APEP psychosis

Question 1

What are the positive symptoms of psychosis according to Crow (1980/85)?

Answer 1

Positive symptoms are excesses or distortions of normal functioning and include delusions, hallucinations, disorganized thinking, and misperceptions. These symptoms are typically more observable.

Question 2

What are the negative symptoms of psychosis according to Crow (1980/85)?

Answer 2

Negative symptoms reflect a decrease or loss of normal functioning, including blunted affect (reduced emotional expression), poor initiation and planning of tasks, poverty of speech (limited speech output), and anhedonia (loss of interest or pleasure in activities).

Question 3

What is a delusion?

Answer 3

A false belief that is held despite evidence to the contrary. Common types include delusions of persecution, grandeur, control, and reference.

Question 4

How common are delusions in people hospitalized for psychosis?

Answer 4

Delusions are experienced by 75% of those hospitalized for psychosis (Maher, 2001).

Question 5

What are the main types of delusions?

Answer 5

Delusions of Persecution, Delusions of Grandeur, Delusions of Control, Delusions of Reference

Question 6

What is the prevalence of auditory hallucinations in people with psychosis?

Answer 6

70% of people with psychosis experience auditory hallucinations (Cleghorn et al., 1992).

Question 7

What other types of hallucinations can occur in psychosis besides auditory?

Answer 7

Visual, olfactory, tactile, and gustatory hallucinations.

Question 8

What does the presence of hallucinations suggest in psychosis?

Answer 8

It may suggest a reality-monitoring deficit and a self-monitoring deficit.

Question 9

How common are hallucinations in non-psychotic populations?

Answer 9

4-25% of non-psychotic populations may experience hallucinations (Beck & Rector, 2003).

Question 10

What are the features of disorganized thinking and speech in psychosis?

Answer 10

Derailment, loose associations, tangential thinking, clanging, neologisms, word salads, and poverty of content.

Question 11

What are negative symptoms of psychosis?

Answer 11

Affective flattening, Avolition, Alogia, Anhedonia, Asociality.

Question 12

What are some historical issues in psychosis diagnoses?

Answer 12

Psychosis was historically thought to be caused by a tangible morbid process in the brain, with early diagnoses categorized as “dementia praecox” (early-onset dementia).

Question 13

Who coined the term schizophrenia and what did it mean?

Answer 13

Eugen Bleuler (1857-1939) coined the term schizophrenia, meaning “split mind” (from Greek: schizen = split, phren = mind).

Question 14

What are the diagnostic criteria for schizophrenia?

Answer 14

2 or more of the following: delusions, hallucinations, disorganized speech, grossly disorganized/catatonic behavior, negative symptoms, and a deterioration in work, relationships, or self-care for at least 6 months.

Question 15

How is psychosis categorized in the ICD-10 and DSM-V?

Answer 15

ICD-10: schizophrenia, schizotypal, and delusional disorders.
DSM-V: schizophrenia spectrum and other psychotic disorders.

Question 16

What is the current view on psychosis according to Professor Peter Kinderman?

Answer 16

Psychosis is seen as a continuum with normal experiences, not a distinct disorder.

Question 17

What are the common appraisals of anomalous experiences in the general population?

Answer 17

These experiences can be viewed differently across cultures, including as spiritual or religious experiences.

Question 18

What is the ‘need for care’ in psychosis?

Answer 18

The need for care is determined by the severity of symptoms, the cultural background, and the impact on the person’s life and functioning.

Question 19

What are the prevalence rates of schizophrenia?

Answer 19

Lifetime prevalence is 0.3-0.66%, or 2.3% if schizophrenia spectrum disorders are considered. Men typically have an earlier onset (around 18 years) compared to women (around 25 years).

Question 20

What are some environmental risk factors for psychosis?

Answer 20

Migration, urban environment, poverty, childhood abuse, bullying, and cannabis use.

Question 21

What is the diathesis-stress model in the context of psychosis?

Answer 21

It posits that psychosis arises from the interaction between genetic vulnerability (diathesis) and environmental stressors.

Question 22

What are the common biological factors linked to schizophrenia?

Answer 22

Genetic predisposition, dopamine dysregulation, and abnormalities in brain structure.

Question 23

What psychological factors contribute to psychosis?

Answer 23

Cognitive deficits such as impaired self-monitoring, and cognitive biases that maintain psychotic symptoms.

Question 24

What sociocultural theories are related to psychosis?

Answer 24

The Sociogenic Hypothesis (psychosis caused by social factors) and Social Selection (drift) Theory (people with psychosis tend to move into lower socioeconomic groups).

Question 25

How is treatment for psychosis typically approached?

Answer 25

Medication is commonly used to manage acute psychosis, with antipsychotics alleviating symptoms. Psychological therapies such as CBT can be effective in managing symptoms, especially in reducing paranoia and improving social functioning.

Question 26

What are the side effects of antipsychotic medications?

Answer 26

Antipsychotic medications can have distressing side effects, and up to 74% of patients may discontinue them over time.

Question 27

What is the effectiveness of Cognitive Behavioral Therapy (CBT) in treating psychosis?

Answer 27

CBT has small to medium effects on reducing total symptoms, positive symptoms, depression, and hallucinations, with some evidence of improvement in social functioning

Question 28

What is the relationship between psychosis and violence?

Answer 28

The link between psychosis and violence is small. Substance use is a much stronger predictor of violent behavior in those with psychosis.

Question 29

What is the significance of the “prodrome” in psychosis?

Answer 29

The prodrome refers to the early stage of psychosis, marked by subtle symptoms like reduced concentration, sleep disturbance, and suspiciousness, which may precede full-blown psychosis.

