SZD

Question 1

What is the lifetime risk of schizophrenia?

Answer 1

1%

Question 2

What are the main risk factors for SZD?

Answer 2

FHx
Environmental (e.g. Winter births, viral illnesses, CNS pathologies)
Life events (e.g. Migration, urban environment, childhood trauma...)
Substance misuse (cannabis, amphetamines)
Perinatal trauma (hypoxia, maternal stress, intrauterine infection)

Question 3

What is the relationship between DOPAMINE and SZD?

Answer 3

TOO MUCH DOPAMINE in SZD (increased occupancy of DA receptors).

3 main brain DA pathways:

1. Mesocortical/Mesolimbic (behaviour - APx want to target this bit) - increased mesolimbic DA activity gives positive symptoms, decreased mesocortical activity gives negative symptoms.
2. nigostriatal - voluntary movements
3. Tuberofundibilar - prolactin secretion

All APx are antagonistic at post-synaptic DA receptors

Question 4

Along with DA, what other NTs are associated with SZD?

Answer 4

5-HT, glutamate, ACh, GABA

Question 5

What is the GENERAL presentation of SZD?

Answer 5

Fundamental and characteristic distortions of thinking and perception.
Affects that are inappropriate and blunted.
(Clear consciousness and intellectual capacity usually maintained)

Question 6

What are the most important psychopathological phenomena in SZD?

Answer 6

Thought echo / insertion / withdrawal / broadcasting,
Delusional perception and control / influence / passivity,
Hallucinatory voices commenting or discussing the pt in 3rd person,
Thought disorders,
Negative symptoms

Question 7

What are Schneider’s first rank symptoms of SZD? (11)

Answer 7

1. Thought echo
2. 3rd person auditory hallucinations (discussing pt)
3. 3rd person auditory hallucinations (running commentary)
4. Thought insertion
5. Thought broadcasting
6. Thought withdrawal
7. Delusional perception
8. Somatic passivity
9. Made acts
10. Made feelings/affects
11. Made impulses

Question 8

Do not diagnose SZD in the presence of:

Answer 8

• In the presence of extensive depressive/manic symptoms (unless SZD px clearly predates affective)
• Overt brain disease (including epilepsy)
• During states of drug intoxication/withdrawal

Question 9

What is paranoid SZD?

Answer 9

Relatively stable, often paranoid delusions, usually accompanied by hallucinations (auditory, perceptual disturbances)

Question 10

What is hebephrenic SZD?

Answer 10

Prominent affective changes (mood shallow, inappropriate)
Delusions and hallucinations (fleeting and fragmentory)
Thought disorganised
Speech incoherent
Social isolation tendency
Rapid development of negative symptoms (esp flattening of affect, loss of volition)

Question 11

What are the POSITIVE symptoms of SZD?

Answer 11

Hallucinations
Delusions
Thought disorder

(Normally people do not experience these symptoms. Calls attention to illness, esp in acute phase. Focus of drug Rx. Good prognosis)

Question 12

What are the NEGATIVE symptoms of SZD?

Answer 12

Avolition (decreased motivation)
Anhydonia (reduced pleasure)
Alogia (poverty of speech)
Asociality (reduced desire for relationships)
Affect blunt

(Part of a continuum of normal traits. Often a late feature. Less treatment responsive)