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| Frage | Antworten |
| What is psychosis? | A state in which there is a loss of contact with reality. Includes: Delusions, Hallucinations and Formal thought disorder. NB: Hallucinations are percepts, not beliefs. |
| Describe the features of a delusion. | A pathological belief a person holds with absolute subjective certainty and it cannot be rationalised away. No external proof - held even with contradictory evidence. It has personal significance. It cannot be understood as part of the subjects cultural or religious background. NB: delusions may be true, but the grounds that they derive the belief from are pathological - this is often the case with delusions of infidelity. |
| What is a hallucination? | Percept without an object i.e. a sensory experience without an external stimulus. Can be any sensory modality. Experienced in external space. |
| What is formal thought disorder? | A pattern of disordered language use that reflects disordered thought form. Can sometimes be difficult to describe. E.g. loosening of association (derailment), flight of ideas, circumstantial thoughts, tangential thoughts, thought block. |
| What are the First Rank Symptoms of Schizophrenia? | Remember as 3 groups of 3; 3 Thought possessions, 3 auditory hallucinations and 3 others. THOUGHT POSSESSIONS: Thought withdrawal, thought insertion and thought broadcasting. AUDITORY HALLUCINATIONS: Thought echo, 3rd person auditory hallucinations, running commentary. OTHERS: Delusion of somatic passivity (patients feel something that is moving them, out of their control - so it is a delusion AND a haptic hallucination), delusional perception and delusions of control (inc. made action, made emotion made volition). If a patient has one of these symptoms and you can't find an organic cause, it is likely they have schizophrenia. |
| What is meant by positive and negative symptoms of schizophrenia? | POSITIVE SYMPTOMS: Delusions, hallucinations, thought disorder, disorganised behaviour. NEGATIVE SYMPTOMS: Blunted affect, avolition, poverty of speech, social withdrawal, reduced attention. Chronic schizophrenics will have more negative symptoms, which may be more difficult to treat, as antipsychotics are only really effective against positive symptoms. |
| What other things should you ask in a psychotic history? | Apart from eliciting psychotic symptoms, also ask about abnormalities in mood,deterioration in personal functioning and risk. |
| Give a differential diagnosis for psychosis. | ORGANIC CAUSES: Delirium (eg sepsis), medication induced (steroids, stimulants, dopamine agonists), endocrine disorders (Cushings, hypo/hyperthyroidism), neurological disorder (eg TLE, MS, movement disorders, Wilson's disease, Huntington's). Other systemic disease (eg porphyria, SLE). OTHER PSYCHIATRIC DISORDERS: Schizophrenia, schizoaffective disorder, delusional disorder, schizotypal disorder, acute and transient psychotic disorder, mood disorder (mania, severe depression). SUBSTANCE AND ALCOHOL MISUSE: alcohol withdrawal, intoxication with stimulants, cannabis. |
| What are the features of delusional disorder? | Just delusions, no disorders of perception. These patients have non-bizarre delusions, eg infidelity, hypochondriacal. |
| Describe the features of Schizophrenia | Need to have had symptoms persistently for at least 28 days. No "organic" cause. First rank symptoms. Persistent hallucinations and delusions. May also have negative and cognitive symptoms. (IQ is often 10 points lower than average. Brain atrophies over time. Lack of social conditioning - Theory of Mind). |
| What is the epidemiology of Schizophrenia? | Lifetime risk is 1/100. M=F. Very rare below ge 14. Rare 16 to 18 years.Peak incidence is 23 years in men and 26 years in women. Urban>rural. Lower social class. |
| What is the aetiology of schizophrenia? (Bio-Psycho-Social model). | BIO: Genetic/family history (poss multiple genes). Obstetric complication - increased risk. Dopamine theory. Neurodevelopmental theory. PSYCHO: Cognitive errors - jumping to conclusions. Premorbid schizotypal personality. SOCIAL: Urban living (x2 to x3 risk). Migrations (x3). Life events (including physical and sexual abuse). Ethnicity (x4 in Afro-Caribbeans in UK; higher incidence also in South Asians). |
| Describe in more details the increased familial risk of schizophrenia. | IDENTICAL TWIN = 46% risk ONE SIBLING/FRATERNAL TWIN = 15% BOTH PARENTS = 40% ONE PARENT = 15% ONE GRANDPARENT = 6% NO RELATIVES AFFECTED = 1% |
| What is the prodrome like for schizophrenia? | Time when individual is gradually developing symptoms but has not met criteria for diagnosis: Non-specific negative symptoms. Emotional distress/agitation without reason. Transient psychotic symptoms. The longer the DUP (duration of untreated psychosis), the worse outcome. Average DUP is over a year. |
| What are good prognostic features for schizophrenia? | Female gender. Married. Family history of affective disorder. Acute onset. Good premorbid personality. Early treatment. Prominent mood symptoms. Good response to treatment. |
| What are poor prognostic features for schizophrenia? | Generally the opposite to the good prognostic features already mentioned, PLUS: family history of schizophrenia. High EE. Substance misuse. Prominent negative symptoms. early onset. Lack of insight/non-compliance. |
| What is the breakdown of outcomes in schizophrenia? | 20% after first episode never have another episode. 30% have continuous illness, not free of symptoms. 25% improve, but require an extensive support network. There is risk of premature death due to suicide, cardiovascular disease and type 2 diabetes. |
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