Psychosis

Question 1

what is psychosis?

Answer 1

difficulty perceiving and interpreting reality

Question 2

what are all of the positive symptoms of psychosis?

Answer 2

hallucinations
delusions

delusions

Question 3

what are hallucinations?

Answer 3

percepts in absence of a stimuli

Question 4

what are delusions?

Answer 4

fixed, false beliefs out of keeping with social/cultural background

Question 5

what are all of the types of hallucinations?

Answer 5

auditory - voices commenting on you/talking to each other
visual
somatic/tactile
olfactory (rare)

Question 6

what are all the types of delusion?

Answer 6

persecutory
control
reference
mind reading
grandiosity
religious
guilt
somatic
thought broadcasting/insertion/withdrawal

Question 7

what are the negative symptoms of psychosis?

Answer 7

alogia
anhedonia
avolition/apathy
affective flattening

Question 8

what is alogia?

Answer 8

poverty of speech

slow to respond, little content

Question 9

how does anhedonia present?

Answer 9

lack of pleasure

Question 10

how does avolition/apathy present?

Answer 10

lack of motivation

Question 11

what is affective flattening?

Answer 11

unchanging facial expressions, few expressive gestures
poor eye contact
monotone (lack of intonation)
inappropriate reactions (smiling talking about something sad)

Question 12

what are the disorganisation symptoms of psychosis?

Answer 12

bizarre behaviour/appearance
thought disorder

thought disorder

Question 13

what is thought disorder?

Answer 13

derailment
circumstantial speech
pressured speech
distractibility
incoherent/illogical speech

Question 14

what is the typical onset of psychosis?

Answer 14

can occur at any age
peak incidence at adolescence/early 20s
peak later in women

Question 15

what is the typical course of psychosis?

Answer 15

chronic and episodic

very variable

Question 16

what is the morbidity for psychosis?

Answer 16

substantial - disorder and increased risk of common health issues
significant impact on education, employment and functioning

Question 17

what is the mortality of psychosis?

Answer 17

substantial - 15yr life expectancy loss
28% excess mortality for suicide
all mortality causes 2.5% inc.

Question 18

what is the typical layout for a psychiatric history?

Answer 18

history of presenting concern
past psychiatric history
background history
past medical history and medicines
corroborative/collateral history

Question 19

what are all the points for mental state examination?

Answer 19

appearance + behaviour
speech
mood
thoughts
perceptions
cognition
insight

Question 20

what are the environmental risk factors for psychosis?

Answer 20

drugs
prenatal/birth complications
maternal illness

Question 21

what is the management for psychosis?

Answer 21

pharmalogical - antipsychotics etc
psychological - CBT, avatar therapy
social support- benefits

Question 22

what are the side effects of antipsychotics?

Answer 22

constipation
parkinsonism
akathisia
tardive dyskinesia
agranulocytosis, neutropenia
increased appetite, weight gain, diabetes
dysrhythmia, long QTc
hyperprolactinaemia

Question 23

• What neurotransmitter system is most implicated in the mechanism of antipsychotics?

Answer 23

Excess Dopamine in the mesolimbic system

Question 24

• What kind of drugs, therefore, are most antipsychotics?

Answer 24

dopamine anatgonists

Question 25

What side effect can certain antipsychotics cause?

Answer 25

Extra Pyramidal Side Effects (Parkonsonism, etc)

Question 26

What makes something a ‘typical’ vs ‘atypical’ antipsychotic

Answer 26

Typical cause EPSE
- Atypical e.g. olanzapine are less likely to cause EPSE

Question 27

• What are other side effects of antipsychotics? (6)

Answer 27

• CNS → EPSEs, sedation
  
  • Haematological → agranulocytosis, neutropenia
  • Metabolic → increased appetite, weight gain, diabetes
  • GI → constipation
  • Pituitary → more prolactin (release suppressed by dopamine)
  • Cardiac → dysrhythmia, long QTc (can cause palpitations, fainting, seizures)