Important Questions for IGNOU PGDCFT MSCCFT MCFT002 Exam with Main Points for Answer - Unit 9

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Unit 9 Schizophrenia and Other Psychotic Disorders

1. Differentiate between delusion and hallucination.

Delusion is a false, unshakeable belief that is out of keeping with the patient’s social and cultural background and this belief is not shared by other people of the same social and cultural background.

Hallucination is defined as ‘a perception without an object’ referred to sense organs of the body. This false perception is not a sensory distortion or a misinterpretation, but which occurs at the same time as real perceptions.

2. Define Psychosis.

Psychosis is defined broadly as impairment of reality testing. The person may have delusions or hallucinations or disorganised behaviour

3. What are the causes of psychosis?

Psychosis can be caused by physical conditions known as organic psychosis, from psychoactive substance use such as cannabis known as substance induced psychosis or it can be without apparent cause known as psychological or functional psychosis.

4. Enumerate the psychotic disorders other than schizophrenia as listed in ICD-10.

Psychotic disorders other than schizophrenia in ICD-10 chapter V, mainly are:

i) Schizotypal disorder,

ii) Persistent delusional disorders,

iii) Acute and transient psychotic disorders,

iv) Induced delusional disorder,

v) Schizoaffective disorder,

vi) Other non-organic psychotic disorder, and

vii) Unspecified non-organic psychosis.

5. Name the hallucinations which are characteristic of schizophrenia.

Auditory hallucinations are the most common type of hallucinations in schizophrenia. Sometimes, patients may have visual or tactile or olfactory hallucinations.

Following types of auditory hallucinations are characteristic of schizophrenia:

• Running commentary: Voices comment on the behaviour,

• Commanding: Voices command them to do things,

• Third person: Voices talk to each other about the patient, and

• Thought echo: Patients hear aloud exactly whatever they think.

Somatic passivity is special type of hallucinations in which the patient believes that she or he is passive recipient of the bodily sensations caused by an external agency. The patient may report that electric sensations in her or his body are being caused by her or his neighbours and she or he is reluctantly receiving them causing her or him discomfort.

6. Name delusions that are found in schizophrenia / What are the false beliefs that persons with schizophrenia may have?

Delusions that are seen in schizophrenia are usually false, firm beliefs considered as strange by family members or friends of the patient. These can be any of the following type:

• Delusion of control wherein patients believe that some external agency is controlling their emotions, behaviour or sensations and they have to unwillingly feel, do or experience these.

• Delusion of reference in which patients believe that people are talking about them or are laughing at them even when it is not so in reality. They may believe that there is talk about them on television, radio and newspaper.

• Delusions of persecution where patients believe that they are being cheated, harassed or poisoned. They may believe that others are spying on them, plotting against them or their family members.

• Bizarre delusions are improbable and absurd beliefs, for example the patient may report that ‘four persons are residing inside my stomach and whenever they fight among themselves they cause pain in my stomach’.

• Delusions of thought withdrawal and insertion in which patients believe that their thoughts are withdrawn or new thoughts are being inserted into their mind by some invisible external force.

• Delusion of thought broadcast where patients believe that their thoughts are known to others without their speaking them aloud through some invisible mechanism.

• Delusional perception in which patient attributes a new meaning, usually in the sense of self-reference, to a normally perceived object. For example, sudden belief in a patient that a tree in front of his house meant that he was not a man. This tree was there all these years in front of his house and he never thought of it earlier.

7. Enumerate reasons for poor compliance to treatment in persons with schizophrenia.

Main reasons for poor compliance to treatment in persons with schizophrenia are as follows:

• Patient or family members may believe that schizophrenia is not a medical illness; they may not believe that medications can treat it,

• No quick benefit and rather waiting for some more time, patient or family members can discard treatment,

• Myth that drugs are mind controlling or drugs are addictive,

• Prescribing doctors may not have explained the treatment plan adequately,

• Side effects of the drugs,

• Family members may incorrectly stop treatment when the patient is feeling better,

• Substance abuse like alcohol, cannabis interfere with the effectiveness of treatment, leading to stopping the medications, and

• Cost of treatment and long term of treatment.

8. How does psychoeducation help in the treatment of schizophrenia?

Psychoeducation about schizophrenia is targeted towards patient and family members. Components included are:

• Schizophrenia is a biological disease like heart disease with multifactorial causation.

• Rationale for various treatments, side effects and dosage of drugs.

• Ensuring drug compliance.

• Variation in outcome.

• Keeping a record of symptoms, name of medications, side effects and effectiveness of the medications.

• Identification of symptoms early and to prevent a relapse.

• Role of drug compliance.

• Role of daily planned and structured routine, engaging in tasks or occupation.

• Providing encouragement and support to patient.

• Suggestions for coping with the disorder.

9. What are the types of treatment available for schizophrenia?

Pharmacological and psychosocial treatments are available for treatment of schizophrenia. Treatment components include drugs, psycho-education, family based interventions, cognitive behaviour therapy for individual symptoms like delusions or hallucinations, social skills training and rehabilitation. Drugs remain mainstay of treatment.

10. What will you tell the family members regarding the chances of recovery of a person suffering from schizophrenia?

Regarding chances of recovery, it is seen that about 45 per cent show recovery after one or more episodes, and about 20 per cent show continuing symptoms and associated disability, and about 35 per cent show a mixed pattern with varying degrees of remission and exacerbations of different length as reported by major studies involving treatment of large number of persons with schizophrenia.

However these can not be applied to individual cases. Some pointers to predict good chances of recovery are late age of onset of disorder, early treatment seeking, women, presentation with positive symptoms, well adjusted work and social functioning prior to onset of disorder, good social support and absence of substance abuse, absence of symptoms of brain damage.

There is no cure but only treatment is possible; even if one is improved totally there can deficits in social functioning and cognitive functioning and might require long term drugs and other psychosocial interventions for better outcome.

11. What are the manifestations of psychosis?

The patients with schizophrenia present with three groups of features:

Positive Symptoms

Hallucinations
Delusions
Formal Thought Disorder
Catatonic Signs

Negative Signs
Cognitive impairment

12. What do you mean by organic psychosis?

The term "organic", in the context of mental disorders, signifies a condition that arises from a demonstrable pathology affecting the brain or other bodily systems.

13. How is diagnosis of a psychotic disorder made?

ICD-10 diagnostic criteria for Schizophrenia

At least one of the following must be present most of the time for a month:

1) Thought echo, thought withdrawal, thought insertion, or thought broadcast,

2) Delusions of control connected with the movements of the body or extremities, specific thoughts, acting or feelings,

3) Delusional perception,

4) Hallucinatory voices giving running commentary on patient’s actions, discussing the patient between them, or voices coming from some parts of the patient’s body, or

5) Bizarre or culturally inappropriate delusion.

At least two of the following first three must be present most of the time for a month; or last one symptom for 2 years:

1) Persistent daily hallucinations accompanied by delusions,

2) Incoherent speech,

3) Catatonic symptoms, or

4) Negative symptoms and a significant and consistent change in personal behaviour. Such symptoms should not be due to organic causes or due to psychoactive substance use.

14. How will you predict who will respond better to treatment?

The studies have reported that outcome is better in developing rather than developed world. Better tolerance of the sick role, availability of suitable jobs, supportive family attitudes and extended family networks have been suggested as explanations are the factors for better outcome in developing countries.

Features related to good prognosis are female gender, late onset, good premorbid (status of the patient before he or she had schizophrenia) social functioning, acute presentation with positive symptoms, married status, good work histories, good support system and family history of mood disorders.

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