schizophrenia (longer)

Question 1

define psychosis

Answer 1

inability to distinguish symptoms of delusion, hallucination or disordered thinking from reality

Question 2

define a delusion?

Answer 2

unshakeable belief which is out of keeping with person’s social & cultural background

it is held with extraordinary conviction

Come in many types e.g. grandiose, paranoid, hyperchondiacal etc

Question 3

examples of delusion

Answer 3

grandiose

paranoid

hypochondriacal

self referential

Question 4

aetiology of psychosis

Answer 4

biological factors

psychological factors

social factors

Question 5

biological factors involved in the aetiology of psychosis

Answer 5

genetics

neurochemistry

obstetric complications

maternal influenza

malnutrition and famine

winter birth

substance misuse

Question 6

biological factors involved in the aetiology of psychosis

Answer 6

genetics

neurochemistry

obstetric complications

maternal influenza

malnutrition and famine

winter birth

substance misuse

Question 7

Who gets Schizophrenia?

Answer 7

Onsets mostly 15-35 yrs and affects both genders equally

Hits a surprisingly high 1 in 100 people

Question 8

What’s the difference between +ve and -ve symptoms of schizophrenia?

Answer 8

+ve add something to the patient’s mind e.g. a hallucination, delusion or disordered thinking

-ve take something away e.g. apathy, anhedonia or lack of/incongruity of emotional affects & reactions

Question 9

Before diagnosing schizophrenia, what other psychotic illnesses should be ruled out first?

Answer 9

Transient psychosis - often caused by substance abuse
Affective psychoses (Depressive or Manic Episode with Psychotic Symptoms)
Delirium
Other physical problem e.g. brain tumour

Question 10

A psychotic patient is suffering from prominent visual hallucinations, is oft terrified, has persecutory and fleeting delusions all of which worsens at night. Is this schizophrenia?

Answer 10

Not likely, it sounds like a patient suffering from delirium.
The fear affect, evanescent delusions and worsening at night is all indicative

Question 11

What pattern would the symptoms follow in a depressive psychosis?

Answer 11

Delusions are likely to be very -ve e.g. of guilt, worthlessness or persecution
Hallucinations are often derogatory voices

LOW MOOD

Question 12

How would a manic psychoses present?

Answer 12

Delusions of grandeur, special powers or a messianic role

ELEVATED MOOD

Question 13

How do we manage schizophrenia?

Answer 13

Early Intervention Services
Antipsychotics
Psychological Interventions
Perinatal Care

Question 14

What are Early Intervention Services

Answer 14

Early services provided by a clinician in partnership with other professions e.g. social work to address social issues surrounding the patient including:;

• Housing
• Problems at work or with benefits
• Social skills training
• Substance abuse
• Support for families/carers

Question 15

What psychological interventions are common in schizophrenia?

Answer 15

CBTp
Family therapy
Cognitive Remediation
Social skills training

Question 16

What do we mean by perinatal care with schizophrenic patients?

Answer 16

A lot of anti-psychotics are teratogenic so you must counsel on this and help them if they wish to become pregnant

Also there is a high risk of relapse in the post-partum which patient’s must be counselled on and prepared for

Question 17

What are some good prognostic factors?

Answer 17

Absence of FH
Acute onset
No -ve symptoms
Female
Late Onset
Supportive Home & good Premorbid function
A clear Precipitant

Question 18

What are some bad prognostic factors?

Answer 18

Insidious onset
Starts in childhood
-ve symptoms

Question 19

What are the symptoms of disordered thinking?

Answer 19

Thought Echo - Hear’s own thoughts outloud

Insertion - Someone else putting thoughts in my head

Withdrawal - Thoughts dropping from or being stolen from my head

Broadcasting - Other people can hear my thoughts

Question 20

How do we diagnose Schizophrenia? (ICD-10)

Answer 20

Atleast one of … for >1month:

• Alienation of thought
• Delusions of control, influence or passivity
• Hallucinatory voices (often a commentary)
• Persistant impossible, culturally innapropriate delusions

Question 21

We can also diagnose schizophrenia with 2 of the following list: (still under ICD-10)

Answer 21

• Persistant hallucinations of any kind (every day for 1 month)
• Breaks/interpolations in train of thought or neologisms –> Incoherent speech
• Catatonic behaviour e.g. random excitement, posture, waxy flexibility, negativism or stupor
• Negative symptoms e.g. apathy, anhedonia or lack of affect