Schizophrenic disorder

Question 1

define psychosis

Answer 1

impairment of reality testing

Question 2

disorders with psychotic symptoms/differential diagnosis

Answer 2

• brief psychotic disorder: psychotic symp less than 1 month
• schizophreniform disorder: symp > 1 month but < 6 month

-schizophrenia: symp for > 6 month

-mood disorder with psychotic features

-schizoaffective disorder:initially present with mood disorder + psychosis,mood disturbance disappears but psychotic symptoms persist for more than 2 weeks

-delusional disorder ( non bizarre unshakeable false beliefs with no hallucinations)

-psychotic disorder due to gen medical cond/prescribed meds (levodopa,steroids,bromocriptine)/illicit drug use inclusing alcohol

-post partum psychosis

Question 3

phases of schizo

Answer 3

prodromal phase: negative symptoms
acute phase: positive symptoms
residual phase ( aft antipsychotics):negative symptoms

-relapses,remission or residual phase throughout life

Question 4

Negative symptoms of schizophrenia:5A

Answer 4

1)Affective blunting (x emotional expressions
2)Alogia (poverty of speech)
3)Avolition (Lack of motivation)
4)Asocial (social withdrawal)
5)Apathy (detachment fr rest of the world/ lose interest in everything)

Question 5

positive symptoms

Answer 5

-Delusions
-hallucinations
-disorganised speech (incoherence with looseness of association)
-disorganised or catatonic behaviour

Question 6

schneider’s first rank symptoms of schizophrenia ( any 1 for diagnosis aft ruling out mood disorder,organic causes)

Answer 6

1. thought echo: voices telling aloud what patient thinks

2.running commentary

3.3rd person auditory hallucination: 2 or more voices critically discussing about the patient

4.thought broadcasting/accessible thought:belief that his thoughts are conveyed to others

5.though withdrawal:belief in an external force removing one’s thoughts

6.thought insertion/alienation:beleif in an external force putting thoughts into one’s mind

7. delusion of control(passivity phenomena)/made act, made affect:belief that ones feelings and emotions are under control by an external force

8.delusional perception: the unshakeable belief that normal events occuring around have a special meaning or convey a special message to the patient

Question 7

elicit thought echo

Answer 7

do u hear voices that tell u aloud what you are thinking?

Question 8

elicit running commentary

Answer 8

do you hear voices that critically comment on your action

Question 9

elicit 3rd person auditory hallucination

Answer 9

do u hear 2 or more voices critically discussing about you

Question 10

elicit thought broadcasting/accessible thought

Answer 10

do u believe that whatever u think is accessible to others and they come to know them

Question 11

elicit though withdrawal

Answer 11

do you believe that an external force is taking away your thoughts and you are devoid of thoughts

Question 12

elicit thought insertion/alienation

Answer 12

do you believe that your thoughts are not yours but put into u by an external agency or force

Question 13

elicit delusion of control(passivity phenomena)/made act, made affect

Answer 13

do u believe that your emotions n actions are not under your ctrl but controlled by an external force and you are passively receiving them?

Question 14

elicit delusional perception

Answer 14

do you believe that events occurring around you have a special meaning to you or convey a special message to u.

Question 15

paranoid schizo

Answer 15

delusions + auditory hallucinations

Question 16

disorganized/ hebephrenic schizo

Answer 16

disorganised behaviour + disorganised speech + affective blunting

Question 17

catatonic schizophrenia

Answer 17

2 or more catatonic symptoms

Question 18

residual schizo

Answer 18

no longer positive symptoms,only negative symptoms

Question 19

simple schizophrenia

Answer 19

only negative symptoms

Question 20

undifferentiated schizo

Answer 20

symptoms not fitting in any other types

Question 21

elicit delusion of persecution

Answer 21

do u believe that others are plotting to harm u or working against u to endanger your life? if yes explain further

Question 22

elicit delusion of reference

Answer 22

do u believe that wherever u go people are talking about u and making gestures referring to u
OR
do u think the programs in TV and radio are about u or have reference to u

Question 23

delusion of infidelity

Answer 23

do u believe that your spouse/partner is unfaithful to u and having and affair with someone else?
if yes,explain further

Question 24

true hallucinations: 5 req to dif fr pseudohallucination
1) must be perceptions without stimulus

Answer 24

when u hear the voices can you see the persons who are speaking
OR
when u hear the voices can others around you hear these voices

Question 25

2) experience must be objective*

Answer 25

is the voice coming fr out there(objective) or within u

Question 26

3) perceiving through sense organs*

Answer 26

are the voices perceived through the ears?

Question 27

4)should occur in the awakened state whether clear or clouded consciousness

Answer 27

when do u hear the voices? is it related to sleep?

Question 28

5) lack of insight*

Answer 28

is it a real experience or can it be your imagination

Question 29

types of auditory hallucination

Answer 29

2nd person hallucination
3rd person hallucination
command hallucination

Question 30

symptoms of paranoid schizo

Answer 30

bizzare delusions only
OR
any delusions + prominent auditory hallucinations
OR
prominent auditory hallucination only

Question 31

what is meant by disorganised speech

Answer 31

incoherent with thought derailment
- looseness of association

Question 32

symptoms in catatonic schizo:2 or more catatonic symp

Answer 32

1.motor immobility
stupor (mutism+akinesia)
posturing
waxy flexibility

2.catatonic excitement (opp to 1)- excessive purposeless motor activity

3.odd behaviour/speech which is repetitive
automatic obedience
negativism
mannerism
stereotypes
perseveration
ambivalence/ambitendence
echolalia/echopraxia

Question 33

how to maximize compliance

Answer 33

psychoeducation to patient and family
depot antipsychotic injection
home visits
antipsychotic drops

Question 34

comorbidities

Answer 34

depression/post psychotic depression
substance use disorder including alcohol

Question 35

good prognostic indicators

Answer 35

female
late onset
good premorbid func in edu,job,marriage
no fam history
acute onset
prominent positive symp
duration of untreated psychosis less than a year