Neurobiology and clinical features of psychosis

Question 1

What is psychosis?

Answer 1

• a loss of boundaries with reality and loss of insight (aware that something is wrong with them)

Question 2

Psychosis is a loss of boundaries with reality and loss of insight (aware that something is wrong with them). What are the primary features of psychosis?

Answer 2

• delusions
• hallucinations
• conceptual disorganisation
• negative symptoms (flat affect (mood), low motivation, social skills)
• cognitive disorder

Question 3

Neurodevelopmental trajectories are longitudinal developmental patterns captured by behavioural features such as motor function and language, in the general population as a whole. Which neurotransmitter is proposed to excite the pre-frontal synapses that may prime a patient into developing psychosis?

1 - serotonin
2 - dopamine
3 - acetylcholine
4 - glutamate

Answer 3

4 - glutamata

Question 4

When we talk about patients hearing voices, we can hear the examples where people say it was 2nd and 3rd person. What does 2nd and 3rd person mean in terms of psychosis?

Answer 4

• 2nd = when someone refers to you. For example: ‘you can wait here’
• 3rd = when you are being talked about. For example: ‘he is being unreasonable’

Question 5

What are hallucinations?

1 - patient is able to sense (hear, smell, taste etc) something that doesn’t exist, but no external stimulus
2 - patient has false and fixed belief that doesn’t keep with non social grounding
3 - loses touch with social surroundings like not there but looking from outside through glass
4 - loses touch with social surrounding and no longer interacts with society

Answer 5

1 - patient is able to sense (hear, smell, taste etc) something that doesn’t exist, but no external stimulus

Question 6

Hallucinations are where someone sees, hears, smells, tastes or feels things that don’t exist outside their mind (only they experience this), with no external stimulus. Essentially patients experience a perception without a stimulus. What does it mean to have a perception, but no stimulus?

1 - neurons in brain fire, telling the brain something is there, but there is no auditory stimulus
2 - neurons in brain do not fire, but brain thinks something is there, no auditory stimulus
3 - neurons in brain fire, telling the brain something is there, with auditory stimulus

Answer 6

1 - neurons in brain fire, telling the brain something is there, but there is no auditory stimulus
- auditory processing of the brain is firing and hearing something
- no auditory stimulus was provided in the first place, so auditory processing of the brain is working without an auditory stimulus

Question 7

What does it mean when a patient has insight into psychosis?

Answer 7

• they are aware of their condition
• they are aware what is happening (voices etc) are abnormal
• do they think their condition requires treatment

Question 8

What is schizophrenia?

Answer 8

• form of psychosis
• patient may not always be able to distinguish their own thoughts and ideas from reality

Question 9

In clinical practice symptoms of psychosis are often grouped into 3 categories. What are the 3 categories?

1 - good, bad, cognitive
2 - positive, neutral and negative
3 - positive, negative and cognitive
4 - negative, positive and neutral

Answer 9

3 - positive, negative and cognitive

Question 10

In clinical practice symptoms of psychosis are often grouped into 3 categories:

1 - positive symptoms
2 - negative symptoms
3 - cognitive symptoms

Positive symptoms are those that are most well known. What are the 3 positive symptoms?

1 - hallucinations, delusions, disordered thoughts
2 - flat affect, poor motivation, loss of social skills, poverty of thought
3 - flat affect, poor motivation, disordered thoughts
4 - hallucinations, delusions, loss of social skills

Answer 10

1 - hallucinations, delusions, disordered thoughts

Question 11

In clinical practice symptoms of psychosis are often grouped into 3 categories:

1 - positive symptoms
2 - negative symptoms
3 - cognitive symptoms

What are the 4 negative symptoms?

1 - hallucinations, delusions, disordered thoughts
2 - flat affect, poor motivation, loss of social skills, poverty of thought
3 - flat affect, poor motivation, disordered thoughts
4 - hallucinations, delusions, loss of social skills

Answer 11

2 - flat affect, poor motivation, loss of social skills, poverty of thought
- flat affect (lack of expression)
- poor motivation
- loss of social skills
- poverty of thought

Question 12

In clinical practice symptoms of psychosis are often grouped into 3 categories:

1 - positive symptoms
2 - negative symptoms
3 - cognitive symptoms

What are the 3 cognitive symptoms?

1 - hallucinations, delusions, disordered thoughts
2 - flat affect, poor motivation, loss of social skills, poverty of thought
3 - flat affect, poor motivation, disordered thoughts
4 - poor attention, poor memory, poor planning ability

Answer 12

4 - poor attention, poor memory, poor planning ability

Question 13

Psychosis is an illness characterised by a loss of boundaries with reality and loss of insight, with primary features of delusions, hallucinations, conceptual disorganisation, negative symptoms and cognitive disorder. A psychotic episode must include any of these symptoms with a significant severity, delusions, hallucinations, conceptual disorganisation, negative symptoms and cognitive disorder). How long does a psychotic episode need to last to be called a psychotic episode?

