1 - PSY - Psychosis and Schizophrenia

Question 1

define psychosis - including?

Answer 1

state in which there is a loss of contact with reality - including hallucinations, delusions, formal thought disorder

Question 2

define hallucination

Answer 2

percept without object - experienced in external space

Question 3

define delusions

Answer 3

pathological belief - cannot be rationalised away, held with no proof, personal significance, not based in pts culture/faith

Question 4

define formal thought disorder

Answer 4

pattern of disordered language reflecting disordered from of thought - derailment, flight of ideas, circumstantial/tangential thoughts

Question 5

positive symptoms of schizophrenia

Answer 5

delusions
hallucinations
disorganised behaviour
thought disorder

Question 6

negative symptoms of schizophrenia

Answer 6

social withdrawal
avolition
poverty of speech
reduced attention
blunted affect

Question 7

schneiders first rank symptoms of schizophrenia…

Answer 7

A - auditory hallucinations
B - broadcasting of thought
C - controlled thought (delusions of control including passivity)
D - delusional perception

Question 8

Give examples of these symptoms:
Thought echo-
Third person auditory hallucinations-
delusional perception-
made volition-
somatic passivity

Answer 8

• hearing thought spoken aloud
• voices referring to pt as “he/she”
• ascribes a delusional idiosyncratic value to a percept - “heard bell ring and I knew i would win wimbledon”
• pt reports their will is under external control
• sensations in body believed to be controlled by external force

Question 9

Organic causes of psychosis - 5 areas

Answer 9

• delirium
• medication - steroids, stimulants, dopamine agonists
• endocrine - cushings, hyper/hypothyroidism
• neuro disorder - ms, huntingtons and wilsons, epilepsy
• systemic diseases - SLE

Question 10

Schizophrenia diagnostic criteria

Answer 10

Sx > 28 days
no organic cause found
first rank symptoms/persistent hallucinations and delusions
may also have negative/cognitive symptoms

Question 11

Schiz epidemiology - lifetime risk? m to f? peak incidence?

Answer 11

1/100 roughly
m=f
m 23yo
f 26yo
urban>rural

Question 12

Schiz aetiology

• bio - 3
• psycho - 2
• social - 4

Answer 12

bio - genetic factors FHx, obstetric complications increase risk, dopamine theory (how AP meds work)
psycho - cognitive errors, premorbid person (schizotypal disorder)
socail - migration, urban living, life events, ethnicity

Question 13

Prodrome

Answer 13

when pt gradually develops symptoms before meeting diagnostic criteria - negative Sx, distress/agitiation, transient psychotic Sx

Question 14

Good prognostic factors for schiz

Answer 14

female
acute onset
early Tx
prominent mood Sx

Question 15

Poor prognostic factors

Answer 15

high expressed emotion
substance misuse
prominent negative Sx
early onset
No insight/compliance

Question 16

Investigations - physical?

Answer 16

examination 
bloods
urine for drugs (probs most important)
ECG
others if indicated

Question 17

Investigations - psychosocial

Answer 17

collateral history

if indicated - OT assessment, social assessment, carer assessment

Question 18

common reasons for non compliance

Answer 18

lack of insight, SE of meds, med/prescriber delusions, pt feels better when “ill”, pt think meds not required after remission

Question 19

what physical health problems are schiz pts more at risk of

Answer 19

CV disease, diabetes, stroke

due to AP increasing risk of metabolic syndrome, smoking, poor diet and exercise

Question 20

Treatment resistant schiz - define?

Answer 20

lack of response to adequate doses of 2 diff AP’s

Question 21

Treatment resistant schiz - do what before diagnosing?

Answer 21

review diagnosis
rule of co morbid substance misuse
ensure dose,duration and compliance with prev treatment

Question 22

Treatment resistant schiz- what drug? risks? monitoring? other SE’s?

Answer 22

Clozapine, neutropenia + (rare) fatal agranulocytosis

FBC for 18weeks, then every 2 weeks for a year, then every 4 weeks

hypersalivation, cardiomyopathy, myocarditis, dm and sezures

Question 23

Psychological treatment of schiz

Answer 23

Cbt, family intervention therapy, psychoeducation