Psych - Psychosis

Question 1

What contributes to madness?

Answer 1

• Psychosis
• Personality disorder
• Dementia
• Encephalopathy/ brain injury
• Delirium

Question 2

What contributes to psychosis?

Answer 2

• Schizophrenia
• Drugs, metabolism, endocrine, infection
• Mania, depression, psychotic disorders

Question 3

What are the 2 defining features fo psychosis?

Answer 3

Hallucinations Delusions

Question 4

What is reality failure?

Answer 4

Group of pathologies which disrupt the process of receiving and interpreting reality.

Question 5

How do we perceive reality?

Answer 5

Through consciousness - the content of consciousness is screened via attention - both active and passive.

Question 6

What are auditory verbal hallucinations?

Answer 6

Thoughts or internal monologues experienced as external or 3rd person

Question 7

How common are auditory verbal hallucinations?

Answer 7

Affect around 5% of the healthy population however are common with psychosis

Question 8

How can auditory verbal hallucinations cause mental disorders?

Answer 8

These combined with emotional state, poor coping, past/family history of psychosis and cognitive difficulties can lead to the formation of mental disorders

Question 9

What are delusions?

Answer 9

Fixed, false, unshakeable beliefs out of cultural context

Question 10

Why do we get delusions?

Answer 10

They are our bodies response to perplexity. Our brain cannot interpret and organise sensory input, so rather than breaking down, it will create confabulations or delusions to bridge the gap between sensory input and our cognition

Question 11

In what demographic do we see a greater prevalence of delusions?

Answer 11

We often see more delusions in populations which have historically been controlled or persecuted. With these people, we see more persecutory delusions, such as accusing your neighbours of trying to kill you.

Question 12

What is meant by the positive or negative symptoms of schizophrenia?

Answer 12

Positive symptoms mean that they are added onto the normal human experience. Negative symptoms on the other hand are the result of aspects of the normal human experience being taken away from us.

Question 13

What are the positive symptoms of schizophrenia?

Answer 13

We have hallucinations which are extremely common and can be very real for people with schizophrenia. We also have delusions which can be grandiose or persecutory, or delusions of control/interference.

Question 14

What are the negative symptoms of schizophrenia?

Answer 14

Anhedonia Apathy Social withdrawal Blunted mood

Question 15

What are the disorganised symptoms of schizophrenia?

Answer 15

Formal thought disorder Aimlessly wandering/ abnormal behaviour Inappropriate affect e.g. violence Disorganised speech or behaviour

Question 16

What is perplexity?

Answer 16

This is a disruption of language and meaning whereby normal experiences appear aberrantly salient. Also, with perplexity there is always the sense that something strange is going on

Question 17

What is the disruption of the sense of self?

Answer 17

Your thoughts and experiences lose their ownership ie you no longer see them as your own thoughts, as the ‘other’ invades your world.

Question 18

Describe the genetic component of schizophrenia

Answer 18

There is a significant genetic component to SCZ. Heritability = 80% Single parent heritability is 10% but both parents having SCZ = 50%. MZ twin heritability = 40%. There are over 200 genes affecting SCZ as well as environmental influences

Question 19

What is the role of dopamine?

Answer 19

NT involved in the reward pathway - we get reward for spotting errors (salience)

Question 20

What is salience?

Answer 20

Term that refers to anything that is different or noticeable compared to our surroundings

Question 21

What are the causes of psychosis?

Answer 21

Genetic component (SCZ) Childhood adversity or abuse Recreational drugs Neurodevelopment e.g. premature birth or hypoxia/infection Life stressors

Question 22

How does adversity/abuse contribute to psychosis?

Answer 22

We get a sensitised striata dopaminergic pathway

Question 23

How do recreational drugs contribute to psychosis?

Answer 23

Account for 25% of psychosis - an earlier age of smoking cannabis and a stronger strain of cannabis is associated with an increased psychosis risk

Question 24

What treatments are available for psychosis?

Answer 24

Antipsychotics Psychological therapy Social therapy

Question 25

What antipsychotics are available?

Answer 25

Antidopaminergic Serotonergic Cholinergic Typical/atypical

Question 26

What psychological therapy is available?

Answer 26

CBT (psychosis) Avatar therapy - gives a sense of agency over the auditory verbal hallucinations

Question 27

What social support is available?

Answer 27

Supportive environment provided Benefits Budgeting/ employment support

Question 28

What is the neuroanatomy of the dopamine pathways?

Answer 28

We have 4 pathways: striatum, cortical, livic and pituitary

Question 29

What are some of the potential side effects of antipsychotics?

Answer 29

Neurological e.g. movement problems Prolactin Metabolic e.g. weight gain Muscarinic Haematological e.g. neutropenia Cardiac e.g. arrhythmia Sedation

Question 30

What is the link between mental illness and violence?

Answer 30

Most patients are more likely to be victims than aggressors except for schizophrenia patients. When untreated their risk of violence increases by 2-4, however with alcohol violence of normal people, the risk increases by 10-20.

Question 31

What is the pathophysiology of schizophrenia?

Answer 31

Dopamine 2 receptors are heavily involved and we get the disorganisation of the default mode network. This creates stimulus independent thought and self regulation. In SCZ, we can see through PET scans that there is an excess of striatal dopamine, especially in response to stress, causing symptoms of schizophrenia.