Psychiatry
Schizophrenia and Psychotic Disorders
Schizophrenia for MBBS and NEET-PG: positive and negative symptoms, first-rank features, antipsychotics, extrapyramidal effects and neuroleptic malignant syndrome, mapped to NMC codes PS5.
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Schizophrenia and Psychotic Disorders
Schizophrenia for MBBS and NEET-PG: positive and negative symptoms, first-rank features, antipsychotics, extrapyramidal effects and neuroleptic malignant syndrome, mapped to NMC codes PS5.
This chapter covers schizophrenia and the wider group of psychotic disorders. It details the positive and negative symptoms and first-rank features, the dopamine hypothesis, the typical and atypical antipsychotics with their side effects, and the emergencies and prognostic factors examiners test.
High-yield: Schizophrenia and Psychotic Disorders
- Schizophrenia is a chronic psychotic disorder with positive, negative and cognitive symptoms, typically beginning in late adolescence or early adulthood.
- Positive symptoms are delusions, hallucinations, disorganised speech and behaviour; negative symptoms are blunted affect, avolition, alogia and social withdrawal.
- Auditory hallucinations, especially a running commentary or third-person voices, are characteristic of schizophrenia.
- First-rank symptoms described by Schneider include thought insertion, withdrawal and broadcasting, delusional perception and passivity phenomena.
- The dopamine hypothesis holds that excess dopamine activity in the mesolimbic pathway drives positive symptoms.
- Diagnosis under ICD generally requires characteristic symptoms present for about a month.
- Antipsychotics are the mainstay of treatment; typical agents block dopamine D2 receptors and control positive symptoms.
- Atypical antipsychotics such as risperidone and olanzapine treat both positive and negative symptoms with fewer movement side effects.
- Clozapine is reserved for treatment-resistant schizophrenia and requires blood monitoring for agranulocytosis.
- Extrapyramidal side effects of typical antipsychotics include acute dystonia, parkinsonism, akathisia and tardive dyskinesia.
- Neuroleptic malignant syndrome is a rare emergency with high fever, muscle rigidity, autonomic instability and a raised creatine kinase.
- A good prognosis is suggested by acute onset, a clear precipitant, prominent mood symptoms and good premorbid functioning.
- Brief psychotic disorder, schizophreniform disorder and schizoaffective disorder differ from schizophrenia mainly by duration and mood features.
- Long-term management combines antipsychotics with psychosocial rehabilitation, family education and adherence support.
Antipsychotics and adverse effects
- **Typical antipsychotics:** Block dopamine D2 receptors; control positive symptoms but cause extrapyramidal effects.
- **Atypical antipsychotics:** Risperidone, olanzapine; treat positive and negative symptoms with fewer movement effects.
- **Clozapine:** For treatment-resistant disease; monitor for agranulocytosis.
- **Emergencies:** Neuroleptic malignant syndrome: fever, rigidity, autonomic instability, raised creatine kinase.
NMC competencies in this chapter
- **PS5.1:** Distinguishing psychotic and non-psychotic disorders
- **PS5.2:** Clinical features and positive and negative symptoms of schizophrenia
- **PS5.3:** Treatment of schizophrenia including behavioural methods
- **PS5.4:** Family education in schizophrenia
- **PS5.5:** Pharmacological basis and side effects of antipsychotics
- **PS5.6:** Conditions for specialist referral in psychosis
Frequently Asked Questions
What are positive and negative symptoms of schizophrenia?
Positive symptoms are added experiences such as delusions and hallucinations, while negative symptoms are losses such as blunted affect, avolition and social withdrawal. Negative symptoms often respond less well to treatment.
What is neuroleptic malignant syndrome?
It is a rare but life-threatening reaction to antipsychotics with high fever, muscle rigidity, autonomic instability and a raised creatine kinase. It requires stopping the drug and urgent supportive care.
When is clozapine used?
Clozapine is reserved for treatment-resistant schizophrenia that has failed at least two other antipsychotics. It needs regular blood monitoring because of the risk of agranulocytosis.
What are the extrapyramidal side effects?
They are movement disorders from dopamine blockade: acute dystonia, drug-induced parkinsonism, akathisia and, with long-term use, tardive dyskinesia.
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