Schizophrenia and Psychosis

Question 1

Schneider’s 1st rank symptoms

-diagnosis

Answer 1

Minimum 1 1st rank symptom for MAJORITY OF 1 MONTH
Not diagnostic but common in schizophrenia
Auditory 3rd person hallucinations
-discussion, commentary, echo
Thought disorder
-insertion, withdrawal, broadcast
Passivity phenomena
-made actions/feelings/somatic passivity
Delusional perception

Negative symptoms - incongruent affect, anhedonia, alogia, avolition
Catatonia
Neologists

Question 2

Risk factors

Answer 2

Male in 20s
Slow/delayed child development
Pregnancy/birth trauma or complications - low birth weight?
Maternal infection in pregnancy

FHx
Afro Carribean
Social deprivation
Urban living in youth

Question 3

Types and their characteristics

Answer 3

Paranoid - delusions, hallucinations
Hebephrenic - jumbled speech, inappropriate silly behaviour
Simple - negative symptoms only
Residual - symptoms present before now but only present negative symptoms
Catatonic - disturbed mv

Question 4

Types of antipsychotic medication

• SE
• examples

Answer 4

Typical - haloperidol, promethazine, chlorpromazine
-dystonia, tardive dyskinesia, Parkinsonism, akinthesia, v sedative

Atypical - olanzapine, risperidone, clozapine

• T2DM, weight gain, CVD, sedation
• risperidone - High PRL, amenorrhea, gynecomastia
• aripiprazole - reduced weight related SE

Question 5

Management of schizophrenia

• initial
• prevention of relapse
• treatment resistant

Answer 5

Initial - atypical antipsychotic
-stay on medication for min 1 year

Relapse - may need sectioning or admission

• deterioration in mental state => lose insight
• if they relapse, must stay indefinitely on medication

Depots - for poor compliance, risk of OD

• -risperdal, depixol, clopixol, piportil
• SE risk higher due to long action

Treatment resistant - clozapine

• must have tried 2 other APs (1 must be atypical), given in MHS
• SE - agranulocytosis, myocarditis - monitor initially with weekly bloods
• dose uptitrated until correct plasma level obtained

Question 6

Epidemiology

Prognosis

Answer 6

1% lifetime risk

Mortality => reduction in life expectancy due to suicide, premature death
Morbidity => increased DM, IHD, HepC, HIV, substance misuse

Question 7

Presentation

• Prodrome
• Acute episode

Answer 7

Not present in everyone
Deteriorate in personal functioning
-disturbed communication and affect
-unusual behaviour and ideas
-apathy, social withdrawal and reduced interest in ADLs
-memory, concentration problems
-transient psychotic symptoms

Auditory hallucinations most common

• delusions
• behavioural disturbance
• agitation, distress

Question 8

Differentials for psychotic disorders

Answer 8

Severe depression, bipolar

• predominance of mood symptoms which may trigger psychosis
• schizophrenia dominated by psychosis

Schizoaffective disorder - psychosis and mood symptoms present within 2wks of each other

Puerperal psychosis - acute symptoms within 2 weeks of birth

Persistent delusional disorder - no hallucinations but single delusion that persists

Induced delusional disorder - shared delusion between 2 people with close emotional connection
-disappears when separated

Brief psychotic disorder - symptoms last less than 1 month

PTSD - existence of a traumatic trigger

Drug induced - cannabis, CS, opioids, cocaine, amphetamines

Delirium, sepsis

CVD, brain tumour, temporal epilepsy, PD, HD