Schizophrenia and Psychotic Disorders

Question 1

What is psychosis?

Answer 1

Inability to distingish between symptoms of hallucinations, delusions and disordered thinking from reality.

Question 2

What are hallucinations?

Answer 2

• have the full force and clarity of true perception
• no external stimulus
• located in external space
• not willed or controlled
• 5 special senses; auditory, visual, tactile, olfactory, gustatory

Question 3

What are delusions?

Answer 3

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

• gradoise
• paranoid (persecutory)
• hypochondriacal
• self referential

Question 4

How common is schizophrenia and what does it affect in a person?

Answer 4

• 1/100 population
• F:M equal
• 15-35 yrs onset age
• thinking
• emotion
• behaviour

Question 5

What are the positive and negative symptoms of schizophrenia?

Answer 5

• hallucincations
• dellusions
• disordered thinking
• apathy
• lack of interest
• lack of emotions

Question 6

What is the ICD-10 definition of schizophrenia?

Answer 6

For > 1 month in the absence of organic or affective disorder;

• one of:
• alienation of thought (echo, insertion, withdrawal, broadcasting)
• delusion of control, influence or passivity
• hallucinatory voices discussing patient
• persistant delusions, culturally inapropriate and completely impossible
• or two of:
• persistant hallucinations
• neologisms, breaks or interpolations in the train of thought
• catatonic behaviour
• “negative” symptoms

Question 7

What are biological factors in the aetiology of schizophrenia?

Answer 7

• genetics
• neurochemistry
• obstetric complications
• maternal influenza
• malnutrition + famine
• winter birth
• substance misuse

Question 8

What are social and psychosocial factors in the aetiology of schizophrenia?

Answer 8

• occupation + social class
• migration
• social isolation
• life events as precipitants
• cultural factors

Question 9

What are differentials for schizophrenia?

Answer 9

• delirium/acute organic brain syndrome
• affective psychoses
• depressive episode
• manic episode
• schizoaffective disorder

Question 10

What is the management for schizophrenia?

Answer 10

• CBT
• cognitive remediation
• family intervention
• antipsychotics
• ECT

Question 11

What are factors for a good prognosis?

Answer 11

• no family history
• good premorbid function
• clear precipitant
• acute onset
• mood disturbance
• prompt treatment
• maintainance of initiative, motivation

Question 12

What are factors for a poor prognosis?

Answer 12

• slow insideous onset
• prominent negative symptoms
• substance misuse + smoking (esp. if started in childhood)