Schizophrenia and delusional syndromes flashcards
12 high-yield MRCP Part 1 cards from the Intellect Medicos Psychiatry course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.
Study these 12 cards Save progress — free account
-
What is the first-line treatment for first-episode schizophrenia?
Show answer
An oral antipsychotic (e.g. olanzapine or risperidone) plus CBT for psychosis, with family intervention.
Why? NICE recommends combining drug and psychological treatment. The choice of antipsychotic is guided by side-effect profile and patient preference.
-
When is clozapine indicated in schizophrenia?
Show answer
When schizophrenia has not responded to at least two different antipsychotics (at least one atypical) at adequate dose and duration.
Why? Clozapine is the only antipsychotic with clear evidence in treatment-resistant schizophrenia, but its side effects limit it to this setting.
-
Name three of Schneider's first-rank symptoms of schizophrenia.
Show answer
Any three of: thought insertion, withdrawal or broadcasting; audible thoughts; voices discussing or commenting (third person); passivity (made feelings, impulses or actions; somatic passivity); delusional perception.
Why? First-rank symptoms are strongly suggestive of schizophrenia when organic causes and mood disorders have been excluded.
-
What is the name of the delusion that a familiar person has been replaced by an identical impostor?
Show answer
Capgras syndrome.
Why? It is a misidentification delusion seen in schizophrenia, dementia and brain injury.
-
A severely depressed 78-year-old man insists that he is dead and that his insides have rotted away. What is the name of this syndrome?
Show answer
Cotard syndrome (nihilistic delusion).
Why? It is most often seen in severe psychotic depression and may need urgent treatment such as ECT because of poor intake.
-
An 84-year-old woman with advanced macular degeneration sees vivid small people in her living room. She knows they are not real. Cognition is normal and there are no other hallucinations. What is the most likely diagnosis?
Show answer
Charles Bonnet syndrome.
Why? Complex visual hallucinations from severe visual loss, with insight preserved and no other psychiatric or brain disease. Only vision is affected.
-
Name three negative symptoms of schizophrenia.
Show answer
Any three of: flat (blunted) affect, anhedonia, avolition (poor motivation), alogia (poverty of speech), social withdrawal.
Why? Negative symptoms respond poorly to antipsychotics and predict a worse prognosis than positive symptoms.
-
The lifetime risk of schizophrenia is about ______ in the monozygotic twin of an affected person and about 10–15% in the child of one affected parent.
Show answer
50%
Why? This shows a strong genetic contribution, with environmental factors (cannabis, obstetric complications, childhood trauma) also important.
-
The lifetime risk of schizophrenia is about 50% in the monozygotic twin of an affected person and about ______ in the child of one affected parent.
Show answer
10–15%
Why? This shows a strong genetic contribution, with environmental factors (cannabis, obstetric complications, childhood trauma) also important.
-
Name three poor prognostic factors in schizophrenia.
Show answer
Any three of: male sex, gradual (insidious) onset, poor premorbid functioning, no precipitating stressor, predominant negative symptoms, no mood symptoms, family history of schizophrenia.
Why? Good prognosis is linked with female sex, acute onset, a clear precipitant, positive and mood symptoms and good premorbid function.
-
A 32-year-old has had recurrent manic episodes with grandiose delusions. Between mood episodes he still hears voices for several weeks while his mood is normal. What is the most likely diagnosis?
Show answer
Schizoaffective disorder.
Why? Psychotic symptoms occur both with and without prominent mood episodes. In mania or depression with psychotic features, the psychosis occurs only during the mood episode.
-
What is the first-line drug treatment for catatonia (stupor, mutism, posturing, waxy flexibility)?
Show answer
A benzodiazepine, usually lorazepam. ECT is used if it fails or the catatonia is life-threatening.
Why? Catatonia can occur in schizophrenia, mood disorders and medical illness. Antipsychotics can worsen it and raise the risk of NMS.