Schizophrenia: Clinical Aspects

Question 1

Neurosis vs Psychosis

• Which of these fall under neurosis, which fall under psychosis?
  
  • OCD
  • Depressive disorder
  • Anxiety disorder
  • Schizophrenia
  • Depressive psychosis
  • Somatisation disorders
  • Organic
  • Adjustment disorder
  • Bipolar disorders

Answer 1

• Neurosis
  
  • Anxiety disorder
  • Depressive disorder
  • OCD
  • Adjustment disorders
  • Somatisation disorders
• Psychosis
  
  • Organic
  • Schizophrenia
  • Bipolar disorders
  • Depressive psychosis

Question 2

….: respond to antidepressant or SSRI vs ….: respond to antipsychotic medication

Answer 2

Neurosis: respond to antidepressant or SSRI vs Psychosis: respond to antipsychotic medication

Question 3

Neurosis: respond to … or … vs Psychosis: respond to … medication

Answer 3

Neurosis: respond to antidepressant or SSRI vs Psychosis: respond to antipsychotic medication

Question 4

What is Psychosis?

• An illness characterised by a loss of boundaries with … and loss of …, with primary features of …, …. and conceptual disorganisation.
• A psychotic episode is deemed to be 1 week duration of either of these symptoms at significant severity
• Often associated with some sort of … disturbance

Answer 4

• An illness characterised by a loss of boundaries with reality and loss of insight, with primary features of delusions, hallucinations and conceptual disorganisation.
• A psychotic episode is deemed to be 1 week duration of either of these symptoms at significant severity
• Often associated with some sort of behavioural disturbance

Question 5

What is Psychosis?

• An illness characterised by a loss of boundaries with reality and loss of insight, with primary features of delusions, hallucinations and conceptual ….
• A psychotic episode is deemed to be … … duration of either of these symptoms at significant severity
• Often associated with some sort of behavioural disturbance

Answer 5

• An illness characterised by a loss of boundaries with reality and loss of insight, with primary features of delusions, hallucinations and conceptual disorganisation.
• A psychotic episode is deemed to be 1 week duration of either of these symptoms at significant severity
• Often associated with some sort of behavioural disturbance

Question 6

What is a Delusion?

• … held firmly but on … grounds, not affected by … argument or evidence to the contrary, and … shared by someone of similar age, educational, cultural, religious or social background
• Types of delusion include: primary (Delusional perception), secondary, persecutory, -of reference, grandiose, -of guild, nihilistic, -of passivity etc.

Answer 6

• Belief held firmly but on inadequate grounds, not affected by rational argument or evidence to the contrary, and not shared by someone of similar age, educational, cultural, religious or social background
• Types of delusion include: primary (Delusional perception), secondary, persecutory, -of reference, grandiose, -of guild, nihilistic, -of passivity etc.

Question 7

What is a Delusion?

• Belief held … but on inadequate grounds, not affected by rational argument or … to the contrary, and not shared by someone of similar …, educational, cultural, … or … background
• Types of delusion include: primary (Delusional perception), secondary, persecutory, -of reference, grandiose, -of guild, nihilistic, -of passivity etc.

Answer 7

• Belief held firmly but on inadequate grounds, not affected by rational argument or evidence to the contrary, and not shared by someone of similar age, educational, cultural, religious or social background
• Types of delusion include: primary (Delusional perception), secondary, persecutory, -of reference, grandiose, -of guild, nihilistic, -of passivity etc.

Question 8

Types of delusion include: … (Delusional perception), secondary, …, -of reference, …, -of guilt, nihilistic, -of passivity etc.

Answer 8

Types of delusion include: primary (Delusional perception), secondary, persecutory, -of reference, grandiose, -of guilt, nihilistic, -of passivity etc.

Question 9

Types of delusion include: primary (… perception), …, persecutory, -of reference, grandiose, -of guilt, …, -of passivity etc.

Answer 9

Types of delusion include: primary (Delusional perception), secondary, persecutory, -of reference, grandiose, -of guilt, nihilistic, -of passivity etc.

Question 10

Grandiose Delusion - what is this?

Answer 10

Grandiose - mania or related mood, may think they are put on earth for a particular purpose

Question 11

… delusions occur when someone believes others are out to harm them despite evidence to the contrary.

Answer 11

Persecutory delusions occur when someone believes others are out to harm them despite evidence to the contrary.

Question 12

What is a Nihilistic delusion?

Answer 12

A delusion that nothing exists, or that a significant aspect of the self (such as one’s brain or the outside world) does not exist - associated with very low mood/psychotic depression

Question 13

What is a Delusion of passivity?

Answer 13

feel that you are under control of something externally - making you do things

Question 14

Delusion

• ?Due to error of … of …
• Pay attention to something you see - attribute with more value than someone who is healthy
  
  • E.g. stones outside window - think stones are looking at you in strange way - if healthy, may think stones are weird but would dismiss these thoughts

Answer 14

• ?Due to error of salience of attribution
• Pay attention to something you see - attribute with more value than someone who is healthy
• E.g. stones outside window - think stones are looking at you in strange way - if healthy, may think stones are weird but would dismiss these thoughts

Question 15

Delusion

• ?Due to … of salience of attribution
• Pay attention to something you see - attribute with more … than someone who is healthy
  
  • E.g. stones outside window - think stones are looking at you in strange way - if healthy, may think stones are weird but would dismiss these thoughts

Answer 15

• ?Due to error of salience of attribution
• Pay attention to something you see - attribute with more value than someone who is healthy
• E.g. stones outside window - think stones are looking at you in strange way - if healthy, may think stones are weird but would dismiss these thoughts

Question 16

Delusion content often has particular relevance, for example:

Answer 16

• Religious - persecution by devil
• Persecution by authority figure/govt
• Controlled by implant
• Responsibility for world tragedy
• Followed by seagulls

Question 17

A Hallucination is a perception experienced in the absence of ….

