Psychosis

Question 1

General description of psychosis

Answer 1

Psychosis refers to conditions characterized by positive symptoms such as delusions and hallucinations; negative symptoms such as diminished affective expression and reduced goal-directed behaviour; and disorganized thinking and behaviour

Question 2

What is one to understand from the terms negative and positive symptoms?

Answer 2

Negative symptoms are the lack of abilities that should be present.
Positive symptoms are the presence of symptoms that are not part of ‘‘normal’’ people.

Question 3

What kind of term is psychosis?

Answer 3

An umbrella term

Question 4

How many % of people meet the diagnostic criteria for schizophrenia?

Answer 4

Just under 1%

Question 5

What are positive symptoms of diagnosis?

Answer 5

Delusions and hallucinations

Question 6

What are negative symptoms in psychosis?

Answer 6

Diminished emotional expression, avoliation, alogia, anhedonia, asociality

Question 7

What kind of disorganization is seen in psychosis?

Answer 7

Formal thought disorder, disorganised behaviour, catatonic behaviour

Question 8

What are delusions?

Answer 8

A firmly held belief for which there is no evidence or which is not accepted by other members of the person’s culture.

Question 9

What are common delusions in psychosis?

Answer 9

Persecutory: That one will be harmed

Control: That some force is controlling the self

Referential: That cues or comments are directed at the self

Grandiose: That one has exceptional abilities, wealth, fame or significance

Somatic: That part of the body has an unusual function or is unhealthy

Thought withdrawal: That some force has removed one’s thoughts

Thought insertion: That some force has inserted
thoughts into one’s mind

Thought broadcasting: That one’s thoughts are being broadcast out loud so others can hear them

Erotomanic: That another person is in love with the self

Delusional jealousy: That one’s romantic partner is unfaithful

Question 10

What are hallucinations?

Answer 10

A vivid perception-like experience (e.g. hearing voices or seeing visions) in the absence of a corresponding external stimulus. The person may or may not have insight into the non-veridical nature of the hallucination.
Delusions may develop to explain the hallucinations (e.g. the TV station is controlling me by beaming electricity into my pelvis, and I can feel this).

Question 11

What are some hallucinations that could occur in psychosis?

Answer 11

Auditory: Hallucinations of sounds, usually hearing voices
V
isual: Hallucinations of images, usually people but occasionally unformed images such as flashes of light

Geometric: Hallucinations of tunnels, spirals, lattices or cobwebs

Tactile: Hallucinations of being touched, shocked, or something crawling under the skin

Somatic: Hallucinations of physical experiences within the body, for example electricity

Olfactory: Hallucination of odours such as burning rubber or decaying flesh

Gustatory: Hallucination of tastes, usually unpleasant

Question 12

What is diminished emotional expression?

Answer 12

Decreased verbal and non-verbal expression of emotions with the voice, face, and hands. Also referred to as blunted or flattened affect.

Question 13

What is avolition?

Answer 13

Decreased purposeful goal-directed activity

Question 14

What is alogia?

Answer 14

Decreased speech output

Question 15

What is anhedonia?

Answer 15

Decreased capacity to experience pleasure or recall pleasantness of positive events

Question 16

What is asociality?

Answer 16

The lack of motivation to engage in social interaction, or a preference for solitary activities

Question 17

What is formal thought disorder?

Answer 17

Disorganized thinking shown by incoherent switching from one topic to another (derailment or loose associations) and difficulty maintaining a coherent train of thought from A to B

Question 18

What is disorganized behaviour?

Answer 18

Difficulty organizing, planning and completing activities of daily living

Question 19

What is catatonic behaviour?

Answer 19

Decreased reactivity to the environment shown by lack or verbal or motor responses (stupor), little speech (mutism), resistance to instructions (negativism), maintaining self-imposed bizarre rigid postures (posturing) or externally imposed postures (waxy flexibility), purposeless excessive motor activity (catatonic excitement), repetitive movements (stereotypy), mimicking others speech (echolalia), or mimicking others movements (echopraxia)

Question 20

Subtypes of schizophrenia in ICD10

Answer 20

Paranoid, hebephrenic and catatonic schizophrenia

Question 21

What is the reasoning behind the subtypes of schizo in ICD10, and how are the subtypes described?

Answer 21

Subtypes are defined on the basis of the most prominent symptom.

In paranoid schizophrenia,
paranoid delusions, usually accompanied by auditory hallucinations, are the most prominent symptoms.

In hebephrenic schizophrenia, diminished or inappropriate affective expression
is the predominant symptom, coupled with formal thought disorder or avolition.

In catatonic schizophrenia, either retarded or excited catatonic behaviour is the principal feature.

Question 22

Are there subtypes of schizo in DSM5?

Answer 22

No. They were dropped in DSM-5. Research hasshown that these subtypes are not consistently differentiated by family history, course, prognosis or treatment response.

Question 23

How does DSM5 categorise schizo?

