Schizophrenia and Psychotic Disorders

Question 1

What is psychosis?

Answer 1

Psychosis represents an inability to distinguish between symptoms of hallucination, delusion and disordered thinking from reality

Question 2

Presentation of psychosis

Answer 2

Hallucinations
Delusions
Confused and disturbed thoughts

Question 3

What are hallucinations?

Answer 3

Where someone sees, hears, smells, tastes or feels things that do not exist outside their mind

Question 4

What are delusions?

Answer 4

Where a person has an unshakeable belief in something untrue

Question 5

What are persucatory delusions?

Answer 5

Where the person may believe an individual or organisation is making plans to hurt or kill them

Question 6

What are grandiose delusions?

Answer 6

Where the person may believe they have power or authority

For example, they may think they’re the president of a country or they have the power to bring people back from the dead

Question 7

What are psychotic episodes?

Answer 7

Often unaware that their delusions or hallucinations are not real, which may lead them to feel frightened or distressed

Question 8

What are signs of confused and disturbed thoughts?

Answer 8

Rapid and constant speech
Disturbed speech
A sudden loss in their train of thought, resulting in an abrupt pause in conversation or activity

Question 9

What is puerperal psychosis?

Answer 9

Postnatal psychosis, severe form of postnatal depression

Question 10

Illnesses with psychotic symptoms

Answer 10

Schizophrenia
Delirium
Severe affective disorder

Question 11

What is the most common cause of psychosis?

Answer 11

Schizophrenia

Question 12

Positive symptoms of schizophrenia

Answer 12

Hallucinations
Delusions
Disordered thinking

Question 13

Negative symptoms of schizophrenia

Answer 13

Apathy
Lack of interest
Lack of emotions

Question 14

How is schizophrenia diagnosed?

Answer 14

For more than a month in the absence of organic or affective disorder
At least one of the following:
- 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. being able to control the weather)
- Persistent hallucinations in any modality, when occurring every day for at least one month
- Neologisms, breaks or interpolations in the train of thought, resulting in incoherence or irrelevant speech
- Catatonic behaviour, such as excitement, posturing or waxy flexibility, negativism, mutism and stupor
- “Negative” symptoms such as marked apathy, paucity of speech, and blunting or incongruity of emotional responses

Question 15

What are the types of schizophrenia?

Answer 15

Paranoid schizophrenia
Hebephrenic schizophrenia
Catatonic schizophrenia
Undifferentiated schizophrenia
Post schizophrenic depression
Residual schizophrenia
Simple schizophrenia
Other schizophrenia
Unspecified schizophrenia

Question 16

What are the types of auditory hallucination?

Answer 16

Hearing their thoughts being repeated aloud

3rd person auditory hallucinations- a running commentary on their actions, or voices arguing about them

Question 17

What are some delusions about thought alienation?

Answer 17

Thought withdrawal
Thought insertion
Thought broadcasting

Question 18

What is thought withdrawal?

Answer 18

Their thoughts are being taken from their head by some external force or person

Question 19

What is thought insertion?

Answer 19

That thoughts are being inserted into their heads by some external force or person

Question 20

What is thought croadcasting?

Answer 20

That their thoughts are being read and broadcast to others

Question 21

What are passivity phenomena?

Answer 21

Delusions that their thoughts, feelings, or impulses are driven by some external force or person

Question 22

What is somatic passivity?

Answer 22

A delusion that some external force is causing physical sensations (which may be hallucinations) in their body

Question 23

What is delusional perception?

Answer 23

A delusion which arises because of a completely unrelated happening in external reality e.g. “Three letters, which is the number of the Holy Trinity, came through my letter box, and then I realized I was the son of God”

Question 24

Non psychotic symptoms of schizophrenia

Answer 24

Mood disturbance

Unusual behaviour

Question 25

Differential diagnosis in apsychotic patient

Answer 25

Psychotic mania or depression Delirium Drug induced psychosis or intoxication Medication e.g. steroids Cerebral causes e.g. tumour, infection, infarction, epilepsy Endocrine disease e.g. thyroid, chronic hypoglycaemia, Cushing's, Addison's Systemic illness such as anaemia, carcinoma, or sarcoid

Question 26

Acute stage treatment of schizophrenia

Answer 26

Antipsychotic medication | Sedatives

Question 27

Long term treatment of schizophrenia

Answer 27

Antipsychotic medication Support in the community e.g. housing, employment, support worker Rehabilitation in dedicated facilities

Question 28

Scheider's first rank symptoms of schizophrenia

Answer 28

A - Auditory Hallucinations B - Broadcasting of Thought C - Controlled Thought (delusions of control) D - Delusional Perception

Question 29

What is shown on a brain scan in someone with schizophrenia?

Answer 29

Enlarged ventricles

Question 30

Which neurotransmitter is most implicated in schizophrenia?

Answer 30

Dopamine

Question 31

What are the extrapyramidal side effects associated with typical antipsychotics?

Answer 31

Parkinisonism | Acute dystonias

Question 32

What increases the chance of relapse of schizophrenia?

Answer 32

Non compliance to treatment Misuse of illicit substances High expressed emotion at home Major life events

Question 33

What are the side effects of clozapine?

Answer 33

``` Neutropenia Seizures Idiopathic hyperthermia Weight gain Hypersalivation ```

Question 34

How can schizophrenia cause diabetes?

Answer 34

Associated with stress, and an increase of cortisol, which may increase the risk of diabetes Antipsychotics (especially clozapine/olanzapine) cause weight gain/insulin resistance

Question 35

Which antipsychotics can cause hyperprolactinaemia?

Answer 35

Amisulpride Risperidone Typical Antipsychotics

Question 36

What is caused by hyperprolactinaemia?

Answer 36

``` Galactorrhea Menstrual irregularities Sexual dysfunction Osteoporosis Increased risk breast cancer ```

Question 37

Good prognostic factors in schizophrenia

Answer 37

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

Question 38

Poor prognostic factors in schizophrenia

Answer 38

Slow, insidious onset and prominent negative symptoms are associated with a worse outcome 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 Poorer if starts in childhood

Question 39

Which antipsychotics are more likely to cause tardive dyskinesia?

Answer 39

Typical antipsychotics

Question 40

Which antipsychotics are more likely to cause weight gain and diabetes?

Answer 40

Typical psychotics

Question 41

Third generation antipsychotics

Answer 41

Aripiprazole

Question 42

What are the cardiac effects of antipsychotics?

Answer 42

QTc elongation

Question 43

Positive symptoms of schizophrenia

Answer 43

Hallucinations Delusions Disordered thinking

Question 44

Negative symptoms of schizophrenia

Answer 44

Apathy Lack of interest Lack of emotions

Question 45

Acute presentation of schizophrenia treatment

Answer 45

IV lorazepam