Answer 17

an external stimulus

Question 18

Define Hallucination

Answer 18

A perception experienced in the absence of an external stimulus

Question 19

Hallucination

• A … experienced in the absence of an external stimulus
• In any sensory modality but … commonest in psychosis
• ? Due to internal … attribution error

Answer 19

• A perception experienced in the absence of an external stimulus
• In any sensory modality but auditory commonest in psychosis
• ? Due to internal perception attribution error

Question 20

A hallucination can be in any sensory modality but auditory is commonest in …

Answer 20

psychosis

Question 21

This brain scan shows someone experiencing a …

Answer 21

hallucination

Question 22

Conceptual Disorganisation

• … processes are confused, disconnected or disorganized as demonstrated by what they say.
• This is something … and not … of by the individual.
• Also called Loosening of associations (of thought) or Knight’s move thought or Schizophrenic thought disorder or Disorder of form of thought or Formal thought disorder

Answer 22

• Thought processes are confused, disconnected or disorganized as demonstrated by what they say.
• This is something observed and not complained of by the individual.
• Also called Loosening of associations (of thought) or Knight’s move thought or Schizophrenic thought disorder or Disorder of form of thought or Formal thought disorder

Question 23

Conceptual Disorganisation

• Thought processes are confused, disconnected or disorganized as demonstrated by what they say.
• This is something observed and not complained of by the individual.
• Also called …. of associations (of thought) or Knight’s move thought or … thought disorder or Disorder of form of thought or Formal thought disorder

Answer 23

• Thought processes are confused, disconnected or disorganized as demonstrated by what they say.
• This is something observed and not complained of by the individual.
• Also called Loosening of associations (of thought) or Knight’s move thought or Schizophrenic thought disorder or Disorder of form of thought or Formal thought disorder

Question 24

Development of the entity of schizophrenia within ‘psychosis’

• Esquirol 1838 - Described course and prognosis of … and separated it from the diagnostic group of mood disturbances (melancholia) which had a better outcome.
  
  • Melancholia - severe …/ deep …

Answer 24

• Esquirol 1838 - Described course and prognosis of insanity and separated it from the diagnostic group of mood disturbances (melancholia) which had a better outcome.
  
  • Melancholia - severe depression/ deep sadness

Question 25

Development of the entity of schizophrenia within ‘psychosis’

• Kraepelin 1898 - Defined ‘dementia …’ with onset in adolescence of progressive, irreversible decline in mental function. Different forms:
  
  • Hebephrenic - silly, giggly, odd ideas
  • … - movement problems, stiff, still
  • Paranoid - delusions
  • Simplex - negative symptoms, detachment, inner world
• Distinguished … from manic depressive illness

Answer 25

• Kraepelin 1898 - Defined ‘dementia praecox’ with onset in adolescence of progressive, irreversible decline in mental function. Different forms:
  
  • Hebephrenic - silly, giggly, odd ideas
  • Catatonic - movement problems, stiff, still
  • Paranoid - delusions
  • Simplex - negative symptoms, detachment, inner world
• Distinguished schizophrenia from manic depressive illness

Question 26

Kraepelin 1898

• Defined ‘… praecox’ with onset in adolescence of progressive, irreversible decline in mental function.
• Different forms:
  
  • … - silly, giggly, odd ideas
  • Catatonic - movement problems, stiff, still
  • Paranoid - delusions
  • … - negative symptoms, detachment, inner world
• Distinguished schizophrenia from manic … illness

Answer 26

• Defined ‘dementia praecox’ with onset in adolescence of progressive, irreversible decline in mental function.
• Different forms:
  
  • Hebephrenic - silly, giggly, odd ideas
  • Catatonic - movement problems, stiff, still
  • Paranoid - delusions
  • Simplex - negative symptoms, detachment, inner world
• Distinguished schizophrenia from manic depressive illness

Question 27

Bleuler 1911

• Coined the term … ‘splitting of the mind’ - nothing to do with what we now know about psychosis - and described fundamental symptoms: abnormal associations, autism, abnormal affect, ambivalence

Answer 27

• Coined the term schizophrenia ‘splitting of the mind’ - nothing to do with what we now know about psychosis - and described fundamental symptoms: abnormal associations, autism, abnormal affect, ambivalence

Question 28

Schneider 1946

• Defined … … Symptoms pathognomic of schizophrenia

Answer 28

• Defined First Rank Symptoms pathognomic of schizophrenia

Question 29

… - (of a sign or symptom) specifically characteristic or indicative of a particular disease or condition.

Answer 29

Pathognomic - (of a sign or symptom) specifically characteristic or indicative of a particular disease or condition.

