Psychosis

Question 1

Psychosis

Answer 1

loss of touch with reality
difficult perceiving and interpreting reality

Question 2

What are negative symptoms of psychosis?
Loss of function

Answer 2

Alogia (slow speech),
Anhedonia (not experiencing pleasure),
Avolition/apathy (low will/self care),
Affective flattening (emotionally flat, poor eye contact)

Question 2

What are positive symptoms of psychosis?
Gain of function

Answer 2

Hallucinations (usually auditory, but any modality), Delusions (consider thought broadcasting, insertion and withdrawal)

Question 3

What is the definition of delusion?

Answer 3

Fixed, false belief that is not understandable considering the person’s sociocultural upbringing

Question 4

What are disorganisation symptoms of psychosis?

Answer 4

Bizzare behaviour (social, clothing, aggression),
Formal Thought Disorder (lack of thought form - loose association)

Question 5

What is the typical onset of psychosis?

Answer 5

Any age, but peak incidence in adolescence/early 20s

Question 6

What usually precedes psychosis?

Answer 6

Prodromal symptoms - changes to personality, social behaviour, thought process, usually misdiagnosed as depression

Question 7

How can cannabis use act as a risk factor for psychosis?

Answer 7

Brings the onset of psychosis forward

Question 8

What are some other environmental risk factors for psychosis?

Answer 8

Birth complications, socioeconomic deprivation, childhood trauma

Question 9

What things would you look out for in appearance and behaviour in psychosis?

Answer 9

Bizzare clothing,
psychomotor agitation/retardation, (may be due to induced parkinsonism from anti-psychotics)
self-neglect,
self-injury,
echophenomena (mimic movements),
eye contact

Question 10

What things would you look out for in speech in psychosis?

Answer 10

Rate, Volume, intonations (monotonous)

Question 11

Why is it important to assess for mood in psychosis?

Answer 11

High risk of another mental disorder such as depression, there is a suicide risk

Question 12

What is affect?

Answer 12

emotional range
may become flattened/ blunted
causes them to react inappropriately (may laugh in sad situations)

Question 13

What things would you look out for in thought content in psychosis?

Answer 13

Thought insertion, thoughts that weren’t his
withdrawal
broadcasting

Question 14

What things would you look out for in perceptions in psychosis?

Answer 14

Hallucinations, potentially command hallucinations (risk), assess if they are pseudohallucinations (they are aware they are hallucinations) or not

Question 15

Types of auditory hallucinations

Answer 15

1st person, echo
2nd person, talking to you
3rd person, talking about you

Question 16

What things would you look out for in cognition in psychosis?

Answer 16

Check for orientation and confusion (time,place,person)
affects cognition in long term

Question 17

What things would you look out for in insight in psychosis?

Answer 17

Are they aware of hallucinations, usually lacks insight

Question 18

What is a consequence in patients lacking insight in psychosis?

Answer 18

Poor compliance with treatment, consent for treatment may not be achieved as they do not believe that they are sick

Question 19

Diagnosis

Answer 19

Send to early diagnosis psychosis team, watch over a longer period of time before coming up with a final diagnosis

Question 20

What are 3 categories of management for psychosis?

Answer 20

Antipsychotic medication,
CBT, for more chronic, stable patients
Social support

Question 21

What is the typical action of antipsychotics in psychosis?

Answer 21

Dopamine antagonists
meso-limbic system in the brain
partial agonist will still reduce dopamine as it is competing with the native agonist

Question 22

What are EPSEs and why do they occur?

Answer 22

Extrapyramidal Side Effects, from dopamine blockage of nigrostriatal system (basal ganglia relevant for posture and tone)
outside the pyramid of the medulla

Question 23

What are some examples of EPSEs?

Answer 23

Parkinsonism (bradykinesia, hunched over gait),
Acute dystonic reactions (involuntary contractions),
Tardive dyskinesia (irregular movements), orofacial dyskinesia
Akathisia (cannot stay still), internal restlessness

Question 24

What types of antipsychotics cause less EPSEs?

Answer 24

Atypical antipsychotics have less EPSEs, unlike typical EPSEs

Question 25

What are some other effects of antipsychotics?

Answer 25

Sedation/Weight Gain, due to blockage of histamine receptor
Agranulocytosis,
Dysrhythmia,
Constipation