Schizophrenia and Psychotic Disorders

Question 1

Describe psychosis

Answer 1

Severe forms of mental illness
Represents an inability to distinguish between symptoms of delusion, hallucinations and disordered thinking from reality

Question 2

Describe hallucinations

Answer 2

Have the full force and clarity of true perception
Located in external space and no external stimulus
Not willed or controlled
5 special senses

Question 3

Describe delusional beliefs

Answer 3

Unshakeable idea or belief which is out of keeping with the person’s social and cultural background
Ex. grandiose, paranoid, hypochondriacal and self referential

Question 4

What illness may experience psychotic symptoms?

Answer 4

Schizophrenia
Delirium
Severe affective disorder - depressive or manic episodes with psychotic symptoms

Question 5

Describe schizophrenia

Answer 5

Severe mental illness affecting thinking, emotion and behaviour
Most common cause of psychosis

Question 6

What is the epidemiology for schizophrenia?

Answer 6

Affects 1 per 100 population
Males and females equally
Age of onset is 15-35 years - earlier in men

Question 7

What are the symptoms of schizophrenia?

Answer 7

Positive - Hallucinations, delusions and disordered thinking
Negative - Apathy, lack of interest and lack of emotions

Question 8

What is the criteria for schizophrenia in ICD-10?

Answer 8

At least one of - alienation of thought, passivity delusions, hallucinations and persistent delusions
Or at least 2 of - persistent hallucinations, breaks in train of thought, catatonic behaviour and negative symptoms

Question 9

What is the aetiology of psychosis?

Answer 9

Biological, psychological, social and evolutionary factors

Question 10

What are some biological factors for schizophrenia?

Answer 10

Genetics, neurochemistry, obstetric complications, maternal influenza, maturation and famine, winter birth and substance misuse

Question 11

Describe neurochemistry as a biological factor for schizophrenia

Answer 11

Dopamine hypothesis
Glutamate, GABA, noradrenaline and serotoninergic transmission

Question 12

What are some neurological abnormalities which are a factor for schizophrenia?

Answer 12

Reduced brain volume (3%), ventricular abnormalities, cytoarchitectural abnormalities, reduced frontal lobe performance, eye tracking, soft neurological signs and EEG abnormalities

Question 13

What are some social and pyschosocial factors for schizophrenia?

Answer 13

Occupation and social class
Migration
Social isolation
Life events

Question 14

What are the symptoms for delirium or acute organic brain syndrome?

Answer 14

Consequent upon brain or systemic disease
Prominent visual experience, hallucinations and illusions
Affect of terror
Delusions are precursory
Fluctuating and worse at night

Question 15

What are the symptoms for depressive episode with psychotic symptoms?

Answer 15

Delusions of guilt, worthlessness and persecution
Derogatory auditory hallucination

Question 16

What are the symptoms for manic episodes with psychotic symptoms?

Answer 16

Delusions of grandeur - special powers and messianic roles
Gross overactivity, irritability and behavioural disturbance

Question 17

Describe schizoaffective disorder

Answer 17

Mix of affective (depressive, manic or mixed) and schizophrenia features which occur at the same time
All criteria met
Mood disturbance may be present
Lasts at least a month

Question 18

What are some psychological therapies used in schizophrenia?

Answer 18

CBT
Cognitive remediation
Family intervention
Social skills training

Question 19

What is the prognosis and recovery for schizophrenia?

Answer 19

80% recovery after first episode of psychosis
50% have a moderate recovery
Early intervention

Question 20

What are good prognostic factors for schizophrenia?

Answer 20

Absence of family history
Good premorbid function
Clear precipitant
Acute onset
Mood disturbance
Prompt treatment
Maintenance of initiative

Question 21

What are poor prognostic factors for schizophrenia?

Answer 21

Slow, insidious onset and prominent negative symptoms
Shorter life expectancy is linked to CVD, resp. disease and cancer
Suicide risk is 9 times higher

Question 22

How are schizophrenic patients functioning at 10 years?

Answer 22

65% had no psychotic symptoms at 10 years
46% had none for more than 2 years

Question 23

Describe cognition and schizophrenia

Answer 23

Chronic schizophrenic patients show poorer cognition than first onset patients
There is no decline in cognition in follow up studies of first onset