Y4 - Schizophrenia Tutorial

Question 1

What is psychosis?

Answer 1

When a person loses touch with reality

Question 2

What is schizophrenia?

Answer 2

A severe, long term mental disorder, characterised in the acute stage by psychotic symptoms and in the chronic stage by deficits of affect, motivation and thinking

Question 3

What are the clinical features of schizophrenia?

Answer 3

Delusional beliefs
Thought disorder
Hallucinations
Passivity phenomenon 
Thought withdrawal, insertion, broadcasting
Delusional perceptions

Question 4

What are the negative symptoms of schizophrenia?

Answer 4

Apathy, amotivation, avolition, affective blunting, alogia (poverty of speech), anhedonia, disturbed attention

May also get occupation decline and cognitive dysfunction

Question 5

What are the types of delusions?

Answer 5

Persecutory 
Reference
Bizarre
Grandiose 
Depressive 
Passivity 
Religious

Question 6

What are grandiose delusions?

Answer 6

Believing you are famous, a god, or publicly important

Question 7

What are persecutory delusions?

Answer 7

Suspecting you are being spied on or followed etc.

Question 8

What are somatic delusions?

Answer 8

Believing you have a medical condition/physical deficit that you don’t

Question 9

What are delusions of reference?

Answer 9

Thinking random events contain a special meaning for you alone

Question 10

What are bizarre delusions?

Answer 10

Believing in things that are impossible

Question 11

What is thought alienation and that are the forms of it?

Answer 11

Where patient feels they no longer have control of their own thoughts

Thought broadcasting
Thought insertion
Thought withdrawal

Question 12

What is thought broadcasting?

Answer 12

Believing others can hear or are aware of an individual’s thoughts

Question 13

What are the made phenomena?

Answer 13

“Made” Feeling: the patient has the experience that his feelings are not his own, they have been imposed upon him
Made” Impulses: the patient experiences and generally acts upon a compelling impulse which he believes is not his own
“Made” Acts: the patient experiences his action and his will to be under the control of an outside force

Question 14

What are passivity phenomena?

Answer 14

People feel that some factor of themselves is under the management of other people

Question 15

What is derailment?

Answer 15

Thought disorder symptom marked by interruptions to thought and jumping from one thought to another disconnected thought

Question 16

What are some differential diagnoses for schizophrenia?

Answer 16

Schizotypal, schizoaffective and other delusional disorders
Mania
Personality Disorder
Delirium 
Drug induced
Intracranial pathology
Epilepsy 
Endocrine pathology

Question 17

What investigations should you do if you suspect schizophrenia?

Answer 17

Physical examination
Bloods - FBC, UE, TFTs
Urine - screen for drugs of abuse, microscopy
CT
EEG
ECG required before starting antipsychotic medications to check QTc

Question 18

What are the predisposing factors of schizophrenia?

Answer 18

Genetics

Neurodevelopment

Question 19

What are the precipitating and perpetuating factors of schizophrenia?

Answer 19

Substance misuse
Non-adherence with medications
Life events
High expressed emotion in the family
Poor social support

Question 20

When does the age of onset of schizophrenia tend to be?

Answer 20

Late teen to mid-30s

Question 21

What is the proposed pathology of schizophrenia?

Answer 21

Dopamine theory
Neurodevelopmental disorder - reduction in brain volume (esp frontal and temporal lobes), functional differences in frontal, temporal lobes and hippocampus

Question 22

What pathway is responsible for positive symptoms of schizophrenia?

Answer 22

Misolimbic (from ventral tegmental area to nucleus accumbens)

Question 23

What pathway is responsible for the negative symptoms of schizophrenia?

Answer 23

Mesocortical (VTA to prefrontal cortex)

Question 24

What pathway is responsible for ESPEs?

Answer 24

Nigrostriatal

Question 25

What pathway is responsible for hyperprolactinaemia?

Answer 25

Tuberoinfindibular

Question 26

What are the potential treatments for schizophrenia?

Answer 26

Antipsychotics
Benzos
ECT
CBT
Social input - CPN, social work, rehab, housing

Question 27

Give examples of typical antipsychotics

Answer 27

Haloperidol, chlorpromazine

Question 28

Give examples of atypical antipsychotics

Answer 28

Olanzopine, quetiapine, risperidone, arirpiprazole

Question 29

What is a poor prognosis with schizophrenia associated with?

Answer 29

Male, unmarried, early/insidious onset, non-paranoid type, negative/cataonic symptoms, absence of affective symptoms, FH of schizophrenia