Psych - Psychosis

Question 1

What is psychosis

Answer 1

Difficulty perceiving and interpreting reality

Question 2

What are the causes of psychosis

Answer 2

Schizoaffective disorder
Bipolar I
Schizophrenia
Depression with psychotic features 
Delusional disorder
Other medical conditions
Substance related

Question 3

What are the 3 types of psychosis symptoms?

Answer 3

Postive
Negative
Disorganisation

Question 4

What are the main 2 positive symptoms?

Answer 4

Hallucinations

Delusions

Question 5

What are hallucinations

Answer 5

Perception in the absence of a stimulus

Question 6

What kind of hallucinations can we have

Answer 6

Auditory
Voices talking about you or to each other 
Visual 
Somatic/tactile
Olfactory (rare)

Question 7

What are delusions

Answer 7

Fixed false beliefs out of keeping with social/cultural backgrounds

Question 8

What kind of delusions can we have

Answer 8

Persecutory 
Control 
Reference
Mind reading
Grandiosity 
Religious 
Guilt/sin
Somatic 
Thought broadcasting, thought insertion or thought withdrawal

Question 9

What are the 4 main negative symptoms of psychosis

Answer 9

Alogia
Avolition/apathy
Anhedonia/asociality
Affective flattening

Question 10

What is alogia

Answer 10

Poverty of speech - slow to respond and little content

Question 11

What is avolition

Answer 11

Poor self care, lack of motivation or lack of persistence in work

Question 12

What is affective flattening examples

Answer 12

Unchanging facial expressions
Few expressive gestures
Poor eye contact
Lack of vocal intonations
Inappropriate affect

Question 13

What is anhedonia/ asociality

Answer 13

Few close friends, or social activities

Question 14

What are the 2 main disorganisation symptoms

Answer 14

Bizarre behaviour

Thought disorder

Question 15

What is bizarre behaviour

Answer 15

Bizarre social behaviour, clothing.
Aggression/agitation
Repetitive stereotype behaviours

Question 16

What is thought disorder

Answer 16

Derailment 
Circumstantial speech 
Pressured speech 
Distractibility
Incoherent/illogical speech

Question 17

What is the onset of psychosis

Answer 17

Occurs at any age but most commonly in the late adolescence and early 20s. It is a later onset for females

Question 18

What is the morbidity of psychosis

Answer 18

There is a risk not only from the behaviours associated with psychosis but also increased risk of other medical problems such as heart disease. There is a significant impact on work education and functioning

Question 19

What is the course of psychosis

Answer 19

Often chronic and episodic however is very variable

Question 20

What is the mortality of psychosis

Answer 20

Substantial - knocks off 15 years from life expectancy and there is a high risk of suicide especially with schizophrenia

Question 21

What are the main aspects of the psychiatric history

Answer 21

HPC
Past psych history
Background history (family, personal, social)
PMHx and DHx
Corroborative history

Question 22

Why are medical problems relevant to a psychiatric history

Answer 22

Medical problems can be a cause or consequence of mental disorder or psychiatric treatment

Question 23

What is a corroborative history

Answer 23

This is when we talk to informants such as relatives, friends and the authorities to see if the patient is correct in their tellings - however we need consent to do this

Question 24

What do we examine in the mental state examination

Answer 24

Appearance and behaviour 
Speech
Mood
Thoughts 
Perceptions
Cognition 
Insight

Question 25

What aspects of appearance and behaviour do we look at

Answer 25

General appearance
Facial expression
Posture
Movements
Social behaviour

Question 26

What aspects of speech do we look at

Answer 26

Quantity
Rate
Spontaneity
Volume

Question 27

What aspects of mood do we look at?

Answer 27

Subjective
Objective: 
 - Predominant mood
 - Constancy 
 - Congruity

Question 28

What is incongruity

Answer 28

When their mood does not match up with the current situations. E.g. if they are cheerful when describing sad events

Question 29

What do we look at in terms of thoughts

Answer 29

Stream
Form 
Content: 
- Preoccupation
- Morbid thoughts, suicidality 
- Delusions. overvalued ideas
- Obsessional symptoms

Question 30

What is folie a deux

Answer 30

memory shared delusions between 2 individuals

Question 31

What perceptions do we look for

Answer 31

Illusions
Hallucinations
Distortions

Question 32

What are illusions

Answer 32

Misperception of a real external stimulus

Question 33

What is a pseudohallucination

Answer 33

Hallucinations experienced by the patient however they still maintain insight and are aware that there is no true stimulus

Question 34

What is Charles Bonnet syndrome

Answer 34

Visual hallucinations in someone whose vision is starting to deteriorate

Question 35

What aspects of cognition do we look at

Answer 35

Consciousness 
Orientation
Attention and concentration
Memory
Language functioning
Visuospatial functioning

Question 36

What do we look at in terms of insight

Answer 36

Awareness of oneself as presenting phenomena that are considered abnormal
Recognition that the phenomena are abnormal
Acceptance that they are caused by mental illness
Knowing you need treatment and accepting this

Question 37

What are the 3 main types of treatment offered for psychosis

Answer 37

Pharmacological
Psychological
Social support

Question 38

What antipsychotics can we give

Answer 38

Dopamine antagonists such as olanzapine

Question 39

What are the side effects of antipsychotics

Answer 39

EPSEs
Sedation
GI e.g. constipation
Haematological - agranulocytosis and neutropenia
Metabolic e.g. weight gain, increased appetite, diabetes
Pituitary e.g. increased prolactin
Cardiac e.g. dysrhythmia, long QTc