified?

Answer 16

Must be inferred from patterns of speech = can’t be directly observed

Question 17

What are some examples of thought disorders?

Answer 17

Neologisms, circumstantiality, clanging and punning, loosening of association, Knight’s move thinking, verbigeration

Question 18

What are the types of thought interference?

Answer 18

Thought insertion, withdrawl, broadcasting and blocking

Question 19

How do we process reality?

Answer 19

Reality testing is just another constructed process driven by the brain = involved filtering the info from our senses about the world and interpreting their meaning

Question 20

Can you tell if the filters we use for processing reality aren’t working?

Answer 20

No = everything still seems real

Question 21

What is loss of insight?

Answer 21

Patient is unable to attribute their symptoms to being an illness

Question 22

What are the differentials of psychosis?

Answer 22

Schizophrenia, substance misuse, mania, depression, delirium, dementia

Question 23

What are some features of drug induced psychosis?

Answer 23

May be very florid symptoms or more insidious and chronic = tend to be short lasting if access to substance is removed, not the same as intoxication or withdrawl effects

Question 24

What must you beware of in drug induced psychosis?

Answer 24

Comorbidity of substance use with schizophrenia or bipolar disorder

Question 25

What typifies depressive psychosis and mania with psychosis?

Answer 25

Mood congruent content of psychotic symptoms

Question 26

What are some features of depressive psychosis?

Answer 26

Delusions of guilt, worthlessness, hypochondriasis or poverty Hallucinations of accusing, insulting or threatening voices = typically second person

Question 27

What are some features of mania with psychosis?

Answer 27

Delusions of grandeur, special ability, persecution or religiosity Hallucinations = tend to be second person and auditory Flight of ideas

Question 28

What is delirium?

Answer 28

Acute transient disturbance = clouding of consciousness ranging from subtle drowsiness to unresponsive disorientation, worse at night, may have lucid intervals

Question 29

What are some causes of delirium?

Answer 29

Alcohol withdrawl, septicaemia, organ failure, hypoglycaemia, encephalitis, space occupying lesions

Question 30

What are some features of delirium?

Answer 30

Impaired concentration and memory = esp. new info Visual hallucinations +/- auditory hallucinations Persecutory delusions, irritability and insomnia Psychomotor disturbance = agitation or retardation

Question 31

What are the core symptoms of schizophrenia?

Answer 31

Delusions, auditory hallucinations, thought interference, passivity phenomena

Question 32

What is the first set of ICD-10 criteria for schizophrenia?

Answer 32

At least 1 of = Thought echo, insertion, withdrawl or boradcasting Delusions of control/influence clearly referred to body movements or thoughts Hallucinatory voices Persistent delusions of other kinds that are culturally inappropriate

Question 33

What is the second set of ICD-10 criteria for schizophrenia?

Answer 33

At least 2 of = Catatonic behaviour Persistent hallucinations occurring every day for at least one month when accompanied by delusions Neologisms, breaks or interpolations in train of thought resulting in incoherent speech Negative symptom

Question 34

What are some negative symptoms that occur in schizophrenia?

Answer 34

Marked apathy, paucity of speech, blunting or incongruity of emotional responses

Question 35

What are the subtypes of schizophrenia?

Answer 35

Paranoid = most common, 80% of all cases, 1st rank symptoms predominate Hebephrenic Catatonic = movement disorder predominates

Question 36

What are some examples of other paranoid psychoses?

Answer 36

Persistent delusional disorder, schizotypal disorder, acute and transient psychotic disorder, schizoaffective disorder

Question 37

What are some features of persistent delusional disorder?

Answer 37

Systematised = fixed delusions are the major or only feature

Question 38

What are some features of schizotypal disorder?

Answer 38

Eccentricity and aloofness, social withdrawl, paranoid quasi-delusional ideas, magical thinking, transient auditory hallucinations

Question 39

What are some features of acute and transient psychotic disorder?

Answer 39

Schizophrenia-like symptoms lasting less than a month

Question 40

What are some features of schizoaffective disorder?

Answer 40

First rank symptoms with depression or mania

Question 41

What are some examples of positive syndromes?

Answer 41

Hallucinations, delusions, passivity phenomena, disorder of form of thought

Question 42

What are some examples of negative syndromes?

Answer 42

Reduced amount of speech, reduced motivation or drive, reduced interest or pleasure, reduced social interaction, blunting of affect

Question 43

What is schizophrenia considered to be?

Answer 43

A genetically determined neurodevelopmental vulnerability later triggered by environmental stressors

Question 44

When is the peak incidence of schizophrenia?

Answer 44

``` Males = age 15-25 Females = age 25-35 ```

Question 45

What is schizophrenia associated with?

Answer 45

Perinatal complications = prematurity, prolonged labour, foetal distress, hypoxia

Question 46

What are the risk factors for schizophrenia?

Answer 46

Drug use, urban dwelling, social deprivation, enlarged ventricles and thinner cortices, altered dopamine signalling

Question 47

What is the link between suicide and schizophrenia?

Answer 47

10-15% completed suicide rate in schizophrenics = may occur following recovery of insight, high risk in first week following discharge from hospital

Question 48

What are some indicators of poor prognosis for schizophrenia?

Answer 48

``` Poor premorbid adjustment Insidious onset and childhood/adolescent onset Long duration of untreated psychosis Cognitive impairment Enlarged ventricles ```

Question 49

What are some indicators of good prognosis for schizophrenia?

Answer 49

Shorter time of untreated psychosis Older age of onset and positive family history Marked mood disturbance Female gender