Schizoprenia, schizotpal and delusional disorders

Question 1

What is the ICD-10 definition of Schizophrenia?

- 4 points

Answer 1

• Distortions of thinking and perception
• Blunted/inappropriate affect
• Intact cognitive function
• Psychosis (delusions and hallucinations)

Question 2

When should the diagnosis NOT be made?

Answer 2

If the patient has severe depression or mania
Brain disease or epilepsy
Intoxication or withdrawal

Question 3

What is the genetic risk or inheriting Schizophrenia from a first degree family member?

Answer 3

10-12%

Question 4

What problems during pregnancy are linked to an increased risk of Schizoprenia?

Answer 4

2nd trimester viral illness
Toxoplasmosis
Pre-eclampsia
Foetal hypoxia
Emergency C-section

Question 5

Describe the dopamine pathway in a Schizophrenic patient

Answer 5

Normal - Dopaminergic neurones release a baseline stream of dopamine into the synaptic cleft. This negatively feedbacks, reducing bursts of dopamine when the pathway is stimulated

Schizophrenic - Reduced baseline dopamine, reduced negative feedback, burst of dopamine much greater than usual

Question 6

What are the positive symptoms of Schizophrenia?

Answer 6

Delusions
Hallucinations
Thought echo, insertion, withdrawal, or broadcasting
Can have catatonic symptoms (movement disorders)

Question 7

What are the negative symptoms of Schizophrenia?

Answer 7

Low motivation
Social withdrawal
Emotional flattening
Self-neglect

Question 8

What do need to diagnose Schizophrenia?

Answer 8

ONE clear cut positive symptom that is present for 1 month or more
OR
TWO less clear positive symptoms for 1 month or more

Question 9

What is the medical management of Schizophrenia?

Answer 9

First line - atypical antipsychotics, risperidone or olanzapine
Other - typical antipsychotics - Haloperidol, Chlorpromazine

Question 10

What are the side effects of antipsychotic medication and are they greater with typical or atypical antipsychotics?

Answer 10

Extrapyramidal side effects greater in typical antipsychotics (Haloperidol, Chlorpromazine)

• Dyskinesia - abnormal muscle movements
• Akatheisa - extreme form of restlessness
• Dystonia - abnormal muscle tensing and contraction
• Parkinsonism

Question 11

Paranoid schizophrenia sypmtoms?

Answer 11

Paranoid delusions, hallucinations (mainly auditory) and perpetual disturbances.
Affect, speech, movement usually unaffected

Question 12

Hebephrenic schizophrenia symptoms?

Answer 12

Affect changes are prominent
Irresponsible behaviour
Disorganised thought
incoherent speech
Few delusions or hallucinations

Question 13

Catatonic schizophrenia symptoms?

Answer 13

• Hyperkinesis or Catatonic stupor (movements stop)
• Violent excitement
• Waxy flexibility (maintenance of limbs and body in externally imposed positions)
• Negativism (an apparently motiveless resistance to all instructions or attempts to be moved, or movement in the opposite direction)