1 - 1 episode = >1 week
2 - 1 episode = >2 weeks
3 - 1 episode = >3 weeks
4 - 1 episode = >4 weeks

Answer 13

1 - 1 episode = >1 week

Question 14

What is a delusion?

1 - patient is able to sense (hear, smell, taste etc) something that doesn’t exist, but no external stimulus
2 - patient has false and fixed belief that doesn’t keep with non social grounding
3 - loses touch with social surroundings like not there but looking from outside through glass
4 - loses touch with social surrounding and no longer interacts with society

Answer 14

2 - patient has false and fixed belief that doesn’t keep with non social grounding

Question 15

What is the difference between hallucinations vs delusions?

Answer 15

• BOTH are part of a false reality
• hallucination is a sensory perception
• delusion is a false belief

Question 16

Hallucinations and delusions are BOTH part of a false reality. However, hallucination are a sensory perception and delusion are a false belief. Give an example of a hallucinations and delusion?

Answer 16

• hallucinations can involve seeing someone who isn’t there or hearing people talking when there is no one around
• delusions, on the other hand, can involve someone thinking they are a celebrity when they’re not, for example

Question 17

What is conceptual disorganisation?

1 - patients thought process is organised and succinct
2 - patients thought process is ok, but actions are not
3 - patients thoughts are confused/disorganised with no flow or links

Answer 17

3 - patients thoughts are confused/disorganised with no flow or links
- the topics they talk about do not logically link together
- patients are observed doing this but do not complain about it

Question 18

What are some common things we can see in patients with negative symptoms?

1 - hallucinations, delusions, disordered thoughts
2 - flat affect, poor motivation, loss of social skills, poverty of thought
3 - flat affect, poor motivation, disordered thoughts
4 - poor attention, poor memory, poor planning ability

Answer 18

• flat with little motivation
• socially withdrawal
• reduced emotional reactivity
• increased self neglect (clothes, hair, cleanliness)

Question 19

What are some common things we can see in patients with cognitive symptoms?

Answer 19

• poor attention
• impaired memory
• impaired decision making

Question 20

Schizophrenia is a form of psychosis, where a patient may not always be able to distinguish their own thoughts and ideas from reality. Patients commonly experience auditory hallucinations (MOST COMMON), for which there is no external stimulus. In patients with schizophrenia, what % experience auditory hallucinations?

1 - 15-25%
2 - 35-55%
3 - 60-70%
4 >85%

Answer 20

3 - 60-70%

Question 21

Schizophrenia is a form of psychosis, where a patient may not always be able to distinguish their own thoughts and ideas from reality. Hallucinations are common, where there is no external stimulus, but the patient experiences the sensory stimulus in their own minds. What is the most common sensory hallucination in schizophrenia?

1 - visual
2 - auditory
3 - smell
4 - touch

Answer 21

2 - auditory hallucinations
- 60-70% of schizophrenia experience them

Question 22

Schizophrenia is a form of psychosis, where a patient may not always be able to distinguish their own thoughts and ideas from reality. 60-70% of patients commonly experience auditory hallucinations (MOST COMMON), for which there is no external stimulus. What are the most common types auditory voices patients hear and what does this increase the risk of?

1 - happy voices and increase joy
2 - sad voices that make patient feel upset and sad
3 - derogatory, increasing the risk of suicide

Answer 22

3 - derogatory, increasing the risk of suicide

Question 23

What is attrition error?

1 - incorrect attrition of an individuals actions
2 - incorrect attrition of a patients diagnosis
3 - incorrect attrition of a patients disease severity
4 - incorrect attrition relating to a patients wellbeing

Answer 23

1 - incorrect attrition of an individuals actions
- e.g. you are cut up on the road, you think its because the other driver is just reckless
- BUT in reality the driver may be rushing to see a loved one at the hospital

Question 24

During imaging of auditory hallucinations, oddly which part of the brain involved with speech has been shown to be activated?

1 - brodmanns areas 1, 2 and 3
2 - brodmanns area 4
3 - brodmanns area 17
4 - brodmanns areas 44 and 45

Answer 24

4 - brodmanns area 44 and 45
- commonly referred to as Brocas area and are important for hearing

Question 25

The figure below shows data where patients listened and thought about words after in controls and patients with schizophrenia who are prone to auditory hallucinations. What does the figure tell us?

