General

Question 1

Key features of psychotic disorders

Answer 1

1. Delusions
2. Hallucinations
3. Disorganised thinking (speech)
4. Grossly disorganised or abnormal motor behaviour
5. Negative symptoms

Question 2

Delusions

Answer 2

Def = fixed beliefs that are not amenable to change in light of conflicting evidence
- See MSE for more information

Question 3

Hallucinations

Answer 3

Def = perception-like experiences that occur without an external stimulus

• Vivid and clear, with the full force and impact of normal perceptions, and not under voluntary control
• Auditory hallucinations most common. Usually experienced as voices that are distinct from the individual’s own thoughts
• The hallucinations must occur in the context of a clear sensorium - those that occur while falling asleep or waking up (hypnopompic) are considered to be within the range of normal experience
• May be a normal part of religious experience in certain cultural contexts

Question 4

Disorganised thinking (speech)

Answer 4

• Disorganised thinking (formal thought disorder) is typically inferred from the individual’s speech
• Individual may switch from one topic to another (derailment or loose associations)
• Answers to questions may be obliquely related or completely unrelated (tangentiality)
• Rarely, speech may be so severely disorganised that it is nearly incomprehensible and resembles receptive aphasia in its linguistic disorganisation (incoherence or ‘word salad’)
• Bc mildly disorganised speech is common and nonspecific, the symptom must be severe enough to substantially impair effective communication

Question 5

Grossly disorganised or abnormal motor behaviour

Answer 5

• May manifest itself in a variety of ways, ranging from childlike ‘silliness’ to unpredictable agitation
• Problems may be noted in any form of goal-directed behaviour -> difficulties in performing ADLs
• Catatonic behaviour = marked decrease in reactivity to the environment. Ranges from resistance to instructions (negativism) to maintaining an rigid, inappropriate or bizarre posture, to a complete lack of verbal and motor responses (mutism and stupor)
• Can also include purposeless and excessive motor activity without obvious cause (catatonic excitement)
• Other features = repeated stereotyped movements, staring, grimacing, mutism and echoing of speech
• Historically associated with schizophrenia, but are nonspecfic and may occur in other mental disorders (e.g. bipolar or depressive disorders with catatonia) and in medical conditions

Question 6

Negative symptoms

Answer 6

• Account for a substantial portion of the morbidity associated with schizophrenia but are less prominent in other psychotic disorders
• Two negative symptoms are particularly prominent in schizophrenia = diminished emotional expression and avolition
• Diminished emotional expression = reductions in the expression of emotions in the face, eye contact, intonation of speech (prosody) and movements of hand/head/face that normally give an emotional emphasis to speech
• Other negative symptoms = alogia (decreased speech output), anhedonia, asociality (apparent lack of interest in social interactions)