psychosis

Question 1

what is psychosis and examples

Answer 1

difficulty perceiving and interpreting reality

umbrella for many diseases, ie- schizophrenia, bipolar I, delusional disorder, drug induced etc

Question 2

types of psychosis symptoms domain

Answer 2

positive

negative

disorganised

Question 3

example of positive symptoms

Answer 3

hallucination-perception in absence of stimulus
-all 5 senses
-commonly auditory
-1st= though echo, 2nd, 3rd person running commentary/command hallucinations

delusions-fixed, false belief not in keeping with social/cultural norms.
-passive experience- thought are controlled by external agent. ie. thought broadcasting, insertion, withdrawal.

Question 4

what are some negative symptoms

Answer 4

alogia
anhedonia
asociality-
avolition
apathy
affective flattening

Question 5

what is alogia

Answer 5

decreased speech

Question 6

what is anhedonia

Answer 6

inability to feel pleasure

Question 7

what is
asociality-

Answer 7

being more alone

Question 8

what is avolition

Answer 8

lack of motivation

Question 9

what is apathy and affective flattening

Answer 9

apathy -lack of enthusiasm

affective flattening-reduced facial expression/body language, poor eye contact

Question 10

examples of disorganised symptoms

Answer 10

-bizzare behaviour=
-aggression, agitation, inappropriate social behaviour

-formal though disorder- lack of logical connection between thoughts

Question 11

psychosis onset, course, morbidity, mortality?

Answer 11

onset- commonly early 20s, (peak later in women)

course- chronic+ episodic

morbidity- impact QoL (risk heart disease)//impact education, employment

mortality-high risk of suicide

Question 12

what is in the Mental state examination (MSE)

Answer 12

A Sailor Makes Tea, Pours Calmly, and Ignores

Appearance and behaviour
Speech
Mood and Affect
Thoughts
Perceptions
Cognition
Insight

Question 13

psych hx for psychosis: HPC/Psych hx, fam hx, environemnt?

Answer 13

HPC: 6-18 months before has prodromal symptoms similar to depression

Psych Hx: increased risk if they had mental issues in the past

fam hx- important as schizophrenia=highly heritable. High concordance in MZ twins. Highly polygenic

environmental-drugs, ACE, prenatal/birth complication

Question 14

Examples of prodromal symptoms in psychosis that’s often misdiagnosed in depression

Answer 14

-increasing isolation
-poor self care
-social withdrawal
-declining academic performance

Question 15

what to look out for in MSE for psychosis - appearance and behaviour

Answer 15

appearance:
Bizarre or inappropriate clothing
Self-neglect
Self-harm injuries

behaviour:
eye-contact
unreactive
agitation
Abnormal movements

Question 16

what to look for in speech compartment of MSE

Answer 16

Comment on rate/rhythm/volume

Question 17

description of thought disorder

Answer 17

circumstantial
tangential
flight of ideas
derailment
word salad

Question 18

what is pseudohallucination (vs hallucination

Answer 18

pseudohallucination:
-insight preserved
-ie voices perceived originating from inside head rather than outside

Question 19

what is tactile hallucination

Answer 19

involving sense of touch- ie ‘can feel chip inside his brain’

Question 20

What difficulties might you have treating someone with poor insight into their psychosis?

Answer 20

-consenting to treatment
-FU attendance
-willing to admit to hospital

Question 21

psychosis diagnosis?

Answer 21

can’t diagnose schizophrenia based from 1 psychotic episode.
-follow up for 3 years under Early Intervention of Psychosis Service

Question 22

management of psychosis

Answer 22

antipsychotic
CBT
social support

Question 23

antipsychotics in psychosis -2 types name of drug

Answer 23

dopamine antagonist-ie.risperidone
(but can also target NTs like serotonin, acetylcholine, histamine)

new partial agonist= aripiprazole

Question 24

describe dopamine activity in psychosis

Answer 24

Increased dopamine activity in mesolimbic dopamine system cause positive symptoms of psychosis

Question 25

side effect of dopamine agonist vs antagonist

Answer 25

agonist- used in parkinson’s disease can cause psychotic symptoms

antagonist: parkinsonism

Question 26

what are extrapyramidal side effects (EPSEs)- explain and give examples

Answer 26

Dopamine blockade in the nigrostriatal (extrapyramidal) dopamine system (parts of the brain that enable us to maintain posture and tone)

Parkinsonism
Acute dystonic reactions
Tardive dyskinesia
Akathisia

Question 27

other side effects of antipsychotics

Answer 27

weight gain, increased prolactin, long QTc

Question 28

management of EPSE

Answer 28

counsel about risk,
use lowest therapeutic dose,
first line= atypical

Question 29

typical vs atypical drugs in antipsychotics what are they

Answer 29

typical- older - first generation

atypical- newer- second generation
– associated with lower EPSE risk. Due to 5HT-2A antagonism