Question 30

Schneider’s First Rank Symptoms (1946)

• ‘In the absence of organic disease signify …’
• … hallucinations:
  
  • Thoughts spoken aloud
  • Third person hallucinations
  • Running commentary
• S… hallucinations
• … insertion - new thought arises that isnt your own, withdrawal -taken out of your mind, by antenna? or broadcast - known to others
• … phenomena - not under your control. Made acts/ impulses/ affects
• Delusional perception - first delusion - believe something is happening e.g. aliens landing due to change in traffic light

Answer 30

• ‘In the absence of organic disease signify schizophrenia’
• Auditory hallucinations:
  
  • Thoughts spoken aloud
  • Third person hallucinations
  • Running commentary
• Somatic hallucinations
• Thought insertion - new thought arises that isnt your own, withdrawal -taken out of your mind, by antenna? or broadcast - known to others
• Passivity phenomena - not under your control. Made acts/ impulses/ affects
• Delusional perception - first delusion - believe something is happening e.g. aliens landing due to change in traffic light

Question 31

Schneider’s First Rank Symptoms (1946)

• ‘In the absence of … disease signify schizophrenia’
• Auditory hallucinations:
  
  • Thoughts spoken aloud
  • Third person hallucinations
  • Running commentary
• Somatic hallucinations
• Thought … - new thought arises that isnt your own, withdrawal -taken out of your mind, by antenna? or broadcast - known to others
• Passivity phenomena - not under your control. Made acts/ impulses/ affects
• … perception - first delusion - believe something is happening e.g. aliens landing due to change in traffic light

Answer 31

• ‘In the absence of organic disease signify schizophrenia’
• Auditory hallucinations:
  
  • Thoughts spoken aloud
  • Third person hallucinations
  • Running commentary
• Somatic hallucinations
• Thought insertion - new thought arises that isnt your own, withdrawal -taken out of your mind, by antenna? or broadcast - known to others
• Passivity phenomena - not under your control. Made acts/ impulses/ affects
• Delusional perception - first delusion - believe something is happening e.g. aliens landing due to change in traffic light

Question 32

Schneider’s First Rank Symptoms (1946)

• ‘In the absence of organic disease signify schizophrenia’
• Auditory hallucinations:
  
  • Thoughts spoken aloud
  • Third person hallucinations
  • Running commentary
• Somatic hallucinations
• Thought insertion - new thought arises that isnt your own, withdrawal -taken out of your mind, by antenna? or broadcast - known to others
• Passivity phenomena - not under your control. Made acts/ impulses/ affects
• Delusional perception - first delusion - believe something is happening e.g. aliens landing due to change in traffic light

Answer 32

• ‘In the absence of organic disease signify schizophrenia’
• Auditory hallucinations:
  
  • Thoughts spoken aloud
  • Third person hallucinations
  • Running commentary
• Somatic hallucinations
• Thought insertion - new thought arises that isnt your own, withdrawal -taken out of your mind, by antenna? or broadcast - known to others
• Passivity phenomena - not under your control. Made acts/ impulses/ affects
• Delusional perception - first delusion - believe something is happening e.g. aliens landing due to change in traffic light

Question 33

ICD 10 Diagnosis of schizophrenia

• A minimum of … of a-d or … of e-h for at least 1 month:
  
  • a) Thought echo, insertion, withdrawal or broadcast
  • b) Delusion of passivity or delusion perception
  • c) Running commentary hallucination or 2 voices discussing the patient
  • d) Persistent delusions of other kinds
  • e) Persistent hallucinations in any modality with accompanying brief delusions
  • f) Breaks in thought resulting in abnormal speech (E.g. incoherent, neologisms)
  • g) Catatonic behaviour e.g. excitement, posturing, waxy flexibility, negativism
  • h) Negative symptoms not due to depression or medication
• In the absence of an organic disorder

Answer 33

• A minimum of one of a-d or two of e-h for at least 1 month:
• a) Thought echo, insertion, withdrawal or broadcast
• b) Delusion of passivity or delusion perception
• c) Running commentary hallucination or 2 voices discussing the patient
• d) Persistent delusions of other kinds
• e) Persistent hallucinations in any modality with accompanying brief delusions
• f) Breaks in thought resulting in abnormal speech (E.g. incoherent, neologisms)
• g) Catatonic behaviour e.g. excitement, posturing, waxy flexibility, negativism
• h) Negative symptoms not due to depression or medication
• In the absence of an organic disorder

Question 34

ICD 10 Diagnosis of schizophrenia

• A minimum of one of a-d or two of e-h for at least 1 month:
  
  • a) Thought echo, insertion, withdrawal or broadcast
  • b) Delusion of passivity or delusion perception
  • c) Running … hallucination or 2 voices discussing the patient
  • d) Persistent … of other kinds
  • e) Persistent … in any modality with accompanying brief delusions
  • f) Breaks in thought resulting in abnormal speech (E.g. incoherent, neologisms)
  • g) Catatonic behaviour e.g. excitement, posturing, waxy flexibility, negativism
  • h) Negative symptoms not due to depression or medication
• In the absence of an organic disorder

Answer 34

• A minimum of one of a-d or two of e-h for at least 1 month:
• a) Thought echo, insertion, withdrawal or broadcast
• b) Delusion of passivity or delusion perception
• c) Running commentary hallucination or 2 voices discussing the patient
• d) Persistent delusions of other kinds
• e) Persistent hallucinations in any modality with accompanying brief delusions
• f) Breaks in thought resulting in abnormal speech (E.g. incoherent, neologisms)
• g) Catatonic behaviour e.g. excitement, posturing, waxy flexibility, negativism
• h) Negative symptoms not due to depression or medication
• In the absence of an organic disorder

Question 35

ICD 10 Diagnosis of schizophrenia

• A minimum of one of a-d or two of e-h for at least 1 month:
  
  • a) … echo, insertion, withdrawal or broadcast
  • b) Delusion of … or delusion …
  • c) Running commentary hallucination or 2 voices discussing the patient
  • d) Persistent delusions of other kinds
  • e) Persistent hallucinations in any modality with accompanying brief delusions
  • f) Breaks in thought resulting in abnormal speech (E.g. incoherent, neologisms)
  • g) … behaviour e.g. excitement, posturing, waxy flexibility, negativism
  • h) Negative symptoms not due to depression or medication
• In the absence of an organic disorder