Answer 25

- both groups have similar neuronal activity when listening to an external stimulus - controls switch off neuronal parts when thinking about words, but schizophrenia patients have higher activity suggesting this may be due to increase neuronal activity - THIS COULD PRESENT AS AN AUDITORY HALLUCINATION, AS THEY HAVE A STIMULUS IN THEIR HEADS ONLY

Question 26

The superior longitudinal fascicules is a white matter tract that connects what? 1 - frontal cortex t auditory areas 2 - frontal speech with auditory areas 3 - motor cortex with auditory areas 4 - occipital cortex with auditory areas

Answer 26

2 - frontal speech with auditory areas - important in patient who have auditory hallucinations

Question 27

When a healthy person thinks about performing a movement or to speak, this is sent to the sensory somatosensory cortex and the movement or speech is performed and then the neuronal activity is reduced. Does the same happen in patients with schizophrenia?

Answer 27

- no - after signal is sent to move or speak to somatosensory by their own brain, the neuronal signal does not then attenuate - patients then think this a actual stimuli and this can then lead to hallucinations

Question 28

When a patient with schizophrenia has auditory hallucinations, should these all be ignored?

Answer 28

- no - they come from within, so are likely trying to tell the patient something important

Question 29

When a patient with schizophrenia has auditory hallucinations, these should not be ignored as they come from within, so are likely trying to tell the patient something important. How can psychologists help manage these auditory hallucinations? 1 - talk over the auditory hallucinations 2 - distraction techniques, neural stimulation, language and perception strategies 3 - medication 4 - CBT

Answer 29

2 - distraction techniques, neural stimulation, language and perception strategies

Question 30

If you are a monozygotic twin (identical twins result from the fertilisation of a single egg that splits in two), is the genetic risk of schizophrenia high? 1 - 10% 2 - 25% 3 - 50% 4 - 99%

Answer 30

3 - 50% - other 50% is proposed to be environmental factors

Question 31

What are the 4 most common environmental risk factors for developing schizophrenia?

Answer 31

1 - obstetric complication (2-3 fold increase) 2 - childhood trauma (5 fold increase) 3 - immigration status (5 fold increase) 4 - cannabis use (2-3 fold increase)

Question 32

What are neurodevelopmental trajectories?

Answer 32

- longitudinal developmental patterns captured by behavioural features such as motor function and language, in the general population as a whole

Question 33

Neurodevelopmental trajectories are longitudinal developmental patterns captured by behavioural features such as motor function and language, in the general population as a whole. Which neurotransmitter is proposed to inhibit the pre-frontal synapses that may prime a patient into developing psychosis? 1 - dopamine 2 - serotonin 3 - glutamate 4 - GABA

Answer 33

4 - GABA

Question 34

Neurodevelopmental trajectories are longitudinal developmental patterns captured by behavioural features such as motor function and language, in the general population as a whole. Around 23 years of age there are 2 key things that happen to neuronal activity that may predispose patients into developing psychosis? 1 - excessive inhibitory and reduced interneuronal activity 2 - excessive inhibitory and reduced interneuronal activity 3 - excessive excitatory and increased interneuronal activity 4 - excessive excitatory and reduced interneuronal activity

Answer 34

4 - excessive excitatory and reduced interneuronal activity - reduced interneuron activity, brains ability to inhibit could lead to positive symptoms - excessive excitatory pruning performed when young as we generally have too many (could account for negative and cognitive symptoms)

Question 35

There are some theories that suggest psychosis is due to an abnormal neurodevelopment disorder and interferences in the normal neural development. The first phase is called the premorbid phase, what does this mean?

Answer 35

- refers to an individual's social, interpersonal, academic, and occupational functioning prior to the onset of psychotic symptoms - said to be a measure of how likely it is a patient will develop psychosis

Question 36

There are some theories that suggest psychosis is due to an abnormal neurodevelopment disorder and interferences in the normal neural development. The second phase is called the prodromal phase, what does this mean?

Answer 36

- where a patient starts to experience changes in themselves - BUT have not yet started experiencing clear-cut psychotic symptoms

Question 37

There are some theories that suggest psychosis is due to an abnormal neurodevelopment disorder and interferences in the normal neural development. The third phase is called the progression phase, what does this mean?

Answer 37

- patients symptoms may go up and down as they age - they can become stable or relapse

Question 38

What is the difference between affect and mood?

Answer 38

- affect = a visible short term reaction like the daily changes in weather - mood = is a state of unconscious feeling, long term like the climate

Question 39

What is functional MRI?

Answer 39

- MRI that measures brain activity - brain activity is detected by changes blood flow

Question 40

Functional MRI is an MRI that measures brain activity by detecting changes in blood flow. How can this be useful in psychosis and schizophrenia?

Answer 40

- can monitor patients brains when they are having hallucinations - when they hear voices we can see activity in the auditory cortex - so patients brains are active during hallucinations

Question 41

Schizophrenia is when a patient has psychotic episodes for >6 months or has re-occurring episodes of psychosis where the patient feels at an interpersonal loss. Is schizophrenia generally diagnosed early or late in age? 1 - early 18-35 years olds 2 - early 15-30 year olds 3 - older 40-60 years old 4 - older >65 years old

Answer 41

1 - early 18-35 years olds