Schizophrenia

Schizophrenias is a type of primary psychotic disorder that can be chronic or relapsing and remitting. It's risk factors include:

• Family history (major risk factor)

• Heavy cannabis use

• Traumatic childhood events

Presentation

• Auditory hallucinations

• Delusions

• Thought disorder - insertion, withdrawal, broadcasting

• Passivity phenomena - sensation of an external influence controlling thoughts or actions

  
  

• Negative symptoms - Apathy, Lack of motivation, Withdrawal, Self-neglect

Diagnosis

At least 1 of:

• Auditory hallucinations

• Thought echo, insertion, withdrawal or broadcasting

• Delusions of control, influence or passivity

• Persistent delusions of other kinds that are culturally inappropriate and completely impossible

OR at least 2 of:

• Persistent hallucinations in any form

• Breaks in the train of thought, resulting in incohorent speech or neologisms (invented words)

• Catatonic behaviour

• Negative symptoms such as marked apathy, paucity of speech and blunting or incongruity of emotional responses

• Significant and consistent change in the overall quality of personal behaviour

N.B. Symptoms have to be present for 1+ month for a diagnosis to be made.

Investigations

• Clinical diagnosis

• Bloods - FBC, LFTs, U&E, Glucose, TFTs

• Urine toxicology

• STI screen

Management

• Sedatives in the acute setting if acute behavioural disturbance e.g. Lorazepam

• Atypical antipsychotics long-term e.g. Risperidone

  • These are preffered over typical antipsychotics (e.g. haloperidol) as they have a lower risk of extra-pyramidal symptoms

Clozapine is given in treatment-resistant cases. A major side-effect with this is Agranulocytosis, so FBC monitoring needs to be done.

Differentials

• Drug-induced psychosis - Usually goes within a month of drug cessation

• Schizoaffective disorder - Schizophrenic symptoms + mood disorder (depression/mania)

• Persistent delusional disorder - Most prevalent symptom is delusion