Schizophrenia (psychotic disorders)

Question 1

Who does schizophrenia affect?

Answer 1

-Can develop at any age but starts most commonly in adolescence and early 20s
-Accounts for 25% of all psychiatric admissions among 10-18 year-olds
-Peak age of onset is later in women
-Men more likely to have negative symptoms and more serious disease
-More common in migrants, urban areas

Question 2

What causes schizophrenia?

Answer 2

-Multiple factors
-Short-lived illnesses are associated with cocaine, amphetamine and cannabis use
-Cannabis is a particular risk in both causing and enhancing future risk of schizophrenia

Question 3

What risk factors are there for schizophrenia?

Answer 3

-FH
-IU and perinatal complications eg prom birth, LBW
-IU infection
-Abnormal early cognitive / neuromuscular development
-Social isolation
-Abnormal family interactions

Question 4

How does schizophrenia present?

Answer 4

-Hallmark symptoms:
–Delusions
–Hallucinations
–Thought disorder
–Lack of insight
(–External control of emotions, somatic passivity)
-Schneider’s first rank symptoms are:
–Auditory hallucinations (3rd person, running commentary, thought echo)
–Delusions about external thought control (thought insertion / withdrawal / interruption / broadcast)
–Delusion perceptions
-Negative / chronic symptoms:
–Underactivity
–Low motivation
–Social withdrawal
–Self neglect
–Emotional flattening

Question 5

How would you diagnose someone with schizophrenia?

Answer 5

-Presence of at least one first rank symptom on more days than not for at least 4 weeks
-Full physical examination and MSE

Question 6

What are the differential diagnoses for schizophrenia?

Answer 6

Organic:
-Drug-induced psychosis
-Temporal lobe epilepsy
-Encephalitis
-Dementia
-Delirium
-Cerebral syphilis
Psychiatric:
-Mania
-Psychotic depression
-Some personality disorders
-Panic disorders
-Dissociative identity disorder

Question 7

How would you investigate a patient with schizophrenia?

Answer 7

LFTs (alcohol abuse)
FBC (macrocytosis –> alcohol abuse)
Serological tests for syphilis
Urine screen for drugs

Question 8

What treatment should be offered for schizophrenia?

Answer 8

Psychological support eg support groups, art therapy, CBT
Biological:
-Highly variable depending on the patient
-Risperidone, Olazanzapine, Amisulpride (2nd gen) are recommended
-Chlorpromazine (1st gen) is a suitable alternative
-Beware EPSEs with 1st gen and metabolic disturbance in 2nd gen
-Aripiprazole is recommended for 15-17yrs
-Beware of raised prolactin (apart from Aripiprazole)
-Clozapine is used in resistant schizophrenia