Psychosis

Question 1

What is psychosis

Answer 1

difficulty perceiving and interpreting reality

Question 2

Common cause

Answer 2

Schizophrenia

Question 3

What are three symptoms domains

Answer 3

positive, negative, disorganised

Question 4

Examples of positive symptoms

Answer 4

• hallucinationsperception in absence of stimulusany sensory modality1st (thought echo) 2nd 3rd person possible
• delusionsfixed false belief not in keeping with sociocultural norms → theme e.g. persecutory, grandiosity
  Can also experience passivity symptoms eg though broadcasting ,thought insertion and thought withdrawal

Question 5

Examples of negative symptoms

Answer 5

• alogiapaucity or poverty of speech
• anhedonia/asocialityfew close friends, interests, impaired social functioning
• avolition/apathypoor self-care, lack of motivation
• affective flatteningunchanging facial expressions, poor eye contact, lack of vocal and emotional range

Question 6

Examples of disorganization symptoms

Answer 6

bizarre behaviour eg inappropriate social behavior,bizarre appearance ,aggression,repetitive behavior

formal thought disorder-lack of logical connection between thoughts eg
Circumstantial thought (get to point after a long time),tangential thought (never get to point) flight of ideas (fast thoughts),derailment of association,word salad

Question 7

types of the latter in worsening order?

Answer 7

circumstantial thought, tangential thought, flight of ideas, derailment/loosening of association, word salad

Question 8

Typical onset and course of psychosis as well as morbidity and mortality

Answer 8

peak incidence early 20s, any age possible

often chronic and episodic

Morbidity increase risk of health problem and impact on education /work

Mortality they lose 15-20 years and high risk of suicide in schizophrenia

Question 9

what is psychosis often preceded by?

Answer 9

prodromal symptoms e.g. increasing isolation and poor self-care

Question 10

What is this misdiagnosed as

Answer 10

Depression

Question 11

psychosis risk factors → non-modifiable?

Answer 11

previous diagnosis with a mental illness, family history (high heritability with polygenic influence)

Question 12

psychosis environmental risk factors?

Answer 12

drug use esp cannabis

prenatal complications, maternal infections

migrant, socioeconomic deprivation, childhood trauma

Question 13

what is echopraxia?

Answer 13

involuntarily mimicking someone else’s movements

Question 14

what is echolalia?

Answer 14

meaningless repetition of someone else’s words

Question 15

examples of 1st rank delusion symptoms?

Answer 15

thought broadcasting, thought insertion, thought withdrawal

• insight preserved in pseudo, true indistinguishable from real perception

Question 16

what distinguishes true hallucinations from pseudohallucinosis?

Answer 16

insight preserved in pseudo, true indistinguishable from real perception
Voices must be perceived as originating from the outside

Question 17

what is one measure of cognition?

Answer 17

addenbrooke’s cognitive examination III

Question 18

what are the three main treatment approaches to psychosis

Answer 18

pharmacological, psychological, social support

Question 19

what do antipsychotic drugs target?

Answer 19

Dopamine system

Question 20

what kind of action do these take?

Answer 20

antagonist or partial agonist
Agonists can cause psychotic symptoms too as increase dopamine activity in mesolimbic dopamine system implicated in causing postive symptoms of psychosis

Question 21

what are extrapyramidal side effects?

Answer 21

side effects outside pyramidal movement pathway

Question 22

What are extrapyramidal side effects caused by

Answer 22

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

Question 23

What does the nigrostriatal system usually do

Answer 23

enable us to maintain posture and tone

Question 24

side effect symptoms?

Answer 24

• parkinsonismbradykinesia, postural instability, rigidity, slow gait, tremor (slow thumb across other fingers)
• acute dystonic reactionsloss of muscle tone
• tardive dyskinesiarepetitive involuntary movements e.g. eye blinking, grimacing
• akathisiainability to remain still

Question 25

antipsychotic drug divisions?

Answer 25

older → typical, first generation

newer → atypical, second generation

Question 26

which is more likely to cause extrapyramidal side effects?

Answer 26

typical as atypical involves 5HT-2A antagonism

Question 27

other antipsychotic side effects?

Answer 27

CNS → EPSEs, sedation

haematological → agranulocytosis, neutropenia

metabolic → increased appetite, weight gain, diabetes

GI → constipation

pituitary → prolactin up

cardiac → dysrhythmia, long QTc

Question 28

Cognitive impairment in schizophrenia

Answer 28

Affects working memory and executive function
Poorer educational attainment
Cognitive imoairement difficukt to treat and cause comorbidity