Schizophrenia and Psychotic Disorders

Question 1

Pychosis?

Answer 1

Lack of insight.

Inability to distinguish between symptoms of delusion, hallucination and disordered thinking from reality

->seen in the most severe forms of mental illness

Question 2

What are hallucinations?

Answer 2

Involved in the five senses e.g. seeing things, hearing things, smelling things

Have the full force and clarity of true perception but there are no external stimuli

Question 3

What is meant by a delusion?

Answer 3

An unshakeable idea or belief which is out of keeping of a person’s social or cultural background.

It is held with extraordinary conviction and the patient cannot be convinced otherwise.

Question 4

What are some of the categories of delusion?

Answer 4

Grandiose
Paranoia
Hypochondrial
Self referential

Question 5

Grandiose?

Answer 5

The patient believing they are the best at something e.g. cleverest, most attractive, etc.

Question 6

Paranoia delusions?

Answer 6

Idea that someone is out to get you or is against you in some way.

Question 7

Hypochondriacal?

Answer 7

Believing you are ill when you are not.

Question 8

Self refrnetial?

Answer 8

Believing things refer to you in some way

e.g. a stabbing in London happened because you went to work this morning

Question 9

Which illnesses have psychotic symptoms?

Answer 9

Schizophrenia
Delirium
Severe affective disorder e.g. depressive episode with psychotic symptoms or manic episode with psychotic symptoms

Question 10

What is the most common cause of psychosis?

Answer 10

Schizophrenia

Question 11

Epidemiology for schizophrenia?

Answer 11

1 in100
Men = Women
Age of onset 15-35

Question 12

Symptoms of schizophenia?

Answer 12

Hallucinations
Delusions
Disordered thinking
Apathy
Lack of interest
Lack of emotion

->diagnosis made if at least two symptoms for at least a month.
In an exam question, if they have schizophrenia symptoms for two weeks, they CANNOT have schizophrenia

Question 13

What is meant by disordered thinking?

Answer 13

Flow of thoughts is disrupted.

May go off on tangents

Question 14

What is meant by schizo fasia or word salad?

Answer 14

Patient does not have structure of speech and cannot put more than 2 or three coherent words together to make sense.

->very hard for actors to reproduce.
If seen this, very likely patient has schizophrenia

Question 15

Catatonia?

Answer 15

Psychomotor
Two types- restless, agitated or non-moving, mute

->not just seen in schizophrenia

Question 16

Which drugs make the symptoms of catatonia disappear for a short spell?

Answer 16

Benzodiazepines

Question 17

Schizoaffective disorder?

Answer 17

A patient that meets all the criteria for schizophrenia
AND
the criteria for either a depressive disorder or a manic episode
AT THE SAME TIME

Question 18

Summarise the diagnostic criteria of schizophrenia.

Answer 18

One month, in the absence of organic or affective disorder. Two of the following:

Alienation of thought- thought echoing, thought insertion, broadcasting of though

Delusions

Hallucinations

Breaks or interpolations in the train of thought, resulting in incoherence irrelevant speech

Catatonic behaviour

Apathy, blunting of emotional response

Question 19

What are some of the biological factors which can increase risks of developing schitzophrenia?

Answer 19

Genetics
Obstetric complications *
Maternal influenza
Malnutrition and famine
Winter birth
Substance misuse

-> * this is why we ask about any birth complications in personal history during psychiatric history taking

Question 20

What are some of the social and psychosocial factors that may increase risks of developing schitzophrenia?

Answer 20

Migration
Occupation and social class
Social isolation
Severe life events

Question 21

What is the main difference between delirium hallucinations and schizophrenic hallucinations?

Answer 21

In delirium, they tend to occur at night and tend to be visual hallucinations

Auditory hallucination is more common in schizophrenia

Question 22

What would be the likely symptoms of depressive episode with psychotic symptoms?

Answer 22

Delusions of guilt, worthlessness
Derogatory auditory hallucinations
Feeling although you are already dead or rotting

Question 23

What would be the likely symptoms of manic episode with psychotic symptoms?

Answer 23

Delusions of grandeur- special powers or messianic roles
Gross overactivity, irritability, behavioural disturbances, manic excitement

Question 24

Summarise treatment for schizophrenia.

Answer 24

Get family involved
Antipsychotic meds
CBT for psychosis
Family therapies potentially