Schizophrenia/Mania/Bipolar

Question 1

The strongest risk factor for developing a psychotic disorder (including schizophrenia) is

Answer 1

family history

Question 2

Schizophrenia rx and FH

Answer 2

Having a parent with schizophrenia leads to a relative risk (RR) of 7.5.

Risk of developing schizophrenia
monozygotic twin has schizophrenia = 50%
parent has schizophrenia = 10-15%
sibling has schizophrenia = 10%
no relatives with schizophrenia = 1%

Question 3

risk factors for psychotic disorders include

Answer 3

Black Caribbean ethnicity - RR 5.4
Migration - RR 2.9
Urban environment- RR 2.4
Cannabis use - RR 1.4

Question 4

Schizophrenia - Schneider’s first rank symptoms

Answer 4

may be divided into auditory hallucinations, thought disorders, passivity phenomena and delusional perceptions

Question 5

Schizophrenia - auditory hallucinations

Answer 5

two or more voices discussing the patient in the third person
thought echo
voices commenting on the patient’s behaviour

Question 6

Schizophrenia - thought disorder

Answer 6

thought insertion
thought withdrawal
thought broadcasting

Question 7

Schizophrenia - Passivity phenomena:

Answer 7

bodily sensations being controlled by external influence

actions/impulses/feelings - experiences which are imposed on the individual or influenced by others

Question 8

Schizophrenia - Delusional perceptions

Answer 8

a two stage process) where first a normal object is perceived then secondly there is a sudden intense delusional insight into the objects meaning for the patient e.g. ‘The traffic light is green therefore I am the King’.

Question 9

Schizophrenia features intact insight

Answer 9

false

impaired

Question 10

Schizophrenia features negative sx including

Answer 10

incongruity/blunting of affect, anhedonia (inability to derive pleasure), alogia (poverty of speech), avolition (poor motivation)

Question 11

Schizophrenia speech features

Answer 11

decreased speech

neologisms: made-up words

Question 12

NICE published guidelines on the management of schizophrenia in 2009:

Answer 12

oral atypical antipsychotics are first-line

cognitive behavioural therapy should be offered to all patients

Question 13

Schizophrenia close attention should be paid to which risk-factor modification

Answer 13

close attention should be paid to cardiovascular risk-factor modification

due to the high rates of cardiovascular disease in schizophrenic patients

Question 14

Schizophrenia & cardiovascular risk modification is linked to?

Answer 14

Antipsychotic medication and high smoking rates

Question 15

Schizophrenia: prognostic indicators

Answer 15

strong family history
gradual onset
low IQ
prodromal phase of social withdrawal
lack of obvious precipitant

Question 16

Bipolar disorder is a chronic mental health disorder characterised by

Answer 16

periods of mania/hypomania alongside episodes of depression.

Question 17

Bipolar disorder - Epidemiology

Answer 17

typically develops in the late teen years

life time prevalence: 2%

Question 18

Two types of bipolar disorder are recognised:

Answer 18

type I disorder: mania and depression (most common)

type II disorder: hypomania and depression

Question 19

mania+hypomania both terms relate to

Answer 19

abnormally elevated mood or irritability

Question 20

with mania there is

Answer 20

severe functional impairment or psychotic symptoms for 7 days or more

May require hospitalization due to risk of harm to self or others

May present with psychotic symptoms

Question 21

hypomania describes

Answer 21

A lesser version of mania
Lasts for < 7 days, typically 3-4 days.

Can be high functioning and does not impair functional capacity in social or work setting

Unlikely to require hospitalization

Does not exhibit any psychotic symptoms

Question 22

psychotic symptoms (e.g.delusions of grandeur or auditory hallucinations) which suggest mania/hypomania

Answer 22

mania

Question 23

Bipolar disorder mx

Answer 23

psychological interventions specifically designed for bipolar disorder may be helpful
lithium remains the mood stabilizer of choice. An alternative is valproate

Question 24

Bipolar disorder mx management of mania

Answer 24

consider stopping antidepressant if the patient takes one; antipsychotic therapy e.g. olanzapine or haloperidol

Question 25

Bipolar disorder mx management of depression

Answer 25

talking therapies (see above); fluoxetine is the antidepressant of choice

Question 26

Bipolar disorder why is it important to address co - morbidities

Answer 26

address co-morbidities - there is a 2-3 times increased risk of diabetes, cardiovascular disease and COPD

Question 27

if symptoms suggest hypomania then NICE recommend referral

Answer 27

routine referral to the community mental health team (CMHT)

Question 28

if there are features of mania or severe depression referral

Answer 28

urgent referral to the CMHT should be made

Question 29

Lithium is mood stabilising drug used most commonly used when?

Answer 29

prophylactically in bipolar disorder but also as an adjunct in refractory depression

Question 30

Lithium pharmacokinetics

Answer 30

It has a very narrow therapeutic range (0.4-1.0 mmol/L) and a long plasma half-life being excreted primarily by the kidneys.

Question 31

Lithium Mechanism of action

Answer 31

not fully understood, two theories:
interferes with inositol triphosphate formation
interferes with cAMP formation

Question 32

Lithium adverse effects

Answer 32

nausea/vomiting, diarrhoea
fine tremor
weight gain
idiopathic intracranial hypertension
leucocytosis

Question 33

Lithium hypo/hyper thyroidism

Answer 33

thyroid enlargement, may lead to hypothyroidism

Question 34

Lithium hypo/hyper parathyroidism

Answer 34

hyperparathyroidism and resultant hypercalcaemia

Question 35

Lithium ECG effects

Answer 35

ECG: T wave flattening/inversion

Question 36

Lithium nephrotoxicity occurs due to

Answer 36

polyuria, secondary to nephrogenic diabetes insipidus

Question 37

Monitoring of patients on lithium therapy

Answer 37

after starting lithium levels should be performed weekly and after each dose change until concentrations are stable

once established, lithium blood level should ‘normally’ be checked every 3 months

thyroid and renal function should be checked every 6 months

Question 38

when checking lithium levels, the sample should be taken when

Answer 38

12 hours post-dose

Question 39

lithium therapy patients should be issued with an information booklet, alert card and record book

Answer 39

true

Question 40

The following symptoms are common to both hypomania and mania
Mood

Answer 40

predominately elevated

irritable

Question 41

The following symptoms are common to both hypomania and mania
Speech & thought

Answer 41

pressured
flight of ideas: characterised by rapid speech with frequent changes in topic based on associations, distractions or word play
poor attention

Question 42

The following symptoms are common to both hypomania and mania
Behaviour

Answer 42

insomnia
loss of inhibitions: sexual promiscuity, overspending, risk-taking
increased appetite