Functional Psychosis

Question 1

Neurosis

Answer 1

Relatively mild mental illness that is not caused by organic disease but not a radical loss of touch with reality. Symptoms of stress (depression, anxiety, obsessive behaviour, preoccupation with physical illnesses)

Question 2

Psychosis

Answer 2

Grossly impaired testing.
e.g., incorrectly evaluate the accuracy of their thoughts and perceptions, and make incorrect inferences about external reality, even in the presence of contrary evidence.

Question 3

What is Psychosis associated with?

Answer 3

Severe impairment of social and personal functioning characterized by social withdrawal and inability to perform the usual social and household occupational roles. Lack of insight.

Question 4

What should you use to understand patient’s symptoms?

Answer 4

Empathy- observation, questioning, rephrasing, and checking if you’ve got it right.

Question 5

Psychotic symptoms

Answer 5

• Occurs on a continuum.
• One pole: grossly disorganised speech and behaviour.
• Other pole: symptoms are mild and difficult to distinguish from normal.

Question 6

Key defining features

Answer 6

Delusions, hallucinations, disorganised thinking (speech), grossly disorganised or abnormal motor behaviour (including catatonia), and negative symptoms.

Question 7

Examples of psychotic disorders

Answer 7

Schizophrenia psychosis, Schizophrenia, Schizoaffective disorder, Bipolar disorder, Brief psychotic disorder, Psychosis secondary to another medical condition, and Substance-induced psychosis.

Question 8

Delusions

Answer 8

Fixed, firmly held, false belief which is not amenable to change even in the face of contradictory evidence. The belief is out of keeping with that of the individual’s cultural group. It is not an article of faith or religious belief.

Question 9

Variety of delusion themes

Answer 9

Religious, grandiose, somatic, referential, nihilistic.

Question 10

Bizarre Delusion

Answer 10

Clearly implausible and not understandable to same culture peers. Does not derive from ordinary life experiences.

Question 11

Bizarre delusions include

Answer 11

Thought withdrawal, Thought insertion, Delusions of control, Thought broadcasting.

Question 12

Non-bizarre delusion

Answer 12

Within realms of possibility but patently untrue.

Question 13

Systematized Delusions

Answer 13

forms an association of ideas that fit into a coherent narrative, even though implausible.

Question 14

Fragmentary delusions

Answer 14

Are bits of poorly, or non-associated ideas.

Question 15

Causes of delusions

Answer 15

Schizophrenia, Bipolar disorder, Delusional disorder, Schizoaffective disorder, Dementia, Delirium, Neoplasms, Epilepsy, Traumatic brain injury, Vitamin deficiencies (Pellagra), Endocrinopathies (thyroid, etc).

Question 16

Hallucinations

Answer 16

A sensory perception that has the compelling sense of reality of a true perception but that occurs without external stimulation of the relevant sensory organ.

Question 17

More on Hallucinations

Answer 17

Not under voluntary control
Auditory more common, sensorium must be clear.
Hypnagogic (falling asleep) and hypnopompic (waking up) normal.
May occur in religious context in certain cultures.

Question 18

Auditory hallucination

Answer 18

One or more voices, familiar or unfamiliar. Commentate, command, echo thoughts.

Question 19

Causes of auditory hallucinations

Answer 19

Schizophrenia, bipolar mood disorder, schizoaffective disorder, substance abuse/intoxication, dementia, tumours

Question 20

Visual hallucinations

Answer 20

Bizarre, transient, usually terrifying, not cinematic.

Question 21

Causes of visual hallucination

Answer 21

Delirium (e.g., DT’s), stroke, neoplasm.

Question 22

Olfactory hallucination

Answer 22

Unexplained smell.

Question 23

Causes of olfactory Hallucination

Answer 23

Epilepsy (Aura)

Question 24

Gustatory hallucinations

Answer 24

Unexplained taste

Question 25

Tactile hallucinations

Answer 25

Crawling sensation on skin

Question 26

Causes of tactile hallucinations

Answer 26

Alcohol withdrawal (DT’s)

Question 27

Somatic hallucinations

Answer 27

Sensations within the body- electric shocks, etc.

