Schizophrenia: Historical and clincal features

Question 1

What are the fundamental symptoms of schizophrenia?

Answer 1

1. Disturbance of ability to formulate coherent thought
2. Disturbance of affect (flattening)
3. Loss of volition
4. Ambivalence
5. Autism

Accessory: Delusions, hallucincations.

Question 2

What are the “classical” subtypes of schizophrenia?

Answer 2

Paranoid: Persecutory delusions

Hebephrenic: Disorganisation syndrome- formal thought disorder.

Catatonic: Multiple motor, volitional and behavioural disorders

Simple: Insidious but progressive impoverishment of mental life, without development of florid symptoms.

Question 3

Liddle’s three syndromes?

Answer 3

Psychomotor poverty: Poverty of speech, decreased spontaneous movement.

Disorganisation syndrome: Inappropriate affect, poverty of speech content, distractablitiy.

Reality distortion: Hearing voices, persecution delusions.

Question 4

What are some contributors to increased morbidity and mortality?

Answer 4

Lack of access to preventative care.

Unhealthy lifestyle

Social deprivation

Smoking

Poor diet

Higher levels of substance use.

Risks: Diabetes comorbid, cardiovascular disease.

Cannabis: Cause 40% increase in psychosis risk. Could be ‘reverse causality’ however. Evidence suggests it’s causal however.

Question 5

What susceptibility genes and proteins have been identified?

Answer 5

SNPs
CNVs (copy number variants)
Rare variants

Neuregulin, Dysbindin, DISC1.

Complement C4 alleles- involved in pruning. Increased C4A expression can cause inappropriate pruning.

Question 6

Give an example of a genetic-environmental risk factor.

Answer 6

COMT. Encodes enzyme involved in dopamine metabolism in synapse. Mutation is valine to methionine, causing less active enzyme.

Question 7

What are some prodromal symptoms?

Answer 7

Dysphoria
Poor concentration, sleep disturbance, paranoid notions, social and emotional withdrawal, academic decline, lack of drive.

Question 8

What is the significance of untreated psychosis?

Answer 8

The longer a psychotic person goes untreated, the less responsive they are to treatment.

This can mean psychosis damages the brain.

Or: Patients with intrinsically poor prognosis present later.

Question 9

What are some negative symptoms?

Answer 9

• Alogia: Decrease in verbal output or expressiveness.
• Affective blunting or flattening.

These are expressive deficits.

• Avolition (Decrease in motivation and drive)
• Asociality
• Anhedonia (lack of pleasure from things)

These are avolition for daily life symptoms.

Question 10

What are examples of abnormal affect?

Answer 10

Blunted/Flattened affect (reduction in emotional intensity)

Inappropriate affect:
Laughing at bad news.

Question 11

What are risk factors for suicide in schizophrenia?

Answer 11

Young
Male
High level of education
Fear of mental disintegration.

Depressive symptoms
Active hallucinations
Presence of insight
Family history of suicide

Question 12

What are some positive symptoms?

Answer 12

Hallucinations
Thought disorders (form of thought, stream of thought, control of thought, thought content)

Question 13

What is a delusion?

Answer 13

‘A false unshakeable belief which is out of keeping with the patients cultural and educational background’

However, this definition is not completely true.

Question 14

What are some common delusional themes?

Answer 14

Grandiose: Belief someone has special significance or power.

Paranoid: Persecution or harm by another group

Nihilistic: Belief you are dead or do not exist.

Erotomanic: Somebody believes they have a special relationship with someones.

Question 15

Neurocognitive deficits?

Answer 15

-Intellectual decline
(IQ)
-Memory (verbal and working)
-Executive function (setting goals, making decisions)
-Attention

SIGNIFICANT COGNITIVE IMPAIRMENTS IN 75% OF PEOPLE WITH SCHIZOPHRENIA