Schizophrenia: Clinical features

Question 1

Which disorders constitute as neurosis?

Answer 1

Anxiety disorders
Depressive disorders
Obsessive compulsive disorder
Adjustment disorders
Somatisation disorders

Question 2

Which disorders constitute as psychosis?

Answer 2

Organic
Schizophrenia
Bipolar disorder
Depressive psychosis

Question 3

Define psychosis

Answer 3

Break from reality

An illness characterised by a loss of boundaries with reality and loss of insight, with primary features of delusions and hallucinations.

Question 4

What is delusion?

Answer 4

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.

Question 5

List the types of delusion

Answer 5

primary (delusional perception), secondary, persecutory, -of reference, grandiose, -of guilt, nihilistic, -of passivity etc.

Question 6

What is a psychotic episode?

Answer 6

A psychotic episode is deemed to be 1 week duration of either of these symptoms at significant severity.

Question 7

What does the content of delusions depend on?

Answer 7

The culture or personal beliefs of the patient

Question 8

What are hallucinations?

Answer 8

A perception experienced in the absence of an external stimulus.

In any sensory modality but auditory commonest in psychosis.

Question 9

What are hallucinations due to?

Answer 9

due to internal perception attribution error

Question 10

Is psychosis different from schizophrenia?

Answer 10

No
Psychosis for many reasons
Psychotic episodes are part of schizophrenia

Question 11

What is Schneider do?

Answer 11

Defined first rank symptoms pathognomic of schizophrenia

Question 12

List Schneider’s first rank symptoms

Answer 12

Auditory Hallucinations:

• Thoughts spoken aloud
• Third person hallucinations
• Running commentary

Somatic hallucinations

Thought insertion, withdrawal or broadcast

Passisivity phenomena. Made acts/ impulses/ affect

Delusional perception

Question 13

List the ICD 10 diagnosis of schizophrenia

Answer 13

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 delusional 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 (eg. incoherent, neologisms)

g Catatonic behaviour eg. Excitement, posturing, waxy flexibility, negativism

h Negative symptoms not due to depression or medication

In the absence of an organic disorder

Question 14

List some affective psychosis

Answer 14

Bipolar disorder
Depressive psychosis
Schizoaffective disorder

Question 15

List some causes of organic psychosis

Answer 15

Epilepsy (temporal lobe)
Infections: encephalitis, subacute sclerosing panencephalitis, neurosyphillis, HIV
Cerebral trauma
Cerebrovascular disease
Demyelination: Multiple sclerosis etc
Neurodevelopmental disorders: velocardiofacial syndrome
Endocrine: thyroid disorders (hyper and hypo), Cushing’s syndrome,
Metabolic: hepatic failure, uraemia
Immunological: SLE
Acute drug intoxication: eg. Ketamine, Cannabis, LSD, PCP, Amphetamine, MDMA
Toxins eg. lead
Dementias

Question 16

List some non-specific signs of schizophrenia

Answer 16

Non-specific signs – bizarre appearance of behaviour – self neglect, talking to themselves, social disturbance including unprovoked violent acts, posturing, clothing, perplexity

Question 17

Describe the mental state examination in acute syndrome

Answer 17

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 18

Describe the mental state examination in chronic syndrome

Answer 18

Appearance and behaviour 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

Hallucinations as in acute syndrome

Insight Impaired

Cognition Normal orientation
but often cognitive decline.

Question 19

What is the prevalence of schizophrenia?

Answer 19

0.2-0.7%

Question 20

Describe the incidence of schizophrenia

Answer 20

2 in 10000 per year

Question 21

Where is schizophrenia more prevalent?

Answer 21

Migrants
Urban drift
Lower social drift

Question 22

Which gender is more likely to be affected?

Answer 22

Men

Question 23

What is the onset of schizophrenia?

Answer 23

Male peak onset 21-26

Female peak onset 25-32

Question 24

Describe the course of schizophrenia

Answer 24

At risk mental state - slow decrease in function
Defined psychosis threshold
Duration of untreated psychosis
Treatment
Function increases
Relapse

Question 25

Describe the prognosis of schizophrenia

Answer 25

Better outcome in 3rd world and with introduction of early intervention services
High suicide rate

Question 26

Describe the components of a good prognosis of schizophrenia

Answer 26

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

Question 27

Describe the components of a bad prognosis of schizophrenia

Answer 27

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 28

Which drug is associated with schizophrenia?

Answer 28

Cannabis - genetically vulnerable

Question 29

What can legal highs do to psychosis?

Answer 29

Can exacerbate psychosis