Schizophrenia

Question 1

What are features of psychosis?

Answer 1

• Hallucinations
• Delusions
• Thought disorganisation
  
  • alogia: little information conveyed by speech
  • tangentiality: answers diverge from topic
  • clanging
  • word salad: linking real word incoherently → nonsensical content

Associated features → agitation/aggression, neurocognitive impairment, depression + thoughts of self harm

Question 2

Which conditions may psychotic symptoms occur in?

Answer 2

• Schizophrenia
• Psychotic depression
• Bipolar disorder
• Puerperal psychosis
• Brief psychotic disorder where symptoms < 1 month
• Neuro → parkinson’s disease, huntington’s disease
• Prescribed drugs eg. steroids
• Certain illicit drugs eg. cannabis, phencylidine

Question 3

What are risk factors for schizophrenia?

Answer 3

• FHx (7.5)
• Black (5.4)
• Migration (2.9)
• Urban environment (2.4)
• Cannabis use (1.4)

Question 4

What are the clinical features of schizophrenia?

Answer 4

Schneider’s first rank symptoms:

• Auditory hallucinations
  
  • two or more voices discussing pt in third person
  • thought echo
  • voices commenting on the pt’s behaviour
• Thought disorder
  
  • thought insertion
  • thought withdrawal
  • thought broadcasting
• Passivity phenomena
  
  • bodily sensations being controlled by external influence
  • actions/impulses/feelings - experiences which are imposed on individual or influenced by others
• Delusional perceptions
  
  • 2 stages - first where normal object perceived then secondly there is a sudden intense delusional insight into objects meaning for the pt eg. ‘the traffic light is green therefore I am the king’

Other features → impaired insight, incongruity, decreased speech, neologisms, catatonia, negative symptoms (blunting affect, anhedonia, alogia, avolition)

Question 5

What are different subtypes of schizophrenia?

Answer 5

• Paranoid schizophrenia → Predominant symptom is that of what are stable, normally paranoid delusions. These are often accompanied by hallucinations (often auditory) but catatonic symptoms and those of abnormal affect, volition and speech are normally absent.
• Hebephrenic schizophrenia → Affective symptoms are prominent with abnormal behaviour. Negative symptoms are significant and social isolation may result.
• Catatonic schizophrenia → Predominant symptoms are those of psychomotor disturbance, and may exhibit both hyperkinesis and stupor as well as automatic obedience and negativism. Other features may include episodes of violent excitement.
• Undifferentiated schizophrenia → Those that meet the diagnostic threshold but do not fit into one of the above categories.

Question 6

What is the management of schizophrenia?

Answer 6

• Oral atypical antipsychotics are first-line
• CBT should be offered to all patients
• Close attention should be paid to cardiovascular risk-factor modification due to high rates of CVD in schizophrenic pts (linked to antipsychotic meds + high smoking rates)

Question 7

Which factors are associated with poor prognosis for schizophrenia?

Answer 7

• Strong family history
• Gradual onset
• Low IQ
• Prodromal phase of social withdrawal
• Lack of obvious precipitant