Schizophrenia and psychotic illness

Question 1

What is the main condition that presents with psychosis?

Answer 1

Schizophrenia

Question 2

What is psychosis?

Answer 2

The inability to distinguish:
Delusions
Hallucination
Disordered thinking

From reality.

+ lack of insight.

Question 3

What does psychosis in an illness mean?

Answer 3

The illness is at its most severe.

Question 4

What is schizophrenia?

Answer 4

A form of psychosis that can be relapsing or remitting.

Question 5

What are the risk factors for schizophrenia?

Question 6

What are the risk factors for schizophrenia?

Answer 6

Family history
Traumatic event in childhood
Chronic cannabis use
immigrant population
DiGeorge syndrome
Malnutrition
Winter birth
Substance misuse

Question 7

What are the positive symptoms of schizophrenia?

Answer 7

Delusion - outside control or reference
Hallucination 
Disorganised speech
Catatonic behaviour
Disorganised behaviour

Question 8

What are the negative symptoms of schizophrenia?

Answer 8

Lack of apathy
Lack of emotion
Avolition (lack of motivation)
Alogia (poverty of speech)
Anhedonia

Question 9

What are the types of thought disorder?

Answer 9

Insertion - thoughts coming into your head that aren’t yours
Withdrawal - thoughts being removed from you head
Broadcasting - thinking others can hear your thoughts

Question 10

Is schizophrenia more common in men or women?

Answer 10

Both the same. Males present earlier.
Males - 28yrs
Females- 32yrs.

Question 11

What are the cognitive symptoms of schizophrenia?

Answer 11

Inability to:
Understand
remember
learn

^VERY subtle.

Question 12

How do most antipsychotic medications work?

Answer 12

By blocking dopamine.

Question 13

What are the types of auditory hallucinations?

Answer 13

Echo
Command
Running commentary

Question 14

What is the 25% rule?

Answer 14

25% of people never have another episode
25% are treatment resistant
25% have some improvement with medication
25% have a big improvement on medication

Question 15

What are the main types of delusion?

Answer 15

Grandiose
Paranoid/persecutory
Hypochondrial
Self referential

Question 16

What is the ICD10 criteria?

Answer 16

At least 1 of:

• Alienation of thought (echo, insertion, withdrawal or broadcasting).
• Delusion of control or influence (someone else is controlling them)
• Auditory Hallucination
• Persistent delusion of other kinds

OR 2 of:

• Hallucination of any sense
• Breaks in train of thought (incoherent or irrelevant speech)
• catatonic behaviour
• Negative symptoms (apathy, speech, emotion).

Question 17

What are catatonic behaviours?

Answer 17

Excitement
Posturing or waxy flexibility
Negativism
Stupor.

Question 18

How long must symptoms be present for to diagnose schizophrenia?

Answer 18

At least 1 month

Question 19

What is the most common subtype of schizophrenia?

Answer 19

Paranoid schizophrenia.

Question 20

What is the most common subtype of schizophrenia?

Answer 20

Paranoid schizophrenia.

Question 21

What is a common neurological abnormality seen in schizophrenia?

Answer 21

Abnormal eye movement.

Question 22

What is schizoaffective disorder?

Answer 22

A mix of affective and schizophrenic like features.

Question 23

How long should antipsychotics be continued for after 1st episode?

Answer 23

At least 2 years.

Question 24

When are females at risk of relapse?

Answer 24

In the post partum period.

Question 25

Which medication is given if the patient is treatment resistant?

Answer 25

Clozapine

Question 26

What indicates a better prognosis?

Answer 26

Higher IQ
Sudden onset
Clear precipitating factor
Strong support network
Absent family history
Good premorbid state
Prompt treatment
POSITIVE FEATURES ARE PREDOMINANT

Question 27

What indicates a poorer prognosis?

Answer 27

Negative features predominant
Slow onset
No identifiable precipitating cause
Younger onset

Question 28

How high is the risk of suicide in schizophrenic patients?

Answer 28

9x higher than general population.