Chapter 25: psychotic disorders

Question 1

Different symptoms in psychosis

Answer 1

1. Cognitive symptoms: impairment in information processing, concentration, memory, reasoning, learning.
2. Negative symptoms: emotional flattening, apathy etc.
3. Affective symptoms: depression, anxiety and mania.

Question 2

Diagnostic criteria for schizophrenia

Answer 2

At least 2 of the following symptoms and at least one of them from the first 3 categories, for at least 6 months:
1. Hallucinations
2. Delusions
3. Disorganised speech
4. Disorganised chaotic behaviour
5. Negative symptoms

Question 3

Four-factor model (of schizophrenia/psychosis)

Answer 3

The onset of schizophrenia:
1. An unexpected increase in dopamine levels leads to enhanced perception of stimuli.
2. Top-down processes consisting of inductive and deductive reasoning to give meaning to the intense and intrusive stimuli.
3. Cognitive tendencies influence the experience (like excessive attention to danger, jumping to conclusions, expectancy bias).
4. Consolidation that continually reinforces the self-created delusional ideas and distorted perception.

Question 4

Neuropathology in psychotic disorders

Answer 4

Schizophrenia causes:
- Different structure, density and thickness of grey matter and some brain regions.
- Less grey matter after one psychotic episode.
- Reduced white and grey matter.
- More activation in the right medial prefrontal cortex and bilateral anterior cingulate cortex.

Question 5

Treatment of psychosis / schizophrenia

Answer 5

• First generation antipsychotics: block the dopamine receptor D2.
• Second generation antipsychotics: target serotonin and glutamate receptors.
• Cognitive rehabilitation.