Answer 35

• A minimum of one of a-d or two of e-h for at least 1 month:
• a) Thought echo, insertion, withdrawal or broadcast
• b) Delusion of passivity or delusion perception
• c) Running commentary hallucination or 2 voices discussing the patient
• d) Persistent delusions of other kinds
• e) Persistent hallucinations in any modality with accompanying brief delusions
• f) Breaks in thought resulting in abnormal speech (E.g. incoherent, neologisms)
• g) Catatonic behaviour e.g. excitement, posturing, waxy flexibility, negativism
• h) Negative symptoms not due to depression or medication
• In the absence of an organic disorder

Question 36

ICD 10 Diagnosis of schizophrenia

• A minimum of one of a-d or two of e-h for at least 1 month:
  
  • a) Thought echo, insertion, withdrawal or broadcast
  • b) Delusion of passivity or delusion perception
  • c) Running commentary hallucination or 2 voices discussing the patient
  • d) Persistent delusions of other kinds
  • e) Persistent hallucinations in any modality with accompanying brief delusions
  • f) Breaks in thought resulting in … speech (E.g. incoherent, neologisms)
  • g) Catatonic behaviour e.g. excitement, posturing, waxy flexibility, negativism
  • h) … symptoms not due to depression or medication
• In the absence of an organic disorder

Answer 36

• A minimum of one of a-d or two of e-h for at least 1 month:
• a) Thought echo, insertion, withdrawal or broadcast
• b) Delusion of passivity or delusion perception
• c) Running commentary hallucination or 2 voices discussing the patient
• d) Persistent delusions of other kinds
• e) Persistent hallucinations in any modality with accompanying brief delusions
• f) Breaks in thought resulting in abnormal speech (E.g. incoherent, neologisms)
• g) Catatonic behaviour e.g. excitement, posturing, waxy flexibility, negativism
• h) Negative symptoms not due to depression or medication
• In the absence of an organic disorder

Question 37

People with … symptoms in schizophrenia exhibit unusual styles and levels of physical movement

Answer 37

People with catatonic symptoms in schizophrenia exhibit unusual styles and levels of physical movement

Question 38

Differential Diagnosis - Schizophrenia

• … psychosis:
  
  • Bipolar disorder
  • Depressive psychosis
  • Schizoaffective disorder
• … psychosis:
  
  • Epilepsy (temporal lobe)
  • Infections: encephalitis, subacute sclerosing panencephalitis, neurosyphillis, HIV
  • Cerebral trauma
  • Cerebrovascular disease
  • Demyelination: MS etc
  • Neurodevelopmental disorders: velocardiofacial symptoms
  • Endocrine: thyroid disorders (hyper and hypo), Cushing’s syndrome
  • Metabolic: hepatic failure, uraemia
  • Immunological: SLE
  • Acute drug intoxication: e.g. Ketamine, Cannabis, LSD, PCP, Amphetamine, MDM
  • Toxins e.g. lead
  • Dementias
• … disorder
  
  • May describe hallucinations, hard to distinguish
  • Eating disorder - strong and unusual ideas - hard to distinguish

Answer 38

• Affective psychosis:
  
  • Bipolar disorder
  • Depressive psychosis
  • Schizoaffective disorder
• Organic psychosis:
  
  • Epilepsy (temporal lobe)
  • Infections: encephalitis, subacute sclerosing panencephalitis, neurosyphillis, HIV
  • Cerebral trauma
  • Cerebrovascular disease
  • Demyelination: MS etc
  • Neurodevelopmental disorders: velocardiofacial symptoms
  • Endocrine: thyroid disorders (hyper and hypo), Cushing’s syndrome
  • Metabolic: hepatic failure, uraemia
  • Immunological: SLE
  • Acute drug intoxication: e.g. Ketamine, Cannabis, LSD, PCP, Amphetamine, MDM
  • Toxins e.g. lead
  • Dementias
• Personality disorder
  
  • May describe hallucinations, hard to distinguish
  • Eating disorder - strong and unusual ideas - hard to distinguish

Question 39

Differential Diagnosis - Schizophrenia

• Affective psychosis:
  
  • Bipolar disorder
  • Depressive psychosis
  • Schizoaffective disorder
• Organic psychosis:
  
  • E… (temporal lobe)
  • Infections: encephalitis, subacute sclerosing panencephalitis, neurosyphillis, HIV
  • C… trauma
  • Cerebrovascular disease
  • Demyelination: MS etc
  • Neurodevelopmental disorders: velocardiofacial symptoms
  • Endocrine: thyroid disorders (hyper and hypo), Cushing’s syndrome
  • …: hepatic failure, uraemia
  • Immunological: SLE
  • Acute drug intoxication: e.g. Ketamine, Cannabis, LSD, PCP, Amphetamine, MDM
  • Toxins e.g. lead
  • Dementias
• Personality disorder
  
  • May describe hallucinations, hard to distinguish
  • Eating disorder - strong and unusual ideas - hard to distinguish

Answer 39

• Affective psychosis:
  
  • Bipolar disorder
  • Depressive psychosis
  • Schizoaffective disorder
• Organic psychosis:
  
