schizophrenia and psychotic disorders

Question 1

psychosis

Answer 1

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

Question 2

clinical presentation of psychosis

Answer 2

hallucinations

delusional beliefs

Question 3

hallucinations

Answer 3

have full force and clarity of true perception
no external stimulus, not willed or controlled

5 special senses: auditory or visual, tactile, olfactory and gustatory

Question 4

delusional beliefs

Answer 4

unshakable idea or belief which is out of keeping with the person’s social and cultural background: it is held with extraordrinary conviction

ex. paranoid, hypochondriacal, self referential, grandiosity

Question 5

which illnesses may have psychotic symptoms

Answer 5

schizophrenia
delirium
severe affective disorder

Question 6

schizophrenia

Answer 6

a severe mental illness affecting thinking, emotion, behaviour

Question 7

schizophrenia: positive symptoms

Answer 7

hallucinations
delusions
disordered thinking

Question 8

schizophrenia: negative symptoms

Answer 8

apathy
lack of interest
lack of emotions

Question 9

schizophrenia: ICD 10

for more that a month in the absence of organic or affective disorder:
at least one of the following

Answer 9

auditory hallucinations
thought disorder
delusions control - passivity
delusional perceptions

Question 10

schizophrenia: ICD 10

or at least 2 of the following

Answer 10

e. persistent hallucinations of any modality, when occurig every day for 1month+
f. neologisms, breaks or interpolations in the train of throught
g. catatonic behaviour
h. negative symptoms

Question 11

schizophrenia: biological factors - genetics

Answer 11

genetics - high heritability

• neuregulin (chromosome 8p)
• dysbindin (chromosome 6p)
• Di George Syndrome

Question 12

schizophrenia: biological factors - neurochemistry

Answer 12

dopamine hypothesis
revised dopamine hypothesis 
glutamate
GABA
noradrenaline 
serotonin

Question 13

schizophrenia: neurological abnormalities

Answer 13

reduce brain volume 3% 
ventricular enlargement 25% (but overlap with normal) 
cytoarchitectural abnormalities
reduced frontal lobe performance 
eye tracking abnormalities
soft neurological signs 
EEG abnormalities

Question 14

other biological factors implicated in schizophrenia

Answer 14

obstetric complications 
maternal influenza
malnutrition and famine 
winter birth 
substance misuse

Question 15

schizophrenia: social and psychosocial factors

Answer 15

occupation and social class (but be aware of ‘drift hypothesis’)
migration
social isolation
life events as precipitants

Question 16

delirium or acute organic brain syndrome

Answer 16

consequent upon brain or systemic disease
prominent visual experience, hallucinations + illusions
affect of terror
delusions are persecutory and evanescent
fluctuating, worse at night

Question 17

affective psychoses

Answer 17

depressive episode with psychotic symptoms

manic episode with psychotic syndromes

Question 18

schizoaffective disorder

Answer 18

mix of affective and schizophrenia like features at the same time

Question 19

management of schizophrenia

Answer 19

psychological therapies: CBT

anti-psychotic drugs

Question 20

prognosis and recovery in schizophrenia

Answer 20

recovery is not simply reduction/cessation of symptoms
being able to live a meaningful and satisfying life as defined by each person

80% recover after 1st episode

Question 21

schizophrenia: good prognostic factors

Answer 21

absence of family history 
good premorbid function: stable personality + relationships 
clear precipitant
acute onset
mood disturbance
prompt treatment 
maintenance of initiative, motivation

Question 22

schizophrenia: poor prognostic factors

Answer 22

slow, insidious onset and prominent -ive symptoms

earlier illness starts

Question 23

what about cognition in schizophrenia

Answer 23

chronic schizophrenic patients show poorer cognition than first onset patients

no decline in cognition in follow-up studies of first onset psychosis

Question 24

dopamine hypothesis

Answer 24

too much dopamine in brsin causes symptoms

Question 25

revised dopamine hypothesis

Answer 25

too much dopamine in mesolimbic pathways leads to positive symptoms
too little dopamine in mesocortical pathway leads to negative symptoms

Question 26

hebephrenic schizophrenia

Answer 26

disorganised

Question 27

catatonic szhizophrenia

Answer 27

unusual sudden movements

Question 28

simple schizophrenia

Answer 28

mostly negative symptoms

Question 29

paranoid schizophrenia

Answer 29

mostly positive symptoms