Schizophrenia and psychotic disorders

Question 1

How is psychosis defined?

Answer 1

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

Question 2

What is the eymology of psychosis?

Answer 2

Disease of the psyche

Question 3

What is a hallucination?

Answer 3

Located in the external space without an external stimulus with the full force and clarity of real perception - can be all 5 senses

Question 4

What is a delusional belief?

Answer 4

Unshakable idea or belief which is out of keeping with the person’s social and cultural background - held with extreme conviction

Question 5

What are the 4 types of delusion?

Answer 5

Grandiose
Paranoid
Hypochondrial
Self referential

Question 6

What illnesses have psychotic symptoms?

Answer 6

Schizophrenia
Delirium
Severe affective disorders

Question 7

What are effects of schizophrenia?

Answer 7

Severe metal illness affecting thinking, emotion, and behaviour and is the most common cause of psychosis

Question 8

What are symptoms positively prognostic of schizophrenia?

Answer 8

Hallucinations
Delusions
Disordered thinking

Question 9

What are symptoms negatively prognostic of schizophrenia?

Answer 9

Apathy
Lack of interest
Lack of emotion

Question 10

How is schizophrenia diagnosed?

Answer 10

For more than a month in the absence of organic or affective disorder, at least one of the following -
Alienation of thoughts as echo, thought insertion or withdrawal, or thought broadcasting
Delusions of control, influence, or passivity,
Hallucinatory voices giving a running commentary on the patient’s behaviour or speaking between themselves
Persistent delusions that are culturally inappropriate or impossible
And OR at least 2 of -
Persistent hallucinations in any modality
Breaks in the train of thought
Catatonic behaviours

Question 11

What are the 3 factors required for psychosis?

Answer 11

Possible predisposing factor
Precipitating factor
Perpetuating factor

Question 12

What are different areas that could cause psychosis?

Answer 12

Biological factors
Psychiatric factors
Social factors

Question 13

What are biological factors for Psychosis?

Answer 13

Genetics
Neurochemistry - Dopamine, glutamate, GABA, serotoninergic transmission
Obstetric complications
Maternal influenza
Malnutrition and famine
Winter birth
Substance misuse

Question 14

What are Conrad’s 4 stages in development of delusions?

Answer 14

State of fear
Delusional idea appears
Effort to make sense of the experience by altering view of the world
Final breakdown as thought and behavioural disorders emerge

Question 15

Why is it thought that migrants are more at risk of psychosis?

Answer 15

Moving from one culture to a completely different one and trying to make sense of it

Question 16

What are social factors in developing psychosis?

Answer 16

Occupation/social class
Migration
Social isolation
Life events precipitating

Question 17

How is schizophrenia managed?

Answer 17

Earlier intervention is better
Give the right antipsychotic - clozapine works well against treatment resistant schizophrenia
CBT
Family therapy

Question 18

What are differentials for psychosis?

Answer 18

Delirium - Prominent visual experience, affect of terror, Delusions are persecutory
Depressive episode with psychotic symptoms
Manic episode with psychotic symptoms

Question 19

How is recovery defined for schizophrenia?

Answer 19

Being able to live a meaningful and satisfying life as defined by each person, in the presence or absence of symptoms

Question 20

What are good prognostic factors for schizophrenia?

Answer 20

Absence of family history
Good premorbid function
Clear precipitating factor
Acute onset
Mood disturbance
Prompt treatment
Maintenance of motivation

Question 21

What are poor prognostic factors for schizophrenia?

Answer 21

Slow insidious onset and prominent negative symptoms
Mortality is 1.6 times higher than general population
Short life expectancy linked to resp/cvs disease
Suicide risk 9 times higher
Violent incident death twice as high
Poorer if childhood psychosis
Many substance misuse