Schizophrenia and psychosis

Question 1

Define psychosis

Answer 1

Psychosis represents an inability to distinguish between symptoms of delusion, hallucination and disordered thinking from reality - ie there is no insight

Question 2

The 3 key symptoms in psychosis are hallucinations, delusions and disordered thinking.

What are hallucinations?

Answer 2

Sensations that have the full force and clarity of true perception - but are created in the mind

They are not willed or controlled by the patient

They can be in all 5 senses - but visual and auditory are the most common

Question 3

The 3 key symptoms in psychosis are hallucinations, delusions and disordered thought

What are delusions?

Give common examples

Answer 3

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

Examples:

• persecutory (aka paranoid)
• grandiose
• hypochondriacal
• self-referential

Question 4

How does psychosis relate to schizophrenia?

Answer 4

Schizophrenia is the most common cause of psychosis

Psychosis is more just a cluster of symptoms seen in certain psychiatric conditions:

• schizophrenia
• delirium
• psychotic depression
• manic episode with psychotic symptoms
• schizoaffective disorder

Question 5

For the epidemiology of schizophrenia:

a) what gender is it more common in?
b) typical age of onset?

Answer 5

a) affects males:females equally
b) 15-35 years - but male onset is typically earlier than female onset

Question 6

What are the symptoms of schizophrenia?

Answer 6

Positive symptoms:

• Psychosis:
  
  • hallucinations
  • delusions
  • disordered thinking

Negative symptoms:

• apathy
• lack of interest
• lack of emotions

Question 7

In order for schizophrenia to be diagnosed, what symptoms/features must a patient have?

(ICD-10 diagnostic criteria)

Answer 7

For more than a month - in the absence of organic or affective disorder…

At least 1 of the following:

• alienation of thought
• delusions of control, influence or passivity
• hallucinatory voices
• persistent delusions

Or at least 2 of the following:

• persistent hallucinations
• neologisms, breaks or interpolations in the train of thought
• catatonic behaviour
• negative symptoms - eg apathy, anhedonia etc

Question 8

Heres the first slide of ICD-10 diagnostic criteria for schizophrenia

Answer 8

Heres the second slide

Question 9

What are the subdivisions of schizophrenia?

Dont need to worry about these too much

Answer 9

Paranoid schizophrenia (mc)

Hebephrenic schizophrenia

Catatonic schizophrenia

Undifferentiated schizophrenia

Residual schizophrenia

Simple schizophrenia

(+ Other & unspecified schizophrenias)

Question 10

What genes are implicated in the development of schizophrenia?

Answer 10

Acknowledged heritability from twin/family studies

Neuregulin (chr. 8p)

Dysbindin (chr. 6p)

Di George syndrome (chr. 22q11 deletion syndrome)

Question 11

There are numerous neurological factors that may be involved in schizophrenia.

What is the relevance of dopamine?

Answer 11

Revised dopamine hypothesis

mesolimbic hyperdopaminergia (causes +ve symptoms)

mesocortical hypodopaminergia (causes -ve symptoms)

these abnormalities are associated with schizophrenia - antipsychotics used to treat the positive symptoms are often dopamine blockers

Question 12

What are the differentials for schizophrenia?

Answer 12

Delirium

Acute organic brain syndrome

Psychotic depressive episode

Manic episode with psychotic symptoms

Schizoaffective disorder

Question 13

How good is the prognosis and recovery in schizophrenia?

Answer 13

80% for ‘recovery’ after first episode - provided there is early intervention

Question 14

What are good prognostic factors for schizophrenia?

Answer 14

Absence of family history

Good premorbid function - stable personality, stable relationships

Clear precipitant

Acute onset

Mood disturbance

Prompt treatment

Maintenance of initiative, motivation

Question 15

What are poor prognostic factors for schizophrenia?

Answer 15

Slow, insidious onset and prominent negative symptoms are associated with a worse outcome.

Mortality is 1.6 times higher than the general population.

Shorter life expectancy is linked to cardiovascular disease, respiratory disease and cancer.

Suicide risk is 9 times higher.

Death from violent incidents is twice as high.

36% of patients have a substance misuse problem and there are high rates of cigarette smoking.

Poorer if starts in childhood