wamss notes schizophrenia and psychotic disorders

Question 1

schizophrenia

Answer 1

Mental disorder characterized by abnormal social behaviour and failure to understand what is real. Characterised by disturbances in speech, perception, cognition, volition & with impaired
functioning

Question 2

epidemiology of schizophrenia

Answer 2

0.7%
Onset M 18-25 F 25-45
Men 4:1

Question 3

criteria for schizophrenia

Answer 3

A. Two of the following, each present for a significant portion of time during 1 month. At least
one of these must be 1-3 (+6 months Sx total)
- Delusions.
- Hallucinations.
- Speech Disorganised (e.g., frequent derailment or incoherence).
- Behaviour grossly disorganized or catatonic
- Negative symptoms (i.e., diminished emotional expression or avolition).
B. Social / occupational dysfunction
C. Continuous signs of the disturbance persist for at least 6 months, must include 1 month of
symptoms that meet criteria A
D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have
been ruled out
E. Not attributable to the physiological effects of a substance or medical condition.

Question 4

subtypes of schizophrenia

Answer 4

paranoid type
disorganised type
catatonic type
undifferentiated type
residual type

Question 5

paranoid type schizophrenia

Answer 5

positive Sx of a persecutory of conspirator nature

Question 6

disorganised type schizophrenia

Answer 6

disorganisation of thought process, emotional + communication
impairment

Question 7

catatonic type schizophrenia

Answer 7

dramatic reduction in movement or dramatic increase in activity

Question 8

undifferentiated type schizophrenia

Answer 8

meets general criteria but nil subtype

Question 9

residual type schizophrenia

Answer 9

Sx less severe than in acute schizophrenia

Question 10

pathophysiology schizophrenia

Answer 10

Evidence for involvement of multiple neurotransmitters.
↑ Dopamine, ↑ Serotonin, ↑ a-Adrenergic ↓ Glutamine, ↓ GABA

Question 11

dopamine hypothesis

Answer 11

Symptoms of schizophrenia largely attributed to disturbed & hyperactive dopamine signal
transduction. Due to the observation that most antipsychotics have dopamine receptor
antagonist effects
- Mesolimbic pathway – Positive symptoms
- Mesocortical pathway – negative symptoms
- Alterations to Brocha’s & Wernicke’s - hallucinations

Question 12

positive schizophrenia symptoms

Answer 12

• Delusions
• Hallucinations
• Disorders of thought + speech
• Disorganised / catatonic behaviour
• Impaired Insight

Question 13

negative symptoms

Answer 13

Deficits of normal emotional responses or other through process, less responsive to Tx &
associated with decreasing in functioning
- Avolition- decrease in motivation to complete goals
- Anhedonia – lack of enjoyment
- Flat or Blunted Affect
- Alogia- Poverty of speech- lack of content in speech
- Poor self-care
- Social withdrawal

Question 14

Ddx for schizophrenia

Answer 14

Substance induced psychosis
Psychosis due to organic causes / medical condition
Mood disorder with psychotic features / Schizoaffective disorder
Dementia & Delirium

Question 15

Tx for acute psychotic episode in schizophrenia

Answer 15

Atypical Antipsychotics – Olanzapine #1, Quetiapine, Aripiprazole, Risperidone
↓ risk of extrapyramidal effects ↑ metabolic syndrome

Question 16

second line Tx for acute schizophrenia

Answer 16

Different Atypical Antipsychotic
Typical Antipsychotic – Chlorpromazine, Haloperidol
↑ extrapyramidal symptoms

Question 17

first line Tx for maintenance therapy for schizophrenia

Answer 17

Atypical Antipsychotics – Quetiapine, Aripiprazole, Olanzapine, Risperidone

Question 18

second line treatment for maintenance therapy for schizophrenia

Answer 18

Different Atypical Antipsychotic
Typical Antipsychotic – Chlorpromazine, Haloperidol

Question 19

depo injections for schizophrenia

Answer 19

TA – haloperidol, zuclopenthixol
AA – aripiprazole, olanzapine, paliperidone, risperidone

Question 20

combination antipsychotic use

Answer 20

Combination antipsychotic use seldom leads to additional clinical improvement & causes
adverse effects

Question 21

non pharmacological treatment for schizophrenia

Answer 21

Psychoeducation- ↑ compliance as insight usually remains poor
Functional Remediation- group program addressing attention, memory, executive functioning & daily functioning
Lifestyle Improvements
Social support
Employment support programs – 80% unemployed
CBT – useful for residual Sx
Substance abuse management

Question 22

Tx for acute agitation in schizophrenia

Answer 22

Sedation & Antipsychotic Properties, need to be short acting
Quetiapine: 50-100mg – oral only
Olanzapine: 5-10 – oral & IM
Midazolam – IM or IV – rapid acting, respiratory depression as a side effect

Question 23

prognosis for schizophrenia

Answer 23

20% reduction in life expectancy
Suicide accounts for 10-30% of deaths
Morbidity – drugs, alcohol. STIs, epilepsy, diabetes
80% reoccurrence
15% functional recovery

Question 24

brief psychotic disorder

Answer 24

Presence of same Sx as Schizophrenia for at least 1-day bur less than 1-month with eventual return to premorbid level of functioning
1day – 1 month

Question 25

what should you do for brief psychotic disorder

Answer 25

Treat for 3-9 months then wean & see if psychosis reoccurs

Question 26

schizophreniform disorder

Answer 26

Meets the same criteria as schizophrenia

1 – 6 months

Question 27

schizoaffective disorder

Answer 27

Disorder that has features of both schizophrenia & a mood disorder
Major manic, depressive or mixed episode with concurrent symptoms that meet criteria A for schizophrenia
Generally psychotic & depressive symptoms have been present for similar amounts of time

Question 28

delusional disorder

Answer 28

Presence of one or more delusions with a duration of at least 1month
Criteria A for Schizophrenia is not met
Hallucinations, if present, are not prominent and are related to the delusional theme
Apart from the impact of delusions functioning is not significantly impaired
If mania or major depression has occurred they have been brief compared to the delusions

Question 29

to qualify for delusional disorder, the delusions have to have been present for at least

Answer 29

one month

Question 30

catatonia

Answer 30

Essential feature is marked psychomotor disturbance that may involve decreased motor activity, decreased
engagement during interview of physical examination or excessive peculiar motor activity
Usually associated with another mental disorder

Question 31

to qualify as catatonia, patients must have 3 or more of the following symptoms

Answer 31

• Stupor- no psychomotor activity, not actively reacting to the environment
• Catalepsy- passive induction of a posture held against gravity
• Waxy flexibility- resistance to positioning by the examiner
• Mutism- little or no verbal response
• Negativism- opposition or no response to external stimuli
• Posturing- spontaneous active maintenance of a posture against gravity
• Mannerism- odd, circumstantial caricature of normal actions
• Stereotypy- repetitive, abnormally frequent, non-goal directed movements
• Agitation, not influenced by external stimuli
• Echolalia- mimicking another’s speech
• Echopraxia- mimicking another’s movements

Question 32

substance / medication induced psychotic disorder

Answer 32

Delusions and/or hallucination that are judged to be due to the physiological effects of a substance/medication
A. Presence of one or both of the following symptoms
- Delusions
- Hallucinations
B. There is evidence that:
- The Sx developed during or soon after substance intoxication or withdrawal after exposure to a
medication
- The involved substance is capable of producing the Sx in criteria A
C. It is not better explained by a psychotic disorder

Question 33

psychosis due to another medical condition

Answer 33

Delusions or hallucinations that are judged to be attributable to the physiological effects of another medical
condition and are not better explained by another mental disorder