Schizophrenia and psychosis

Question 1

Which drug is generally reserved for treatment-resistant schizophrenia?

Answer 1

Clozapine

Question 2

What are the positive symptoms of schizophrenia?

Answer 2

Hallucinations
Delusions
Disordered thinking

Question 3

What are the negative symptoms of schizophrenia?

Answer 3

Apathy
Lack of interest
Lack of emotions

Question 4

What type of hallucinations are most common in schizophrenia?

Answer 4

Third person, auditory hallucinations, often behind the person or in the walls, often criticising or persecuting them

Question 5

What are pseudo-hallucinations?

Answer 5

When the person perceives the voice to be inside their own head. Usually related to a personality disorder rather than schizophrenia.

Question 6

Define “delusion”

Answer 6

an unshakeable idea or belief which is out of keeping with the person’s social and cultural background; it is held with extraordinary conviction

Question 7

Give five types of delusions

Answer 7

Grandiose
Paranoid / Persecutory
Hypochondriacal
Ideas of reference
Nihilistic

Question 8

Give six ways that thought form can be abnormal

Answer 8

Thought blocking
Derailment
Tangentiality
Flight of ideas
Circumstantiality
Loosening of associations

Question 9

Which psychiatric conditions can have psychotic symptoms

Answer 9

Schizophrenia
Delirium
Severe affective disorder
 - Depressive episode with psychotic symptoms
 - Manic episode with psychotic symptoms
Schizo-affective disorder
Dissociative identity disorder

Question 10

Which organic conditions can have psychotic symptoms?

Answer 10

Dementia
Encephalitis
Alcoholic hallucinosis
Cerebral syphilis
Temporal lobe epilepsy
Drugs

Question 11

What investigations should be done when a patient presents with psychosis?

Answer 11

• LFTs and FBC to exclude alcohol abuse
• Serology to syphilis (and HIV/AIDS)
• Urine screen to drug abuse e.g. cannabis

Question 12

How long must symptoms be present in order to diagnose schizophrenia?

Answer 12

At least one month (in absence of an organic of affective disorder)

Question 13

According to ICD-10, schizophrenia can be diagnosed on ONE of ___ (give four possible symptoms)

Answer 13

Alienation of thought
Delusions of control, influence or passivity
Hallucinatory voices
Persistent delusions

Question 14

According to ICD-10, schizophrenia can be diagnosed on TWO of ___ (give four possible symptoms)

Answer 14

Persistent hallucination
Breaks in train of thought
Catatonic behaviour
Negative symptoms

Question 15

Give three examples of high potency typical antipsychotics

Answer 15

• Fluphenazine
• Haloperidol
• Pimozide

Question 16

Give two examples of low potency typical antipsychotics

Answer 16

• Chlorpromazine

* Thioridazine

Question 17

How do typical antipsychotic drugs work?

Answer 17

D2 dopamine antagonists; bind to D2 receptors

Question 18

What are the main risks/side-effects associated with low potency typical antipsychotics?

Answer 18

Cardiotoxicity e.g. long-QT

Anticholinergic adverse effects e.g. sedation and hypotension

Question 19

Give five examples of atypical antipsychotic drugs

Answer 19

Risperidone
Olanzapine
Quetiapine
Aripiprazole
Clozapine

Question 20

How long should patients stay on medication after their symptoms have subsided?

Answer 20

2 years as a minimum, but often continue medication long term to avoid relapse

Question 21

Define “psychosis”

Answer 21

An inability to distinguish symptoms of hallucination, delusion and disordered thinking from reality

Question 22

Give four pathways in the brain that involve dopamine

Answer 22

Mesocortical (motivation)
Mesolimbic (reward)
Nigrostriatal (movement)
Tuberoinfundibular (controls prolactin release)

Question 23

Give some examples of Schneider’s first-rank symptoms of schizophrenia

Answer 23

Auditory hallucinations

• third-person voicing conversing about the pt
• running commentary on the pt’s actions
• thought echo (pt’s thoughts are spoken aloud)

Thought withdrawal
Thought insertion
Thought broadcasting

Delusions of control
Delusional perception

Question 24

Which is the primary neurotransmitter indicated in the theories behind schizophrenia?

Answer 24

Dopamine