  • Epilepsy (temporal lobe)
  • Infections: encephalitis, subacute sclerosing panencephalitis, neurosyphillis, HIV
  • Cerebral trauma
  • Cerebrovascular disease
  • Demyelination: MS etc
  • Neurodevelopmental disorders: velocardiofacial symptoms
  • Endocrine: thyroid disorders (hyper and hypo), Cushing’s syndrome
  • Metabolic: hepatic failure, uraemia
  • Immunological: SLE
  • Acute drug intoxication: e.g. Ketamine, Cannabis, LSD, PCP, Amphetamine, MDM
  • Toxins e.g. lead
  • Dementias
• Personality disorder
  
  • May describe hallucinations, hard to distinguish
  • Eating disorder - strong and unusual ideas - hard to distinguish

Question 40

Differential Diagnosis - Schizophrenia

• Affective psychosis:
  
  • Bipolar disorder
  • Depressive psychosis
  • Schizoaffective disorder
• Organic psychosis:
  
  • Epilepsy (temporal lobe)
  • …: encephalitis, subacute sclerosing panencephalitis, neurosyphillis, HIV
  • Cerebral trauma
  • Cerebrovascular disease
  • Demyelination: MS etc
  • Neurodevelopmental disorders: velocardiofacial symptoms
  • …: thyroid disorders (hyper and hypo), Cushing’s syndrome
  • Metabolic: hepatic failure, uraemia
  • Immunological: SLE
  • Acute … intoxication: e.g. Ketamine, Cannabis, LSD, PCP, Amphetamine, MDM
  • Toxins e.g. lead
  • Dementias
• Personality disorder
  
  • May describe hallucinations, hard to distinguish
  • Eating disorder - strong and unusual ideas - hard to distinguish

Answer 40

• Affective psychosis:
  
  • Bipolar disorder
  • Depressive psychosis
  • Schizoaffective disorder
• Organic psychosis:
  
  • Epilepsy (temporal lobe)
  • Infections: encephalitis, subacute sclerosing panencephalitis, neurosyphillis, HIV
  • Cerebral trauma
  • Cerebrovascular disease
  • Demyelination: MS etc
  • Neurodevelopmental disorders: velocardiofacial symptoms
  • Endocrine: thyroid disorders (hyper and hypo), Cushing’s syndrome
  • Metabolic: hepatic failure, uraemia
  • Immunological: SLE
  • Acute drug intoxication: e.g. Ketamine, Cannabis, LSD, PCP, Amphetamine, MDM
  • Toxins e.g. lead
  • Dementias
• Personality disorder
  
  • May describe hallucinations, hard to distinguish
  • Eating disorder - strong and unusual ideas - hard to distinguish

Question 41

Differential Diagnosis - Schizophrenia

• Affective psychosis:
  
  • Bipolar disorder
  • Depressive psychosis
  • Schizoaffective disorder
• Organic psychosis:
  
  • Epilepsy (temporal lobe)
  • Infections: encephalitis, subacute sclerosing panencephalitis, neurosyphillis, HIV
  • Cerebral trauma
  • Cerebrovascular disease
  • Demyelination: MS etc
  • Neurodevelopmental disorders: velocardiofacial symptoms
  • Endocrine: thyroid disorders (hyper and hypo), Cushing’s syndrome
  • Metabolic: hepatic failure, uraemia
  • Immunological: SLE
  • Acute drug intoxication: e.g. Ketamine, Cannabis, LSD, PCP, Amphetamine, MDM
  • Toxins e.g. lead
  • Dementias
• Personality disorder
  
  • May describe hallucinations, hard to distinguish
• … disorder - strong and unusual ideas - hard to distinguish

Answer 41

• Affective psychosis:
  
  • Bipolar disorder
  • Depressive psychosis
  • Schizoaffective disorder
• Organic psychosis:
  
  • Epilepsy (temporal lobe)
  • Infections: encephalitis, subacute sclerosing panencephalitis, neurosyphillis, HIV
  • Cerebral trauma
  • Cerebrovascular disease
  • Demyelination: MS etc
  • Neurodevelopmental disorders: velocardiofacial symptoms
  • Endocrine: thyroid disorders (hyper and hypo), Cushing’s syndrome
  • Metabolic: hepatic failure, uraemia
  • Immunological: SLE
  • Acute drug intoxication: e.g. Ketamine, Cannabis, LSD, PCP, Amphetamine, MDM
  • Toxins e.g. lead
  • Dementias
• Personality disorder
  
  • May describe hallucinations, hard to distinguish
• Eating disorder - strong and unusual ideas - hard to distinguish

Question 42

Are there signs of schizophrenia?

• Bizarre appearance or behaviour
  
  • Self …
  • ‘talking to …’
  • Social disturbance including … violent acts
  • Posturing
  • Clothing
  • Perplexity
• Side effects of medication
  
  • Parkinsonian symptoms: tremor, rigidity, bradykinesia
  • Tardive dyskinesias including orofacial, athetosis, dystonias
  • Skin discolouration
  • Severe weight gain

Answer 42

• Bizarre appearance or behaviour
  
  • Self neglect
  • ‘talking to themselves’
  • Social disturbance including unprovoked violent acts
  • Posturing
  • Clothing
  • Perplexity
• Side effects of medication
  
  • Parkinsonian symptoms: tremor, rigidity, bradykinesia
  • Tardive dyskinesias including orofacial, athetosis, dystonias
  • Skin discolouration
  • Severe weight gain

Question 43

Are there signs of schizophrenia?

