Schizophrenia and Psychotic Illness

Question 1

Psychosis

Answer 1

This can be used to refer to a lack of insight. It represents an inability to distinguish between symptoms of delusion, hallucination and disordered thinking from reality

Question 2

Hallucinations

Answer 2

These have the full force and clarity of real perception. They are located in external space, but there is no external stimulus present. They can be auditory or visual, tactile (physical contact with an imaginary object), olfactory and gustatory

Question 3

Delusional Beliefs

Answer 3

An unshakeable idea or belief which is out of keeping with the persons social and cultural background; it is help with extraordinary conviction

Question 4

Grandiose Delusions

Answer 4

The delusion that one possess particular qualities that make them superior, genuis, wealth etc

Question 5

Paranoid Delusions

Answer 5

Feeling that everyone is out to get them

Question 6

Hypochondriacal delusions

Answer 6

Feeling that they are ill or suffer from a serious medical condition

Question 7

Self referential Delusions

Answer 7

Self-reference becomes paranoid delusion when one persists in believing oneself to be the target of hostile actions or insinuations, perpetrated by some enemy or band of enemies, when this is actually not the case.

Question 8

Illnesses that have psychotic symptoms

Answer 8

Schizophrenia, delirium, severe affective disorder

Question 9

Epidemiology of Schizophrenia

Answer 9

Affects 1 per 100 population
Males and females equally
Age of onset 15-35 years

Question 10

Positive symptoms of schizophrenia

Answer 10

Hallucinations
Delusions
Disordered thinking

Question 11

Negative Symptoms of Schizophrenia

Answer 11

Apathy
Lack of interest
Lack of emotions

Question 12

Diagnostic Criteria of Schizophrenia

Answer 12

For more than a month in absence of organic or affective disorder, at least one of the following:

a) Alienation of thought as thought echo, thought insertion or withdrawal, or thought broadcasting.
b) Delusions of control, influence or passivity, clearly referred to body or limb movements
actions, or sensations; delusional perception.
c) Hallucinatory voices giving a running commentary on the patient’s behaviour, or discussing him between themselves, or other types of hallucinatory voices coming from some part of the body.
d) Persistent delusions of other kinds that are culturally inappropriate and completely impossible (e.g. beingable to control the weather).

AND OR AT LEAST TWO OF THE FOLLOWING:

e) Persistent hallucinations in any modality, when occurring every day for at least one month.
f) Neologisms, breaks or interpolations in the train of thought, resulting in incoherence or irrelevant speech.
g) Catatonic behaviour, such as excitement, posturing or waxy flexibility, negativism, mutism and stupor.
h) “Negative” symptoms such as marked apathy, paucity of speech, and blunting or incongruity of emotional responses.

Question 13

Paranoid Schizophrenia

Answer 13

This is the most common in which delusions and auditory hallucinations are present

Question 14

Catatonic Schizophrenia

Answer 14

Psychomotor disturbances are prominent, often alternating between motor immobility (stupor) and excessive activity, ridgidity, posturing (maintaining strange postures), echolalia (copying speech) and echopraxia (copying behaviours may occur.

Question 15

Hebephrenic Schizophrenia

Answer 15

Behaviour is irresponsible and unpredictable. Mood inappropriate and affect incongruous, perhaps with giggling, mannerisms and pranks.

Question 16

Residual Schizophrenia

Answer 16

There is a history of one of the types of schizophrenia but in the current illness negaitve and often cognitive symptoms predominate

Question 17

Simple schizophrenia

Answer 17

Negative symptoms with out preceding overt psychotic symptoms

Question 18

Biological Factors implemented in Schizophrenia

Answer 18

Cf Acknowledged heritability from twin/family studies
Neuregulin
Dysbindin
Di George Syndrome
Obstetric complications
Maternal influenza
Malnutrition and famine
Winter birth
Substance misuse

Question 19

Jungs Concept of Collective Unconcious

Answer 19

“ a storehouse of latent memory traces from man’s ancestral past. These typical symbols of myth, fable and fairy stories are not accessible other than through altered consciousness, dreams or perhaps psychosis.”

Question 20

Conrad aetiology of psychosis

Answer 20

a state of fear
the delusional idea appears
an effort to make sense of the experience by altering one’s view of the world
final breakdown, as thought disorder and behavioural symptoms emerge

Question 21

Social and Psychosocial Factors in the development of schizophrenia

Answer 21

Occupation and social class, migration, social isolation, life events

Question 22

Delirium or Acute Organic Brain Syndrome

Answer 22

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 23

Depressive Episode with Psychotic Symptoms

Answer 23

Delusions of guilt, worthlessness and persecution

Derogatory auditory hallucinations

Question 24

Main Episode with Psychotic Symptoms

Answer 24

Delusions of grandeur; special powers or messianic roles. There will be gross overactivity, irritabiluty and behavioural disturbance.

Question 25

Prognosis after first episode of schizophrenia

Answer 25

80% recovery

Question 26

Good prognostic factors of schizophrenia

Answer 26

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

Question 27

Poor prognostic factors of schizophrenia

Answer 27

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