Schizophrenia and Psychotic Disorders

Question 1

How is psychosis characterised?

Answer 1

By the presence of delusions, hallucinations and/or disordered thinking plus a lack of insight

Question 2

What are the characteristics of hallucinations?

Answer 2

Have full force and clarity of true perception
Located in external space
No external stimulus
Not willed or controlled
Can be auditory, visual, gustatory, olfactory or tactile

Question 3

How is a delusion characterised?

Answer 3

A delusion is an unshakeable idea or belief which is out of keeping with the person’s social and cultural background; it is held with extraordinary conviction

Question 4

What are some common types of delusion?

Answer 4

Grandiose
Paranoid/persecutory
Hypochondriacal
Self-referential

Question 5

What are the common causes of psychosis?

Answer 5

Schizophrenia (most common cause)
Delirium
Severe affective disorder
Organic causes such as delirium or brain tumour (should be ruled out before schizophrenia considered)

Question 6

What age is the peak onset of schizophrenia?

Answer 6

15-35

Question 7

What are the positive symptoms of schizophrenia?

Answer 7

Hallucinations
Delusions
Disordered thinking

Question 8

What are the negative symptoms of schizophrenia?

Answer 8

Apathy
Lack of interest
Lack of emotions

Question 9

When is schizophrenia diagnosed?

Answer 9

Schizophrenia can be diagnosed if symptoms are present for more than a month in the absence of organic or affective disorder. Symptoms are as follows:
At least one of the following:
•	Alienation of thought 
•	Delusional perception
•	Hallucinatory voices 
•	Persistent delusions of other kinds 
And/or at least two of the following:
•	Persistent hallucinations 
•	Thought disorder
•	Catatonic behaviour
•	"Negative" symptoms such as marked apathy, paucity of speech, and blunting or incongruity of emotional responses.

Question 10

What are the genetic causes of schizophrenia?

Answer 10

Neuregulin and dysbindin proteins

Di George’s syndrome

Question 11

What biological factors are associated with schizophrenia?

Answer 11

Obstetric complications
Maternal influenza
Malnutrition and famine
Winter birth
Substance misuse

Question 12

What are the main theories explaining the aetiology of psychosis?

Answer 12

Jung’s concept of collective unconscious

Conrad (1958) used the concepts of Gestalt Psychology to identify stages in the development of delusions

Question 13

What social/psychosocial factors cause psychosis?

Answer 13

Occupation
Social class
Migration
Social isolation
Life events as precipitants

Question 14

What factors indicate an organic cause of psychosis?

Answer 14

Consequent upon brain or systemic disease
Prominent visual experience, hallucinations and illusions
Affect of terror
Delusions are persecutory and evanescent
Fluctuating, worse at night

Question 15

What psychotic symptoms will be present with a depressive episode with associated psychosis?

Answer 15

Delusions of guilt, worthlessness and persecution

Derogatory auditory hallucinations

Question 16

What psychotic symptoms will be present with a manic episode with associated psychosis?

Answer 16

Delusions of grandeur; special powers or messianic roles

Gross overactivity, irritability and behavioural disturbance: Manic excitement

Question 17

How is schizoaffective disorder characterised?

Answer 17

Involves schizophrenic and effective symptoms occurring and regressing at the same time

Question 18

What psychological therapy can be given in psychosis?

Answer 18

Cognitive behavioural therapy
Cognitive remediation
Family intervention
Social skills training

Question 19

What is the prognosis following a psychotic episode?

Answer 19

80% of patients experience a full recovery following their first episode of psychosis, with 50% of the remaining having a moderate recovery.

Question 20

What are the good prognostic factors in a psychotic episode?

Answer 20

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

Question 21

What are the poor prognostic factors in a psychotic episode?

Answer 21

Slow, insidious onset and prominent negative symptoms are associated with a worse outcome.
36% of patients have a substance misuse problem and there are high rates of cigarette smoking.
Poorer if starts in childhood

Question 22

What is the prognosis for someone with a psychotic episode with poor prognostic factors?

Answer 22

Mortality is 1.6 times higher than the general population.
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