Question 30

What is the overarching approach to understanding the aetiology of psychosis?

Answer 30

The diathesis-stress model, which suggests that psychosis arises from the interaction of genetic vulnerability (diathesis) and environmental stressors.

Question 31

How do theories of psychosis typically differ in their focus?

Answer 31

Some theories aim to explain specific aspects of psychotic symptomatology (e.g., delusions, hallucinations) rather than the entire spectrum of the disorder.

Question 32

What are the primary categories of theories explaining psychosis?

Answer 32

• Biological Theories (Genetic, Biochemical factors)
• Psychological Theories (Cognitive & Behavioural factors)
• Sociocultural Theories (Social and Familial factors)

Question 33

What are the main biological factors implicated in the aetiology of psychosis?

Answer 33

Genetic factors, dopamine dysregulation, and biochemical imbalances are central biological explanations for psychosis

Question 34

What is the genetic concordance rate for schizophrenia?

Answer 34

The genetic concordance rate for schizophrenia is 50-80%, suggesting a significant hereditary component (Van Os & Kapur, 2009).

Question 35

How is genetic liability for psychosis demonstrated?

Answer 35

Through concordance studies, twin studies, and adoption studies, which show higher risk in those with a family history of schizophrenia.

Question 36

Is schizophrenia caused by a single gene?

Answer 36

No, schizophrenia is unlikely to be caused by a single gene. It is thought to be influenced by multiple genes interacting with environmental factors.

Question 37

What did the Finnish adoptive study by Tienari et al. (2018) reveal about psychosis risk?

Answer 37

The study found that the incidence of psychosis was higher in children adopted by parents with schizophrenia, but only if the adopted family environment was “disturbed,” with poor mental health or communication.

Question 38

What is the dopamine hypothesis in relation to psychosis?

Answer 38

The dopamine hypothesis suggests that psychosis is associated with increased dopamine activity in the brain. Drugs that block dopamine receptors alleviate symptoms, while substances that increase dopamine can trigger psychosis-like symptoms.

Question 39

What evidence supports the dopamine hypothesis?

Answer 39

Studies, including MRI scans and post-mortem research, show that individuals with psychosis have more dopamine receptors in certain areas of the brain (Carlsson, 2001; Seeman & Kapur, 2001).

Question 40

What role does dopamine play in psychosis, according to the aberrant salience hypothesis?

Answer 40

Dopamine may be involved in assigning “salience” (importance) to irrelevant stimuli, leading to misinterpretations of these stimuli as highly significant, which may contribute to delusions and hallucinations (Howes & Nour, 2016).

Question 41

What cognitive deficits are associated with psychosis?

Answer 41

Cognitive deficits in psychosis often involve impaired self-monitoring (Frith, 1992) and difficulties with Theory of Mind, which affects the ability to understand others’ thoughts and intentions.

Question 42

What are cognitive biases and how do they maintain psychosis?

Answer 42

Cognitive biases like attributional bias (Bentall), reasoning bias (Garety), and interpretational bias (Morrison) maintain psychosis by preventing reality testing and reinforcing false beliefs, such as delusions.

Question 43

What is the threat anticipation model in psychosis?

Answer 43

The threat anticipation model (Freeman) suggests that individuals with psychosis are prone to anticipating threats, which leads to paranoia and distorted perceptions of the world.

Question 44

What are the sociocultural theories explaining psychosis?

Answer 44

Two primary sociocultural theories are:

• Sociogenic Hypothesis: Psychosis arises due to social adversity.
• Social Selection (Drift) Theory: People with psychosis may end up in socially disadvantaged circumstances due to their condition.

Question 45

How do adverse life events, such as childhood abuse, contribute to psychosis?

Answer 45

Childhood abuse and victimization increase the risk of developing psychosis, with the Sociogenic Hypothesis highlighting how stress can trigger psychotic episodes (Bebbington et al., 2004).

Question 46

What is “expressed emotion” (EE) and its link to psychosis?

Answer 46

Expressed emotion refers to family environments that are critical, hostile, or overly emotionally involved. High EE is linked to an increased risk of relapse in individuals with psychosis.

Question 47

What evidence supports the role of family environment in psychosis?

Answer 47

While family dynamics like expressed emotion are associated with relapse, there is insufficient evidence to suggest they are specific causes of psychosis

Question 48

How does physical health relate to psychosis?

Answer 48

Conditions like diabetes, cardiovascular disease, and vitamin D deficiencies are associated with psychosis and may impact treatment and recovery.

Question 49

What are common environmental stressors that can contribute to psychosis?

Answer 49

Environmental stressors include migration, urban living, poverty (especially in childhood), sexual and physical abuse, bullying, cannabis use, and poor parental communication.

Question 50

How do developmental factors contribute to psychosis?

Answer 50

Psychosis often develops in a cascade process, with multiple factors accumulating over time to increase the risk of schizophrenia.

Question 51

What is the role of migration in the development of psychosis?

Answer 51

Migration, particularly to urban environments, has been identified as a stressor that increases the risk of developing psychosis, possibly due to social exclusion and adaptation difficulties.

Question 52

How does poverty and inequality contribute to psychosis risk?

Answer 52

Living in poverty or experiencing inequality, especially during childhood, increases the likelihood of developing psychosis, likely due to chronic stress and social disadvantage

Question 53

What is the importance of understanding the aetiology of psychosis in treatment?

Answer 53

A comprehensive understanding of the aetiology allows for more effective treatments, targeting biological, psychological, and sociocultural factors that contribute to the development and maintenance of psychosis.