• Bizarre appearance or behaviour
  
  • Self neglect
  • ‘talking to themselves’
  • Social disturbance including unprovoked violent acts
  • Posturing
  • Clothing
  • Perplexity
• Side effects of medication
  
  • … symptoms: tremor, rigidity, bradykinesia
  • Tardive … including orofacial, athetosis, dystonias
  • Skin discolouration
  • Severe weight gain

Answer 43

• Bizarre appearance or behaviour
  
  • Self neglect
  • ‘talking to themselves’
  • Social disturbance including unprovoked violent acts
  • Posturing
  • Clothing
  • Perplexity
• Side effects of medication
  
  • Parkinsonian symptoms: tremor, rigidity, bradykinesia
  • Tardive dyskinesias including orofacial, athetosis, dystonias
  • Skin discolouration
  • Severe weight gain

Question 44

Are there signs of schizophrenia?

• Bizarre appearance or behaviour
  
  • Self neglect
  • ‘talking to themselves’
  • Social disturbance including unprovoked violent acts
  • Posturing
  • Clothing
  • Perplexity
• Side effects of medication
  
  • Parkinsonian symptoms: T…, R…, bradykinesia
  • Tardive dyskinesias including orofacial, athetosis, dystonias
  • Skin …
  • Severe weight gain

Answer 44

• Bizarre appearance or behaviour
  
  • Self neglect
  • ‘talking to themselves’
  • Social disturbance including unprovoked violent acts
  • Posturing
  • Clothing
  • Perplexity
• Side effects of medication
  
  • Parkinsonian symptoms: tremor, rigidity, bradykinesia
  • Tardive dyskinesias including orofacial, athetosis, dystonias
  • Skin discolouration
  • Severe weight gain

Question 45

Are there signs of schizophrenia?

• Bizarre appearance or behaviour
  
  • Self neglect
  • ‘talking to themselves’
  • Social disturbance including unprovoked violent acts
  • Posturing
  • Clothing
  • Perplexity
• Side effects of medication
  
  • Parkinsonian symptoms: tremor, rigidity, bradykinesia
  • Tardive dyskinesias including orofacial, athetosis, dystonias
  • … discolouration
  • Severe weight …

Answer 45

• Bizarre appearance or behaviour
  
  • Self neglect
  • ‘talking to themselves’
  • Social disturbance including unprovoked violent acts
  • Posturing
  • Clothing
  • Perplexity
• Side effects of medication
  
  • Parkinsonian symptoms: tremor, rigidity, bradykinesia
  • Tardive dyskinesias including orofacial, athetosis, dystonias
  • Skin discolouration
  • Severe weight gain

Question 46

Signs of schizophrenia?

• None of the signs are … to schizophrenia
• Hence no objective pathognomonic signs
• … interview is required for diagnosis
• No lab tests/ predictive imaging
• Genetics on track to identify vulnerability only…

Answer 46

• None of the signs are specific to schizophrenia
• Hence no objective pathognomonic signs
• Clinical interview is required for diagnosis
• No lab tests/ predictive imaging
• Genetics on track to identify vulnerability only…

Question 47

Signs of schizophrenia?

• None of the signs are specific to schizophrenia
• Hence no objective … signs
• Clinical interview is required for diagnosis
• No … tests/ … imaging
• Genetics on track to identify … only…

Answer 47

• None of the signs are specific to schizophrenia
• Hence no objective pathognomonic signs
• Clinical interview is required for diagnosis
• No lab tests/ predictive imaging
• Genetics on track to identify vulnerability only…

Question 48

Signs of schizophrenia all lead to …

Answer 48

stigma

Question 49

Mental State Examination findings in the Acute Syndrome (… symptoms) - Schizophrenia

• Appearance: Preoccupied and withdrawn to restless and unpredictable
• Mood: Blunting of mood, disinhibition, perplexed, anxious
• Disorder of thinking: Vague, formal thought disorder (loosening of associations), Disorders of stream (thought block)
• Delusions: Primary, secondary
• Hallucinations: Auditory, visual, tactile (somatic), olfactory, gustatory
• Insight: Impaired
• Cognition: Normal orientation and memory (initially)

Answer 49

• Positive symptoms:
• Appearance: Preoccupied and withdrawn to restless and unpredictable
• Mood: Blunting of mood, disinhibition, perplexed, anxious
• Disorder of thinking: Vague, formal thought disorder (loosening of associations), Disorders of stream (thought block)
• Delusions: Primary, secondary
• Hallucinations: Auditory, visual, tactile (somatic), olfactory, gustatory
• Insight: Impaired
• Cognition: Normal orientation and memory (initially)

Question 50

Mental State Examination findings in the Acute Syndrome (Positive symptoms) - Schizophrenia

• Appearance: … and withdrawn to restless and unpredictable
• Mood: … of mood, disinhibition, perplexed, anxious
• Disorder of ..: Vague, formal thought disorder (loosening of associations), Disorders of stream (thought block)
• …: Primary, secondary
• Hallucinations: Auditory, visual, tactile (somatic), olfactory, gustatory
• Insight: …
• Cognition: Normal orientation and memory (initially)

Answer 50

• Appearance: Preoccupied and withdrawn to restless and unpredictable
• Mood: Blunting of mood, disinhibition, perplexed, anxious
• Disorder of thinking: Vague, formal thought disorder (loosening of associations), Disorders of stream (thought block)
• Delusions: Primary, secondary
• Hallucinations: Auditory, visual, tactile (somatic), olfactory, gustatory
• Insight: Impaired
• Cognition: Normal orientation and memory (initially)

Question 51

Mental State Examination findings in the Acute Syndrome (… symptoms) - Schizophrenia

• Appearance: Lack of drive and activity. Social withdrawal. Self neglect
• Movement abnormalities: Stupor, catatonia, abnormal movements and tone
• Mood: Blunting of mood. Depression
• Delusions: As in acute syndrome but may be less evident
• Hallucinations: As in acute syndrome but may be less evident
• Insight: Impaired as in acute syndrome
• Cognition: Normal orientation. Disturbed attention. Later cognitive decline.

