Schizophrenia and Psychotic Disorders

Question 1

Define the term psychosis

Answer 1

Represents the inability to distinguish between symptoms of delusion, hallucination and disordered thinking from reality

Question 2

What is the clinical presentation of psychosis?

Answer 2

Hallucinations

5 special senses (auditory, visual, tactile, olfactory and gustatory)

Question 3

Define delusion

Answer 3

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

Question 4

What are some examples of delusions?

Answer 4

Grandiose
Paranoid (correctly persecutory)
Hypochondriacal
Self-referential

Question 5

What is schizophrenia?

Answer 5

A severe mental illness affecting thinking, emotion, behaviour

Question 6

What are the positive symptoms of schizophrenia?

Answer 6

Hallucinations
Delusions
Disordered thinking

Question 7

What are the negative symptoms of schizophrenia?

Answer 7

Apathy
Lack of interest
Lack of emotions

Question 8

What is the criteria for diagnosis for schizophrenia?

Answer 8

For more then a month in absence of organic or affective disorder
Alienation of thought as thought echo, thought insertion or withdrawal, or thought broadcasting.
Delusions of control, influence or passivity, clearly referred to body or limb movements actions, or sensations; delusional perception.
Hallucinatory voices giving a running commentary on the patient’s behaviour, or discussing him between themselves, or other types of hallucinatory voices coming from some part of the body.
Persistent delusions of other kinds that are culturally inappropriate and completely impossible (e.g. beingable to control the weather).

Question 9

What are the different types of schizophrenia?

Answer 9

Paranoid schizophrenia 
Hebephrenic schizophrenia 
Catatonic schizophrenia 
Undifferentiated schizophrenia 
Post-schizophrenic depression 
Residual schizophrenia 
Simple schizophrenia

Question 10

What are the biological factors which may impact a schizophrenic diagnosis?

Answer 10

Obstetric complications
Maternal influenza
Malnutrition and famine
Winter birth
Substance misuse
Di George Syndrome

Question 11

What are the psychological and factors which may impact a schizophrenic diagnosis?

Answer 11

Occupation and social class
Migration
Social isolation
Life events as precipitates

Question 12

What are the clinical features of acute organic brain disorder?

Answer 12

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

Question 13

What are the features of a depressive episode with psychotic symptoms?

Answer 13

Delusions of guilt, worthlessness and persecution

Derogatory auditory hallucinations

Question 14

What are the features of a manic episode with psychotic symptoms?

Answer 14

Delusions of grandeur; special powers or messianic roles

Gross overactivity, irritability and behavioural disturbance: Manic excitement

Question 15

What are good prognostic factors for schizophrenia?

Answer 15

Absence of family history
Good premorbid function - stable personality, stable relationships
Clear precipitant
Acute onset
Mood disturbance
Prompt treatment
Maintenance of initiative, motivation

Question 16

What are poor prognostic factors for schizophrenia?

Answer 16

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

Question 17

What are the management strategy for first episode psychosis?

Answer 17

Antipsychotics continued for 2 weeks

Question 18

What is the management strategy for an acute exacerbation or recurrence of psychosis?

Answer 18

Consider amisulpride, olanzapine, or risperidone

Medication should be continued for at least 4 weeks

Question 19

What is the management strategy to prevent relapse during remission?

Answer 19

Maintenance treatment with antipsychotic for a minimum of 2 years
Consider amisulpride, olanzapine, risperidone

Question 20

What is the management strategy for treatment-resistent schizophrenia?

Answer 20

Clozapine should be offered