Schizophrenia and Psychosis

Question 1

What is the lifetime risk of schizophrenia in the general population?

Answer 1

1/100

Question 2

What is the lifetime risk of schizophrenia if one of your parents has the condition?

Answer 2

1/10

Question 3

What is the lifetime risk of schizophrenia if your identical twin suffers from the condition?

Answer 3

1/2

Question 4

What is the lifetime risk of schizophrenia if you have a sibling with the condition?

Answer 4

1/8

Question 5

Give three genes that are thought to be involved in the development of schizophrenia?

Answer 5

Neuregulin
Dysbindin
DISC

Question 6

What structural brain abnormalities are seen in schizophrenia?

Answer 6

Reduced brain volume
Ventricular enlargement EEG changes
Microscopic changes

Question 7

What chemical appears to be dysregulated in schizophrenia?

Answer 7

Dopamine

Question 8

What is synaptic pruning and how does it relate to schizophrenia?

Answer 8

As we get older we lose nerve connections (synapses) that we do not need. In schizophrenia there is too much of this meaning that there is an excessive loss of synapses.

Question 9

Is schizophrenia more common if you have grown up in an urban or rural area?

Answer 9

Urban

Question 10

What baseline investigations should be done before starting an antipsychotic medication>

Answer 10

Weight
Waist circumfrence
Pulse/BP
Fasting blood glucose , HbA1c, lipids and prolactin levels
Assesment of any movement disorders such as parkinsons
Assessment of nutritional status and activity status

Question 11

When should you do an ECG before starting an antipsychotic medication?

Answer 11

If it is specified on the medications SPC
Cardiovascular risk/history
Any patient being admitted as an inpatient

Question 12

Describe how you would titrate the dose of an antipsychotic medication

Answer 12

1. Start the treatment with a dose at the lower end of the treatment range.
2. Carry out a trial of the medication at the optimum dose for 4 - 6 weeks. and monitor response and side effects

Question 13

How often do patients need their weight measured when they are on an antipsychotic?

Answer 13

Weekly for the first 6 weeks then at 12 weeks, at 1 year and then anually

Question 14

Which anti psychotic has the risk of skin photosensitivity?

Answer 14

Chloropromazine

Question 15

What are bad prognostic indicators in schizophrenia?

Answer 15

1. Poor adjustment pre morbidly
2. Insidious onset
3. Early onset (childhood/adolescence)
4. Cognitive impairment
5. Enlarged ventricles

Question 16

What are the outcomes like in schizophrenia?

Answer 16

20%: One episode with no or minimal impairment
40%: Multiple episodes but with no or minimal impairment
40%: Multiple episodes with significant and progressive impairment

Question 17

What are good prognostic indicators in schizophrenia?

Answer 17

1. Older age of onset
2. Female
3. Marked mood disturbance especially elation
4. Family history of mood disorder

Question 18

What is the suicide rate of schizophrenia?

Answer 18

10 - 15%

Question 19

What are the general characteristics of atypical antipsychotics?

Answer 19

1. Less likely to induce extrapyramidal side effects
2. High 5 HT2A to D2 ratio
3. Better efficacy against negative symptoms
4. Effective in patients that are unresponsive to typical drugs

Question 20

Give some examples of atypical antipsychotics.

Answer 20

olanazpine, risperidone, quetiapine, clozapine, aripiprazole, amisulpride

Question 21

What does the histamine blockade cause in atypical antipsychotics?

Answer 21

Sedation

Increased appetitie