Answer 23

In DSM-5 schizo is categorised as schizophrenia spectrum disorders. These include those
which have the same symptomatology as schizophrenia, but are of briefer duration (brief psychotic disorder where the disturbance is less than a month and schizophreniform disorder where the disturbance is between 1 and 6 months);

those with the same symptomatology as schizophrenia in addition to manic or depressive symptoms (schizoaffective
disorder);

those characterized by a single class of psychotic symptoms (delusional disorder and catatonia);

and those characterized by chronic mild schizophrenia-like symptoms (schizotypal personality disorder)

An attenuated psychosis syndrome for individuals with briefepisodes of one or more psychotic symptoms and insight into these is included in DSM-5 as a schizophrenia spectrum condition deserving further study. This condition is typically shown by those at high risk for developing psychosis

Question 24

Does ICD10 use scizo spectrum disorders? If so - which ones?

Answer 24

Yes. In ICD-10 schizophrenia spectrum disorders include schizophrenia, acute and transient psychotic disorders, schizoaffective disorder, persistent and induced delusional disorders, and schizotypal disorder.

Question 25

What are the diagnostic criteria for schizoprenia in DSM5?

Answer 25

A. Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3):
1. Delusions.
2. Hallucinations.
3. Disorganized speech (e.g., frequent derailment or incoherence).
4. Grossly disorganized or catatonic behaviour.
5. Negative symptoms (i.e., diminished emotional expression or avolition).

B. For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly
below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning).

C. Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or 2) if mood
episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.

E. The disturbance is not attributable to the
physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

F. If there is a history of autism spectrum disorder or a communication disorder of child hood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of
schizophrenia, are also present for at least 1 month (or less if successfully treated).

Question 26

What are the diagnostic criteria forschizoprenia in ICD10?

Answer 26

A minimum of one very clear symptom
(or two or more, if less clear cut)
belonging to any one of the groups (a)
to (d) or at least two of the symptoms
(e) to (h) should have been present
most of the time during a period of 1
month or more.

(a) thought echo, thought insertion or
withdrawal and thought broadcasting

(b) delusions of control, influence, or
passivity, clearly referred to body or
limb movements or specific thoughts,
actions or sensations; delusional
perception

(c) hallucinatory voices giving a running
commentary on the patient’s
behaviour, or discussing the patient
among themselves, or other types of
hallucinatory voice coming from some
part of the body

(d) persistent delusions of other kinds
that are culturally inappropriate
and completely impossible, such
as religious or political identity, or
superhuman powers and abilities

______________________________________

(e) persistent hallucinations in any
modality, when accompanied either
by fleeting or half-formed delusions
without clear affective content, or by
persistent overvalued ideas, or when
occurring every day for weeks or
months on end

(f) breaks or interpolations in the train
of thought, resulting in incoherence or
irrelevant speech or neologisms

(g) catatonic behaviour, such as
excitement, posturing, or waxy
flexibility, negativism, mutism and
stupor

(h) negative symptoms such as marked
apathy, paucity of speech, and blunting
or incongruity of emotional responses,
usually resulting in social withdrawal
and lowering of social performance

(i) a significant and consistent change in
the overall quality of some aspects
of personal behaviour, manifest as
loss of interest, aimlessness, idleness,
a self-absorbed attitude and social
withdrawal

Question 27

Lifetime prevalence for delusional disorder

Answer 27

0.2%

Question 28

Lifetime prevalence for shizoaffective disorder

Answer 28

0.2–1.1%

Question 29

Lifetime prevalence for schizophrenia

Answer 29

0.7%

Question 30

Lifetime prevalence for schizotypal disorder

Answer 30

4%

Question 31

Male to femalie ratio for schizophrenia

Answer 31

1.4:1

Question 32

What can be said about the onset of schizophrenia?

Answer 32

About a third of cases have their first psychotic episodesduring adolescence. The onset of schizophrenia is earlier in males than females

Question 33

Co-morbid disorders for schizo/psychosis

Answer 33

Comorbid alcohol and substance
use is common in schizophrenia.

Symptoms of post-traumatic stress
disorder (PTSD) in response to the experience of psychotic symptoms and hospitalizationare common among trauma survivors with psychosis.

Psychosis occursin up to 6% of people with seizure disorders.

Question 34

Describe the course of schizophrenia

Answer 34

The onset of schizophrenia typically occurs
in late adolescence or early adulthood and may be acute or insidious. Typically the onset takes place over 5 years, starting with negative and depressive symptoms, followed by cognitive and social impairment and finally positive symptoms. Longitudinal studies suggest that there is an early deterioration phase that extends over 5–10 years, a stabilization phase
and a final gradual improvement phase. For 50–70% of cases the condition follows a chronic relapsing course, typically with incomplete remission between episodes. However, up to 40% of service-users show one or more periods of complete recovery with good adjustment for at least a year and 4–20% show complete remission

Question 35

How long does a psychotic episode last?

Answer 35

1-6 months, some extending up to a year. Usually there will be a prodromal periode leading up to the psychosis.

Question 36

Lifespan of people with schizophrenia compared to others

Answer 36

The lifespan of people with schizophrenia is
about 9 years shorter than that of the general population, and this is partly accounted for bythe high rate of suicide during the first 10 years of the disorder and the high rate of comorbid medical disorders.

Question 37

What is the risk of suicide attempts and complete suicide? And when are suicide attempts most prevalent?

Answer 37

About half of all people with schizophrenia attempt suicide or self-harm; the lifetime riskfor completed suicide is 5%; and suicide usually occurs in the early phase of the disorde

Question 38

How many people with schizophrenia show complete remission?

Answer 38

4–20% show complete remission.