Schizophrenia

• What are the symptoms of schizophrenia?

  Auditory hallucinations

  Thought disorders

  Passivity phenomena

  Delusions perceptions

  Impaired insight

  Negative symptoms (blunting of affect, anhedonia, alogia, avolition, social withdrawal)

  Neologism

  Catatonia
• What are the 1st rank symptoms of schizophrenia?

  Auditory hallucinations

  • 2 or more voices discussing patient in 3rd person
  • Thought echo
  • Voices commenting on pts behaviour

  Thought disorders

  • thought insertion
  • thought withdrawal
  • thought broadcasting

  Passivity phenomena

  • bodily sensations being controlled by external influence
  • actions/impulses/feelings - imposed on the individual or influenced by others

  Delusional perceptions

  • 2 stage process
  • normal object perceived -> sudden intense delusional insight into objects meaning for pt
• What is alogia?

  Poverty of speech
• What is avolition?

  Poor motivation
• What are neologisms?

  Made up words
• What factors are associated with poor prognosis in schizophrenia?

  Strong FH

  Gradual onset

  Low IQ

  Prodromal phase of social withdrawal

  Lack of obvious precipitant
• What is the management of schizophrenia?

  Oral atypical antipsychotics (1st line)

  Psychological therapy (supportive & educational)

  CBT - should be offered to all pts

  Family therapy

  Close attention to CV RF modification
• What are the risk factors for schizophrenia?

  FHx of schizophrenia (variants in DRD2, COMT, DAT1 & NRG1)

  Prenatal complications (maternal infections, malnutrition, stress, hypoxia etc.) -> disrupt normal brain development

  Increased paternal age

  Childhood adverse experiences

  Psychological stress

  Stressful life events (bereavement, divorce, abuse)

  Drug misuse (cannabis, cocaine, LSD, amphetamines)
• What are the different classifications of schizophrenia?

  Paranoid schizophrenia

  Hebephrenic schizophrenia

  Catatonic schizophrenia

  Undifferentiated schizophrenia

  Post-schizophrenic depression

  Residual schizophrenia

  Simple schizophrenia
• What are the DDx of schizophrenia?

  Bipolar disorder

  • can both present with psychotic symptoms

  Schizoaffective disorder

  • shares features with schizophrenia & mood disorders

  Major Depressive Disorder w/psychotic features
• What is the common course of schizophrenia?

  Acute episode -> often relapsing & remitting course over extended period of time (years)
• Mood incongruence is typically seen in schizophrenia.
• What are delusions of control?

  A perceived loss of boundary between what is 'self' and 'other'
• What is thought broadcasting?

  Delusional condition in which the affected person believes that others can hear their inner thoughts
• What movement disorder can be seen in schizophrenia?

  Catatonia
• How is schizophrenia diagnosed?

  Clinical diagnosis based on diagnostic criteria
• What is the ICD-11 diagnostic criteria for schizophrenia?

  • At least 2 of the following symptoms present most of the time for a period of 1 month or more… (1 has to be one of the first 4 symptoms)
  • persistent delusions
  • persistent hallucinations
  • thought disorder
  • experience of influence, passivity or control
  • negative symptoms
  • grossly disorganised behaviour
  • psychomotor disturbances
  • Symptoms are not a manifestation of another medical condition, and are not due to the effects of a substance or medication of CNS
• What are the serious side effects on atypical antipsychotics?

  Weight gain

  Excessive salivation

  Agranulocytosis

  Neutropenia

  Myocarditis

  Arrhythmias
• How does tardive dyskinesia present?

  Involuntary, repetitive movements

  Most commonly seen in face & tongue