Schizophrenia

Question 1

DSM 5 criteria for schizophrenia Dx

Answer 1

2+, each present for a significant portion of time during a 1 month period (or less if successfully tx), at least one must be (1), (2), or (3)
1. delusions
2. hallucinations
3. disorganized speech
4. grossly disorganized or catatonic behaviour
5. negative symptoms
level of functioning below level prior to onset of symps
continuous signs of disturbance persisting for at least 6 months
R/o other disorders or substances

Question 2

brief psychotic disorder

Answer 2

at least one of delusions, hallucinations, disorganized speech or grossly disorganized or catatonic behaviour for less than 1 month

Question 3

Schizophreniform disorder

Answer 3

2+ of delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behaviour lasting 1-6 months

Question 4

examples of negative symptoms (the A’s)

Answer 4

Alogia - poverty of speech
Affect restricted/blunted (reduced range of emotion)
Avolition - lack of motivation
Anhedonia - reduced enjoyment in activities
Apathy - lack of interest/concern
Asociality - reduced drive to socialize, tendency to isolate
Cognitive decline (esp sustained attention, memory, executive functioning)

Question 5

prevalence of schizophrenia

Answer 5

1%

more common in males slightly

Question 6

lifetime risk of suicide & attempt in schizophrenia patient

Answer 6

20% risk of attempt

5% will commit suicide

Question 7

classic presentation to first episode psychosis clinic

Answer 7

young male with history of regular cannabis use

Question 8

risk factors for developing schizophrenia

Answer 8

born in late winter/early spring
urban environment/2nd generation migrants
obstetrical complications
FHx
Exposure to influenza and toxoplasmosis
malnutrition
chronic psychostimulant use
advanced paternal age 
regular cannabis use (esp at a young age)
22q11 deletion syndrome
Hx of head injuries/seizures
Cluster A personality disorders

Question 9

do males or females overall have a worse course and why

Answer 9

males - because earlier age of onset (between 17-24) = less time for brain to develop and less time to secure supports, education, occupation etc.
males also have higher rates of substance use, aggression, and negative symptoms

Question 10

average age onset

Answer 10

17-24 for males

females: late 20s and second peak 35-40

Question 11

good prognostic factors

Answer 11

late onset, acute onset, precipitated by a stressor, presence of mood symptoms, Fx of mood disorders, absence of negative symptoms, good premorbid functioning, strong social supports

Question 12

life expectancy vs general population

Answer 12

reduced by 20 years, due to suicide and cardiovascular complications

Question 13

what psychotic symptoms elevate the risk of violence

Answer 13

disorganization, persecutory delusions, erotomanic delusions, morbid jealousy, command hallucinations

Question 14

primary psychotic disorder vs. substance induced psychosis

Answer 14

substance induced - psychosis associated with use of a substance and that substance known to cause psychosis

 - crystal methamphetamine can cause psychosis up to 4-6 weeks
 - usually symptoms resolve within a few days - 1 week
 - commonly auditory hallucinations, persecutory delusions, and/or disorganized behaviour

Question 15

acute tx

Answer 15

if ED and substance induced psychosis = anti psychotics, if simulant induced agitation (no signs of psychosis) = benzos
if agitation + psychosis may need benzos + anti psychotic

Question 16

4 psychosocial treatments of schizophrenia

Answer 16

1. family intervention including psychoeducation - reduces severity of symptoms and hospitalizations
2. supported employment
3. CBT - good for delusions/auditory hallucinations
4. ACT

Question 17

pro dromal period

Answer 17

subtle changes noticed prior to onset of obvious psychotic symptoms
ex: increased isolate, worsening function at work/school, making odd associations, increased irritability, +/- mood symptoms
can last weeks-months, occasionally even years