Schizophrenia and Psychotic Disorders

Question 1

what is psychosis?

Answer 1

inability to distinguish symptoms of delusion, hallucination and disordered thinking form reality

Question 2

how may psychosis present?

Answer 2

> hallucinations

> delusional belief

Question 3

describe hallucinations seen in psychosis

Answer 3

> full clarity of true perception
> no external stimulus
> located in the external space
> not willed or controlled
> tactile/visual/auditory/gustatory/olfactory

Question 4

what is a delusional belief?

Answer 4

unshakable idea/belief out of keeping with a persons social and cultural background held with extraordinary conviction

Question 5

what are the symptoms of schizophrenia?

Answer 5

positive
> hallucinations
> delusions
> disordered thinking

negative
> apathy
> lack of emotion
> lack of interest

Question 6

what is the ICD-10 classification of schizophrenia?

Answer 6

one for 1 month with absence of organic or affective disorder
> persistent delusion
> delusion of control/influence/passivity (clearly referred to limb and body movement
> alienation of thought
> hallucinatory voices

or at least 2 of the following for 1 month
> negative symptoms
> catatonic behaviour
> persistent hallucination in any modality occurring every day for a month
> neologisms breaks or interpolations in train of though

Question 7

what different thought alienation may occur in schizophrenia?

Answer 7

> echo
insertion
withdrawal
broadcasting

Question 8

what different types of hallucinatory voices can occur in schizophrenia?

Answer 8

> from body part
talking about them
running commentary

Question 9

what negative symptoms can be seen in schizophrenia?

Answer 9

> blunting
paucity of speech
marked apathy

Question 10

describe catatonic behaviour seen in schizophrenia

Answer 10

> mutism
> wavy flexibility
> posturing
> excitement
> stupor

Question 11

what psychological factors are associated with schizophrenia?

Answer 11

> social isolation (chicken and egg)

> migrant

Question 12

what biological factors are associated with schizophrenia?

Answer 12

> genetic
> neurochemistry (serotininergic transmission)
> maternal influenza
> obstetric complications
> malnutrition
> substance misuse

Question 13

what is the differential diagnosis for psychosis?

Answer 13

> delirium
> schizophrenia
> manic episode
> depressive episode
> (dementia)

Question 14

what presentation might point to delirium as the cause of psychosis?

Answer 14

> persecutory delusions
> fluctuating (worse at night)
> affect of terror
> visual experience
> acute

Question 15

what are the management options?

Answer 15

> psychological therapies (CBT and family intervention)
antipsychotics
clozapine if resistant

Question 16

what monitoring is put in place if clozapine is commenced?

Answer 16

full blood monitoring regularly for neutropenia

Question 17

what are bad prognostic factors?

Answer 17

> starting in childhood
substance misuse
slow insidious onset and prominent negative symptoms

Question 18

what are good prognostic factors?

Answer 18

> absence of family history
> good premorbid function
> acute onset
> clear precipitant
> mood disturbance
> prompt treatment
> maintenance of motivation

Question 19

how much higher is the mortality rate for people with schizophrenia?

Answer 19

1.6 times higher

Question 20

how much more likely are people with schizophrenia likely to commit suicide?

Answer 20

9 times

Question 21

what is recovery from schizophrenia?

Answer 21

being able to live a full and meaningful and satisfying life defined by each person in the presence or absence of symptoms