Question 28

Causes of somatic hallucinations

Answer 28

Substance abuse/intoxication, schizophrenia, BPAD.

Question 29

Types of Disorganised thinking

Answer 29

Formal thought disorder, Derailment/ loosening of associations, Tangentiality, and Incoherence/ word salad.

Question 30

Formal thought disorder

Answer 30

Loss of the normal flow of thought, typically inferred from individual’s speech.

Question 31

Derailment/ loosening of associations

Answer 31

Jumping from topic to topic

Question 32

Tangentiality

Answer 32

Answer to a question may be obliquely related or completely unrelated.

Question 33

Incoherence/ word salad

Answer 33

Speech that is severely disorganised as to be incomprehensible.

Question 34

THOUGHT DISORDER

Answer 34

flight of ideas. A nearly continuous flow of
accelerated speech with abrupt changes from topic
to topic that are usually based on understandable
associations, distracting stimuli, or plays on words.
When severe, speech may be disorganized and
incoherent.
Characteristic of MANIA.

Question 35

More on loosening of associations

Answer 35

Characteristic of schizophrenia.
Disturbance of thinking showed by speech in which ideas shift from one subject to another that is unrelated or minimally related to the first.
Statements that lack a meaningful relationship may be
juxtaposed, or speech may shift suddenly from one
frame of reference to another. The speaker gives no
indication of being aware of the disconnectedness,
contradictions, or illogicality of speech.

Question 36

Circumstantiality

Answer 36

Pattern of speech that is indirect and delayed in reaching its goal because of excessive or irrelevant detail or parenthetical remarks. The speaker does not lose the point.

Question 37

Catatonia

Answer 37

Decreased reactivity to the environment.
Decreased mobility to complete unawareness or …
Purposeless and unstimulated excessive motor activity (catatonic excitement).
Rigidity and maintenance of postures (‘waxy flexibility’).
Negativism: active resistance to instructions or attempts to move them.
Posturing: assuming bizarre postures.
Echolalia (meaningless repetition of words just spoken by another person) and echopraxia (involuntary repetition or imitation of another person’s actions).

Question 38

Causes of catatonia

Answer 38

Schizophrenia, Depression, Neurological disorders (CVA, neoplasm, head trauma, encephalitis), Metabolic (hypercalcaemia, DKA, homocystinuria, hepatic encephalopathy), Dementia, Delirium.

Question 39

Disorganized behavior

Answer 39

Poor self care.
Unkempt appearance.
Poor hygiene and inability to perform activities of daily living (e.g., shopping, cooking).
Inappropriate and bizarre behavior (e.g., public masturbation, exhibitionism, unusual dress).
Child like silliness to gross agitation.

Question 40

Causes of disorganized behavior

Answer 40

This is a non-specific sign of psychosis.
Can be caused by any serious psychiatric or neuropsychiatric disorder.
Indication of severity of illness.

Question 41

Schizophrenia

Answer 41

Aetiology unknown, likely a cluster of disorders.
Onset in males tends to be younger than in females; usually late teens/early twenties; often has a poorer prognosis.
Tends to run a relapsing and remitting course with gradual, progressive deterioration. However, 10-20% will have a single episode and are symptom free thereafter, although more vulnerable (e.g. unemployment, relationship conflicts, poverty, psychoactive drugs may serve as potential triggers).

Question 42

Positive symptoms of Schizophrenia

Answer 42

Hallucination, delusions, disorders of thought form.

Question 43

Negative symptoms of schizophrenia

Answer 43

Loss of volition, motivation, spontaneous behavior, social withdrawal, anhedonia (inability to experience joy or pleasure), affective flattening and poverty of thought, and alogia (speak less, say fewer words or only speak in response to others).

Question 44

Mx of schizophrenia

Answer 44

Biological: first and second generation antipsychotics.
Non-biological: family intervention, education, supportive counselling, attending to basic needs such as accommodation).

Question 45

Bipolar disorder type 1

Answer 45

Episodes of mania and depression (possibly less severe).
May also be mixed, with features of mania and depression simultaneously.

Question 46

Bipolar disorder type 2

Answer 46

Episodes of hypomania and depression (possibly more severe).