Psychosis

Question 1

psychosis

Answer 1

difficulty in perceiving and interpreting reality

- symptom not a condition

Question 2

what are organic psychosis causes?

Answer 2

a variety of conditions including strokes, brain injury, encephalitis, Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, temporal lobe epilepsy or brain tumours.
Functional psychoses include schizophrenia and mood disorders such as manic-depression.

Question 3

types of symptoms in psychosis

Answer 3

• positive symptoms (experiencing things that aren’t there- adds to reality)
• negative symptoms (opposite)
• disorgnaisation symptoms

Question 4

types of positive symptoms

Answer 4

• Hallucinations:
• Auditory
• Voices commenting on you or talking to each other
• Visual
• Tactile hallucination (feel like sometimes tapping you)
• olfactory hallucinations
• delusions

Question 5

what are delusions?

Give some examples

Answer 5

beliefs with lie outside of normal social or cultural beliefs

• Mind reading
• Grandiosity
• Religious
• Guilt/sin

Question 6

types of negative symptoms

Answer 6

• alogia (poverty of speech- pausing and slow to respond)
• avolition/apathy (poor self care, lack of persistence at work/school, lack of motivation)
• affective flattening (unchanged facial expressions, few expressive gestures, lack of eye contact)
• anhedonia (few close friends, few hobbies)

Question 7

disorganisation symptoms

Answer 7

• thought disorder

- bizarre behaviour

Question 8

peak age of incidence of schiz

Answer 8

adolescence/early 20s -> peak later in women

Question 9

course of schiz

Answer 9

• chronic and episodic

- -> very variable

Question 10

how many years of life is lost in schiz?

Answer 10

15 years

- also 28% of excess mortality due to suicide

Question 11

the psych history

Answer 11

• history of presenting concern
• past psychiatrics history
• background history
• past medical history and medicines
• corroborative history

Question 12

what type of psychological symptoms should you check for in psychosis?

Answer 12

prodromal symptoms

Question 13

management of psychotic disorders

Answer 13

• pharmacological
• psychological
• social support

Question 14

which NT system is most implicated in the mechanism of antipyschotics

Answer 14

• Dopamine
  antipsychotics act on many NTS including serotonin, ACh, histamine. - drug actions are never agonistic when giving dopamine for minimising psychotic issues

Question 15

Extrapyramidal side effects of dopamine blockers?

What can we also call these side effects?

Answer 15

Parkinson’s syndrome side effects:
acute dystonia
tardive dyskinesia
akathisia

Question 16

what is dystonia

Answer 16

motor tone is increased; abnormal postures. If affects larynx it can be fatal.

Question 17

tardive dyskinesia

Answer 17

• repeated oral/facial/buccal/lingual movements - more common in women.

Question 18

akathisia

Answer 18

• inner restlessness
• feel compelled to move but it doesn’t make them feel better.
• most commonly affects the legs

Question 19

typical antipsychotics cause what?

Answer 19

• extrapyramidal side effects at therapeutic doses

- definition isn’t based on pharmacological drug target

Question 20

other examples of side effects of antipsychotics (typical and atypical)?

Answer 20

• EPSE
• GI constipation
• Haematological issues (agranulocytosis, neutropenia)
• metabolic - eat more, gain weight
• cardiac dysrhythmia
• Pituitary causes increased prolactin (release suppressed by dopamine)

Question 21

Describe what bizarre behavior might include

Answer 21

• Bizarre social behaviour
• Bizarre clothing/appearance
• Aggression/agitation
• Repetitive/sterotyped
behaviours

Question 22

Describe what though disorder may include

Answer 22

Derailment
Circumstantial speech
• Pressured speech
• Distractibility
• Incoherent/illogical speech

Question 23

What is the impact of psychosis on morbidity?

Answer 23

Substantial from the disorder itself and increased risk of common health problems e.g. heart disease
Impact on education, employment and functioning

Question 24

What is the impact of psychosis on mortality?

Answer 24

2.5 times all cause mortality
15 years expected life loss
Highest risk of suicide in schiz (28%)

Question 25

What are 2 fundamental parts of diagnosing psychosis?

Answer 25

The psychiatric history

Mental state examination

Question 26

What do we call it when an individual is immobile and mute?

Answer 26

Stupor

Question 27

What are the 4 things we observe when looking at speech?

Answer 27

Quantity
Rate
Spontaneity
Volume

Question 28

What are the 2 types of delusions?

Answer 28

Primary- occurs suddenly (out of the blue)

Secondary (arises from previous abnormal idea/ experience)

Question 29

Whata re the 2 types of hallucinations related to when you’re asleep on awake?

Answer 29

Hypnagogic- occur between wakefulness and REM sleep

Hypnopompic- Occur after having woken up

Question 30

Give an example of a disease related to visual hallucinations

Answer 30

Charles Bonnet Syndrome

Question 31

What is a pseudohallucination?

Answer 31

Either a true perception (illusion) or is coming outside of the head (person is aware it’s abnormal)

Question 32

What is insight?

Answer 32

Aware of oneself as presenting phenomena that other people consider as abnormal
Acceptance that abnormal phenomena are caused my mental illness and that treatment in required