Answer 51

• Negative Symptoms
• Appearance: Lack of drive and activity. Social withdrawal. Self neglect
• Movement abnormalities: Stupor, catatonia, abnormal movements and tone
• Mood: Blunting of mood. Depression
• Delusions: As in acute syndrome but may be less evident
• Hallucinations: As in acute syndrome but may be less evident
• Insight: Impaired as in acute syndrome
• Cognition: Normal orientation. Disturbed attention. Later cognitive decline.

Question 52

Mental State Examination findings in the Acute Syndrome (negative symptoms)

• Appearance: Lack of drive and activity. Social …. Self …
• Movement abnormalities: Stupor, c…, abnormal movements and tone
• Mood: … of mood. Depression
• Delusions: As in acute syndrome but may be … evident
• Hallucinations: As in acute syndrome but may be … evident
• Insight: Impaired as in acute syndrome
• Cognition: Normal orientation. Disturbed attention. Later cognitive …

Answer 52

• Appearance: Lack of drive and activity. Social withdrawal. Self neglect
• Movement abnormalities: Stupor, catatonia, abnormal movements and tone
• Mood: Blunting of mood. Depression
• Delusions: As in acute syndrome but may be less evident
• Hallucinations: As in acute syndrome but may be less evident
• Insight: Impaired as in acute syndrome
• Cognition: Normal orientation. Disturbed attention. Later cognitive decline.

Question 53

Epidemiology of Schizophrenia

• Prevalence:
  
  • 0.2-0.7%
• Incidence:
  
  • …./10,000 per year. Increasing in S London.
• Geography:
  
  • Incidence up to …x variation worldwide
  • Increased rate in … (particularly African Caribbean - culturally isolated Europe)
  • More prevalent in … than … areas (increased rates the larger the town and longer lived there)
• Sex:
  
  • … have earlier onset and more negative symptoms
• Onset:
  
  • Male peak onset 21-26
  • Female peak onset 25-32
• Social class:
  
  • Lower ‘social drift hypothesis’

Answer 53

• Prevalence:
  
  • 0.2-0.7%
• Incidence:
  
  • 2/10,000 per year. Increasing in S London.
• Geography:
  
  • Incidence up to 5x variation worldwide
  • Increased rate in migrants (particularly African Caribbean - culturally isolated Europe)
  • More prevalent in urban than rural areas (increased rates the larger the town and longer lived there)
  • ‘urban drift’
• Sex:
  
  • Men have earlier onset and more negative symptoms
• Onset:
  
  • Male peak onset 21-26
  • Female peak onset 25-32
• Social class:
  
  • Lower ‘social drift hypothesis’

Question 54

What is the prevalence of Schizophrenia?

Answer 54

0.2-0.7%

Question 55

Incidence - Schizophrenia

• …/10,000 per year. Increasing in … London.

Answer 55

• 2/10,000 per year. Increasing in S London.

Question 56

What gender have earlier onset of schizophrenia and more negative symptoms?

Answer 56

men

Question 57

Onset of schizophrenia

• Male peak onset …-…
• Female peak onset …-…

Answer 57

• Male peak onset 21-26
• Female peak onset 25-32

Question 58

Onset of schizophrenia

• … peak onset 21-26
• … peak onset 25-32

Answer 58

• Male peak onset 21-26
• Female peak onset 25-32

Question 59

Schizophrenia is more prevalent in what areas? (rural vs urban)

Answer 59

More prevalent in urban than rural areas (increased rates the larger the town and longer lived there)

Question 60

… … hypothesis, concerning the relationship between mental illness and social class, is the argument that illness causes one to have a … … in social class.

Answer 60

Social Drift hypothesis, concerning the relationship between mental illness and social class, is the argument that illness causes one to have a downward shift in social class.

Question 61

Prognosis of Schizophrenia

• … outcome in 3rd world and with introduction of … … Services
• …% complete recovery and off treatment, demonstrated by line a
• 25% have persistent symptoms after first episode or what was originally described as ‘dementia praecox’ Line B
• >…% have a relapsing remitting illness with some functional impairment between episodes. Line C
• Recurrent episodes may lead to progressive deterioration
• Functional recovery lags behind symptom recovery
• Suicide in 5-10% particularly men within 3 years of onset

Answer 61

• Better outcome in 3rd world and with introduction of Early Intervention Services
• 20% complete recovery and off treatment, demonstrated by line a
• 25% have persistent symptoms after first episode or what was originally described as ‘dementia praecox’ Line B
• >50% have a relapsing remitting illness with some functional impairment between episodes. Line C
• Recurrent episodes may lead to progressive deterioration
• Functional recovery lags behind symptom recovery
• Suicide in 5-10% particularly men within 3 years of onset

Question 62

Prognosis of Schizophrenia

• Better outcome in 3rd world and with introduction of Early Intervention Services
• 20% complete recovery and off treatment, demonstrated by line a
• 25% have persistent symptoms after first episode or what was originally described as ‘dementia praecox’ Line B
• >50% have a relapsing remitting illness with some functional impairment between episodes. Line C
• … episodes may lead to progressive deterioration
• … recovery lags behind symptom recovery
• Suicide in 5-10% particularly … within 3 years of onset

