Schizophrenia & Psychotic Disorders

Question 1

What is the clinical presentation of Psychosis?

Answer 1

Hallucinations which have the full force and clarity of true perception.

Auditory / Visual / Tactile / Olfactory / Gustatory

Question 2

What are the 4 main types of delusions?

Answer 2

• Grandiose
• Paranoid (persecutory)
• Hypochondriacal
• Self Referential

Question 3

What is Schizophrenia (3)

Answer 3

A severe mental illness that affects:

Thinking
Emotion
Behaviour

Question 4

What illness is the commonest cause for psychosis?

Answer 4

Schizophrenia

Question 5

How many people does schizophrenia effect?

Answer 5

1 out of 100 people

Question 6

What is the onset of schizophrenia? (2)

Answer 6

15 - 35 years of age.

M : F
1 : 1

Question 7

What are the 3 most common conditions associated with psychosis?

Answer 7

• Schizophrenia
• Delirium
• Severe affective disorder

Question 8

What are the “positive” symptoms of schizophrenia? (3)

Answer 8

Hallucinations
Delusions
Disordered Thinking

Question 9

What are the “negative” symptoms of schizophrenia? (3)

Answer 9

Apathy
Lack of interest
Lack of emotions

Question 10

What are the KEY diagnostic criteria of schizophrenia? (5)

Answer 10

One or more of the following symptoms for OVER A MONTH:

• Alienation of Thought
• Delusions of control (influence/passivity)
• Hallucinatory VOICES having a RUNNING commentary
• Persistent Delusions

Question 11

What are the MINOR diagnostic criterion for schizophrenia?

Answer 11

Two or more of the following:

• Persistent hallucinations
• Neologisms
• Catatonic Behaviour
• Negative Symptoms

Question 12

What are some differentials of of Schizophrenia?

Answer 12

• Delirium / Acute Organic Brain Syndrome (especially if there’s a fluctuation or worsening at night)
• The Affective Psychoses (Depressive / Manic)
• Schizoaffective Disorder

Question 13

How do we manage schizophrenia? (5)

Answer 13

SIGN1 GUIDELINES: Early intervention is key. The longer without treatment, the worst the prognosis.

• Antipsychotics (choose one with the most appropriate side effects)
• CLOZAPINE is treatment of choice (but no breastfeeding)
• Psychological therapies (CBT for psychosis)
• Relapse prevention

Question 14

What defines recovery for schizoprenia?

Answer 14

“being able to live a meaningful and satisfying life as defines by the person in the present or absence of symptoms”

Question 15

What is the prognosis for schizophrenia?

Answer 15

80% recover after first episode of psychosis.

50% have moderate recovery

Question 16

What is the Scottish Recovery Network of recovery? (3)

Answer 16

Having the ability to living a meaningfully satisfying life

As defined by each individual

In the presence / absence of symptoms.

Question 17

What are some good prognostic factors for schizophrenia? (8)

Answer 17

• Absence of Family History
• Good premorbid function
• Clear precipitant
• Acute onset
• Mood disturbance
• Prompt treatment
• Maintenance of initiative
• Maintenance of motivation

Question 18

What constitutes as a good premorbid state in psychiatry?

Answer 18

Stable Relationships

Stable Personality

Question 19

What are some poor prognostic factors for schizophrenia?

Answer 19

• Slow & insidious onset

- Negative symptoms suggest worse outcome

Question 20

What is the suicide risk in someone with schizophrenia?

Answer 20

9 times higher than average

Violent death is twice as likely.

Question 21

What are some differentials for schizophrenia?

Answer 21

• Psychotic Mania
• Delirium
• Drug induces psychosis
• Medication overdose (steroids)
• Cerebral causes (tumour, epilepsy, infection etc.)
• Endocrine disease (thyroid, Cushing’s, Addisons)
• Systemic illness (anaemia, carcinoma or sarcoid)