Schizophrenia and Psychotic Disorders

Question 1

What is psychosis?

Answer 1

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

Involves a lack of insight

Question 2

What are the characteristics of hallucinations that may be suffered by a patient who is psychotic?

Answer 2

• Have the full force and clarity of true perception
• Located in external space
• No external stimulus
• Not willed or controlled
• Can affect any of the 5 senses

Question 3

Describe the characteristics of the delusions that a psychotic patient may suffer from

Answer 3

• Unshakeable ideas or belief
• Out of keeping with the persons social or cultural background
• Held with extraordinary conviction

Question 4

What are some examples of types of delusions psychotic patients may suffer from?

Answer 4

• Grandiose
• Paranoid (persecutory, “they’re all out to get me”
• Hypochodriacal (I’m sick etc.)
• Self referential (everything refers to me)

Question 5

What are the main conditions associated with psychotic symptoms?

Answer 5

Schizophrenia

Delerium

Severe affective disorders (depression / mania with psychosis)

Question 6

How prevalent is schizophrenia? When does it tend to affect people?

Answer 6

1 in 100 of population has it

Usually develops between 15-35 years of age

Affects men and women equally

Question 7

What is schizophrenia?

Answer 7

Severe mental illness affecting the way you think, your emotions and your behaviour

Question 8

What are the main symptoms of schizophrenia?

Answer 8

Hallucinations
Delusions
Disordered thinking

Apathy
Lack of interest
Lack of emotions

Question 9

What is the diagnostic criteria for schizophrenia?

Answer 9

Having one of the following for more than a month:

• Alienation of thought
• Delusions of control, influence or passivity
• Hallucinatory voices
• Persistent delusions that are culturally inapporpriate and impossible

OR having at least two of the minor diagnostic symptoms

Question 10

What is meant by “alienation of thought” that is experienced by schizophrenic patients?

Answer 10

They are experiencing:

• a thought echo
• someone inserting foreign thoughts into their mind
• someone withdrawing their thoughts from their mind
• their thoughts being broadcasted elsewhere

Question 11

What is meant by “delusions of control, influence or passivity” that is experienced by schizophrenic patients?

Answer 11

• Their body is being controlled from elsewhere
• They are feeling things that aren’t there
• They are being influenced by things that aren’t there

Question 12

What is meant by “hallucinatory voices” that are experienced by schizophrenic patients?

Answer 12

Voices are heard that:

• Give a running commentary on patients behaviour
• Discuss the patient amongst themselves
• Are speaking to them

Question 13

What are the minor diagnostic symptoms that are used to diagnose schizophrenia?

Answer 13

Persistent hallucinations in any modality

Neologisms (making up words), breaks or interpolations in train of thought

Catatonic behaviour (abnormal movements, posturing, stupor)

Negative symptoms (apathy, lack of interest, lack of emotions)

Question 14

Approximately how heritable is schizophrenia?

Answer 14

If one parent is schizo 10% risk for kid

40% if both parents

50% for monozygotic twins

10% for dizygotic twins

Question 15

What is the revised dopamine hypothesis with regards to schizophrenia?

Answer 15

Mesolimbic hyperdopaminergia - too much dopamine in mesolimbic areas causes more positive symptoms

Mesocortical hypodopaminergia - too little dopamine in mesocortical areas seems to cause more negative symptoms

*there is also involvement of glutamate, GABA, noradrenaline and serotoninergic transmission

Question 16

What are some neurological abnormalities that can be seen in schizophrenic patients?

Answer 16

Reduced brain volume of around 3%
Ventricular enlargement of around 25%
Cytoarchitectural abnormalities 
Reduced Frontal lobe performance 
Eye tracking abnormalities 
Soft neurological signs 
EEG abnormalities

Question 17

What are some other factors that may precipitate schizophrenia?

Answer 17

Obstetric complications 
Maternal influenza
Malnutrition and famine 
Winter birth 
Substance misuse

Question 18

What are some social factors that may act as precipitants of schizophrenia?

Answer 18

Occupation and social class

Migration (higher proportion in migrant populations)

Social isolation

Significant life events

Question 19

What does it mean when a psychotic episode occurs with an affective disorder

Answer 19

That the affective disorder is instantly described as severe

Question 20

How does the type of affective episode experienced alongside psychosis tend to influence the nature of the psychosis?

Answer 20

Depressive episode - generally causes delusions of guilt, wothlessness and hopelessness. Often derogatory auditory hallucinations

Manic episode - delusions of grandeur or messianic roles. Person may become grossly overactive

Question 21

What is schizoaffective disorder?

Answer 21

Mixture of schizophrenic and affective features

schizo + depression / mania

Question 22

How is schizophrenia treated?

Answer 22

Antipsychotic

Cognitive behavioural therapy

Psycho education and support

Clozapine if treatment resistant (no result after 2+ antipsychotics)

Question 23

Do people tend to recover from schizophrenia?

Answer 23

20% never have a second episode

50% relapsing remitting symptoms

30% ongoing symptoms

Question 24

What are some factors that indicate good prognosis in the treatment of schizophrenic patients?

Answer 24

Absence of family history 
Good premorbid function (personality / relationships)
Clear precipitant 
Acute onset 
Prompt treatment 
Maintenance of initiative / motivation

Question 25

What are some factors that indicate poor prognosis in the treatment of schizophrenic patients?

Answer 25

Slow, insidious onset of symptoms

Substance misuse

Onset in childhood

Question 26

Is cognition affected by schizophrenia?

Answer 26

Chronic schizophrenia seems to reduce congition but the research isn’t definite

Question 27

What are the “first rank” symptoms of schizophrenia? (according to the CBL exercise)

Answer 27

A - auditory hallucinations

B - Broadcasting of thoughts

C - Controlled thoughts (delusions of control)

D - Delusional perception