Psychosis

Question 1

Define psychosis?

Answer 1

Loss of contact with reality

Caused by a number of psychiatric conditions

Hallucinations, delusions, thought disorders etc.

Question 2

What’s the difference between positive and negative symptoms?

Answer 2

Positive symptoms: thoughts + feelings that are added to a person’s experience (hallucinations, delusions, agitation)

Negative symptoms: things that are taken away or reduced (apathy, low mood)

Question 3

What are the secondary causes of psychosis?

Answer 3

Brain tumour or cyst

Neurological disease: Alzheimer’s, Parkinson’s, epilepsy, dementia

Stroke

Metabolic: hypernatraemia, hypocalcaemia

Endocrine: hyperthyroid, cushings

Drugs

Question 4

Types of psychosis?

Answer 4

Schizophrenia
Schizoaffective disorder
Delusional disorder
Bipolar disorder

Question 5

What are the first rank symptoms of schizophrenia?

Answer 5

1. Thought disorder
   - withdrawal
   - insertion
   - echo
   - broadcast
2. Passivity phenomena
3. 3rd person auditory hallucinations
4. Delusional perception

Question 6

What are the second rank symptoms of schizophrenia?

Answer 6

Delusions

2nd person auditory hallucinations + other types

Catatonia

Negative symptoms

Question 7

What is schizoaffective disorder?

Answer 7

When a patient experiences symptoms of schizophrenia and a mood disorder (mania or depression)

Question 8

Management of schizophrenia?

Answer 8

Psychotherapy
CBT
Support with substance abuse
Family support, therapy
Social support: housing, financial, job

Medication

Question 9

What medication is prescribed in schizophrenia?

Answer 9

Anti-psychotics: typical or atypical

Can give PO or by depot

Benzodiazepines in acute situations

Question 10

What is schizophrenia?

Answer 10

A severe mental disorder, characterised by disruptions in thinking, perception, sense of self

Question 11

Risk factors of schizophrenia?

What often triggers schizophrenia onset?

Answer 11

Family history
Intra-uterine complications and infection
Migrants
Social isolation
Drugs (esp cannabis)

Triggers:

• stress
• drug misuse

Question 12

How would you investigate a patient with psychosis?

Answer 12

Full history and examination

Bloods

Drug and alcohol screen

Urine dip/MSU

CT/MRI head

Question 13

List some psychosocial support offered to patients with schizophrenia?

Answer 13

Psychoeducational programme: support, information, management strategies

Family intervention: education, support

Life skills: managing money, domestic skills, self care

Social skills: behavioural, to be employable, have friends

CBT