Schizophrenia and Psychotic Disorders

Question 1

What does psychosis mean?

Answer 1

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

Question 2

What are the features of hallucinations?

Answer 2

• Have the full force and clarity of true perception
• Located in external space but with no external stimulus
• Not willed or controlled
• Can involve any of the special senses

Question 3

What is a delusion?

Answer 3

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

Question 4

Give the four examples of the types of delusion

Answer 4

• Grandiose
• Paranoid
• Hypochondriacal
• Self referential

Question 5

What are the symptoms of schizophrenia (positive vs negative)?

Answer 5

• Positive: hallucinations, delusions and disordered thinking
• Negative: apathy, lack of interest and lack of emotions

Question 6

What are the ICD 10 criteria for schizophrenia?

Answer 6

• Symptoms for more than one month in the absence of organic or affective disorder
• At least one of: alienation of thought, delusions of thought, influence or passivity, hallucinatory voices and persistent delusions
• And/or at least two of the following: persistent hallucinations, breaks or interpolations in the train of thought, catatonic behaviour and negative symptoms (marked apathy, paucity of speech and blunting/incongruity of emotional response)

Question 7

What are the potential causes of schizophrenia?

Answer 7

• Genetics
• Neurochemistry: dopamine hypothesis, glutamate, GABA and serotonergic transmission
• Obstetric complications
• Maternal influenza
• Malnutrition and famine
• Winter birth
• Substance misuse
• Social: occupation, social class, migration, social isolation and life events

Question 8

What are the differential diagnosis for schizophrenia?

Answer 8

• Delirium/acute organic brain syndrome
• Depressive episode with psychotic symptoms
• Manic episode with psychotic symptoms

Question 9

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

Answer 9

• Delusions of guilt, worthlessness and persecution

- Derogatory auditory hallucinations

Question 10

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

Answer 10

• Delusions of grandeur, special powers or messianic roles

- Gross overactivity, irritabilty and behavioural disturbance: manic excitement

Question 11

What is schizoaffective disorder?

Answer 11

Mix of affective and schizophrenia like features

Question 12

What are the non-pharmacological options for managing schizophrenia?

Answer 12

• Cognitive behavioural therapy
• Cognitive remediation
• Family therapy
• Social skills training

Question 13

List the good prognostic factors for schizophrenia

Answer 13

• Absence of FH
• Good premorbid function: stable personality and relationships
• Clear precipitant
• Acute onset
• Mood disturbance
• Prompt treatment
• Maintenance of initiative and motivation

Question 14

List the poor prognostic factors for schizophrenia

Answer 14

• Slow, insidioous onset and prominent negative symptoms

- Poorer if starts in childhood

Question 15

What effect does schizophrenia have on a patients health?

Answer 15

• Mortality is 1.6 times higher
• Shorter life expectancy: CVS disease, resp disease and cancer
• Suicide risk x9 higher
• 36% of patients have a substance misuse problem