Schizophrenia + Psychosis

Question 1

what is schizophrenia

Answer 1

mental disorder characterised by abnormal social behaviour and failure to understand reality

Question 2

brain abnormalities in schizophrenia

Answer 2

ventricular enlargement
reduced frontal lobe + grey matter volume
disorganised cytoarchitecture in the hippocampus

Question 3

why is there loss of grey matter in schizophrenia

Answer 3

reduced synapses NOT less neurones

Question 4

risk factors for schizophrenia

Answer 4

80% heritability 
daily cannabis use
50% increased risk if viral CNS infection in childhood 
pre-eclampsia
foetal hypoxia

Question 5

what are schneider’s first rank symptoms in schizophrenia

Answer 5

delusional perception 
thought withdrawal/ insertion/ broadcasting 
auditory hallucinations 
somatic hallucinations
passivity phenomena

Question 6

what is passivity phenomena

Answer 6

feelings or actions controlled by ‘external agency’ delusions

Question 7

what are somatic hallucinations

Answer 7

perception of physical experience occurring in the body

Question 8

what is important to ask about auditory hallucinations

Answer 8

2nd person - 'you'
3rd person - 'they' 'he/she'
how many voices?
what do they say?- running commentary/ discussing the patient/ internal dialogue? 
commands?
compelled to act on commands?

Question 9

what is a delusion

Answer 9

a fixed, false belief not based on evidence or fact

Question 10

types of delusions in schizophrenia

Answer 10

grandoise
paranoid
bizarre

Question 11

two types of schizophrenia by symptoms

Answer 11

postitive

negative

Question 12

positive symptoms

Answer 12

delusions
hallucinations
thought disorder

Question 13

negative symptoms

Answer 13

apathy
lack of motivation
social withdrawal
cognitive impairment

Question 14

disorders of thought

Answer 14

thought insertion/ withdrawal/ broadcasting
knights move thinking
flight of ideas
tangential thinking

Question 15

flight of ideas

Answer 15

jumping from one topic to the next with loose connections between concepts

Question 16

knights move thinking

Answer 16

a complete loosening of associations where there is no logical link between one idea and the next

Question 17

tangential thinking

Answer 17

wandering from the topic and never returning to it or providing the information when requested

Question 18

what is catatonia (often seen before introduction of antipsychotic drugs)

Answer 18

state of increased tone in muscles at rest
stupor (unresponsiveness)
hyperactivity
mutism (no speech)

Question 19

by what mechanism is psychosis thought to be induced

Answer 19

overactivity of dopamine in mesocorticgl and mesolimbic systems

Question 20

what drugs can induce psychosis

Answer 20

apomorphine - D2 receptor agonist

amphetamine - releases dopamine into the brain

Question 21

causes of psychosis

Answer 21

schizophrenia 
mania
depression
delirium
dementia
psychoactive substance use

Question 22

definition of psychosis

Answer 22

delusions + hallucinations

• inability to distinguish between experience and reality
• loss of insight

Question 23

what are self referential experiences

Answer 23

the belief that external events are related to oneself

e.g. TV is transmitting messages to me

Question 24

what does the presence of psychosis in depression indicate

Answer 24

very severe depression

Question 25

psychotic symptoms seen in depression

Answer 25

delusions of worthlessness/guilt

hallucinations of accusing/ insulting / threatening voices- typically 2nd person “its your fault”

Question 26

psychotic symptoms seen in mania

Answer 26

grandoise delusions- special ability / religiosity
auditory hallucinations e.g. god’s voice
flight of ideas

Question 27

schizoaffective disorder

Answer 27

schizophrenia + bipolar disorder

Question 28

characteristic of schizoaffective disorder

Answer 28

presence of symptoms typical of schizophrenia + affect disorder
- episodes of either shizo-mania or schizo-depressed

Question 29

what is delirium

Answer 29

acute confusion with transient global disturbance

Question 30

potential causes of delirium

Answer 30

alcohol withdrawal
infection/ septicaemia 
hypoglycaemia 
space occupying lesion 
encephalitis 
drug intoxication/ withdrawal 
post operation hypoxia

Question 31

signs/symptoms of delirium

Answer 31

clouding of consciousness

• ranges from subtle drowsiness to unresponsiveness
• disorientation in time, place, person
• fluctuating severity
• worse at night

impaired concentration/ memory 
visual- hallucinations / illusions 
irritability 
insomnia 
threatening auditory hallucinations
agitation

Question 32

function of D1 receptor

Answer 32

stimulates cAMP

Question 33

function of D2 receptor

Answer 33

inhibits adenylyl cyclase
inhibits voltage activated calcium channels
opens potassium channels

Question 34

which receptor to typical anti psychotics block

Answer 34

D2

Question 35

why are atypical antipsychotics preferred

Answer 35

less likely to cause extra-pyramidal side effects

better at treating negative schizophrenia symptoms

Question 36

why do antipsycotics cause hyperprolactin

Answer 36

block D2 receptors in tuberoinfundibulnar system

Question 37

antipsycotics block histamine receptors, what effects does this cause

Answer 37

increased appetite

sedation

Question 38

anti-psychotics block alpha adrenergic receptors, what effect does this cause

Answer 38

postural hypotension