Answer 62

• Better outcome in 3rd world and with introduction of Early Intervention Services
• 20% complete recovery and off treatment, demonstrated by line a
• 25% have persistent symptoms after first episode or what was originally described as ‘dementia praecox’ Line B
• >50% have a relapsing remitting illness with some functional impairment between episodes. Line C
• Recurrent episodes may lead to progressive deterioration
• Functional recovery lags behind symptom recovery
• Suicide in 5-10% particularly men within 3 years of onset

Question 63

Prognosis of Schizophrenia

• Better outcome in … world and with introduction of Early Intervention Services
• 20% complete recovery and off treatment, demonstrated by line a
• 25% have persistent symptoms after first episode or what was originally described as ‘dementia praecox’ Line B
• >50% have a relapsing remitting illness with some functional impairment between episodes. Line C
• Recurrent episodes may lead to … deterioration
• Functional recovery lags behind symptom recovery
• … in 5-10% particularly men within 3 years of onset

Answer 63

• Better outcome in 3rd world and with introduction of Early Intervention Services
• 20% complete recovery and off treatment, demonstrated by line a
• 25% have persistent symptoms after first episode or what was originally described as ‘dementia praecox’ Line B
• >50% have a relapsing remitting illness with some functional impairment between episodes. Line C
• Recurrent episodes may lead to progressive deterioration
• Functional recovery lags behind symptom recovery
• Suicide in 5-10% particularly men within 3 years of onset

Question 64

Prognosis of Schizophrenia

• 20% complete recovery and off treatment, demonstrated by line a
• 25% have persistent symptoms after first episode or what was originally described as ‘dementia praecox’ Line B
• >50% have a … … illness with some functional impairment between episodes. Line C
• Suicide in …-…% particularly men within 3 years of onset

Answer 64

• Better outcome in 3rd world and with introduction of Early Intervention Services
• 20% complete recovery and off treatment, demonstrated by line a
• 25% have persistent symptoms after first episode or what was originally described as ‘dementia praecox’ Line B
• >50% have a relapsing remitting illness with some functional impairment between episodes. Line C
• Recurrent episodes may lead to progressive deterioration
• Functional recovery lags behind symptom recovery
• Suicide in 5-10% particularly men within 3 years of onset

Question 65

What % of those with schizophrenia commit suicide?

Answer 65

• Suicide in 5-10% particularly men within 3 years of onset

Question 66

Functional recovery of schizophrenia lags behind … recovery

Answer 66

Functional recovery of schizophrenia lags behind symptom recovery

Question 67

Prognosis of Schizophrenia - Good vs bad outcomes

• Highlight whether Good outcomes in:
  
  • Male/Female?
  • Married/single?
  • Family history of affective disorder or Schizophrenia?
  • Good premorbid function
  • Acute/Slow onset?
  • Life event at onset
  • Early treatment/ Long duration untreated?
  • Affective/ Negative symptoms?
  • Good treatment response?
  • Obsessions?
  • Premorbidly schizoid?
  • High expressed emotion in the family?
  • Substance misuse?

Answer 67

• Good outcomes in:
  
  • Male/Female?
  • Married/single?
  • Family history of affective disorder or Schizophrenia?
  • Good premorbid function
  • Acute/Slow onset?
  • Life event at onset
  • Early treatment/ Long duration untreated?
  • Affective/ Negative symptoms?
  • Good treatment response? Yes
  • Obsessions? No
  • Premorbidly schizoid? No
  • High expressed emotion in the family? No
  • Substance misuse? No

Question 68

Poor prognosis of Schizophrenia in the following groups:

Answer 68

• Male
• Single
• Family history of schizophrenia
• Premorbidly schizoid
• Slow onset
• Long duration untreated
• Negative symptoms
• Obsessions
• High expressed emotion in the family
• Substance misuse

Question 69

Good prognosis of Schizophrenia in the following groups

Answer 69

• Female
• Married
• Family history of affective disorder
• Good premorbid function
• Acute onset
• Life event at onset
• Early treatment
• Affective symptoms
• Good treatment response

Question 70

Substance-induced harm

Answer 70

• Majority can smoke cannabis but in those predisposed to psychosis,can cause lots of problems

Question 71

Cannabis increases vulnerability to psychosis

• Impact of cannabis on developing brain is more potent (
• … patients more sensitive to cannabis than controls
• … liability for psychosis is expressed as differential sensitivity to cannabis
• … use sensitises to effect and increases vulnerability to psychosis
• Many new cannabinoid analogues available
• ? Effect of … on psychosis

Answer 71

• Impact of cannabis on developing brain is more potent (<14 years)
• Schizophrenia patients more sensitive to cannabis than controls
• Familial liability for psychosis is expressed as differential sensitivity to cannabis
• Chronic use sensitises to effect and increases vulnerability to psychosis
• Many new cannabinoid analogues available
• ? Effect of CBD on psychosis

Question 72

Cannabis … vulnerability to psychosis

Answer 72

• Cannabis increases vulnerability to psychosis
• Impact of cannabis on developing brain is more potent (<14 years)
• Schizophrenia patients more sensitive to cannabis than controls
• Familial liability for psychosis is expressed as differential sensitivity to cannabis
• Chronic use sensitises to effect and increases vulnerability to psychosis
• Many new cannabinoid analogues available
• ? Effect of CBD on psychosis

Question 73

Genetic vulnerability to psychosis - … is the most likely current social determinant of transition to psychosis -> first episode psychosis

Answer 73

Genetic vulnerability to psychosis - cannabis is the most likely current social determinant of transition to psychosis -> first episode psychosis