Psychosis

Question 1

Describe a drug induced psychosis:

• how long do symptoms last?
• what type of drugs can induce psychosis?
• Does psychotic symptoms in the context of substance misuse always = a drug induced psychosis?

Answer 1

Florid or chronic symptoms, short-lasting if psychoactive substance removed
steroids and antiparkinson drugs can induce psychosis
-NO psychotic symptoms in the context of substance misuse does not always mean it is a drug induced psychosis
(people with schizo. or bipolar more likely to take illicit drugs than the general population)

Question 2

Describe a depressive psychosis;

• is it mood congruent?
• what are the nature of the delusions?
• What are the nature of the hallucinations?

Answer 2

This is a marker of severity of depression

• typified by mood congruent content of psychotic symptoms
• delusions of worthlessness/guilt/hypochondriasis/poverty (nihilistic)
• hallucinations of accusing/insulting/threatening voices (usually 2nd person)

Question 3

What is a catatonia? what are 5 examples?

Answer 3

A state where the person may not respond to stimuli and exhibits strange physical behaviour. The state may involve a particular movement or posture that a patient often performs:
Stupor – the patient is unable to move or speak except for moving their eyes.
Strange postures – that are normally very difficult to hold
Negativism – the patient does the exact opposite of what they are asked
Automatic obedience - Mechanically following instruction, often due to the unresponsiveness to external stimuli caused by catatonia.
Waxy flexibility – the patient has strange muscle tone that allows the doctor to put the patient into physical position that would otherwise be very difficult and/or painful.

Question 4

Describe a manic psychosis:

• is it mood congruent?
• What are the nature of the delusions?
• What are the nature of the hallucinations?
• What thought disorder can be present in particular?
• are symptoms of 1st rank common in schizophrenia?

Answer 4

Mood congruent content of psychotic symptoms:
-delusions of grandeur/special ability/persecution/religiosity/delusions of perception
(these tend to escalate)
-Auditory grandiose delusions
-Flight of ideas
-20% of manic episodes contain a symptom of first rank

Question 5

What is schizoaffective disorder?

Answer 5

• presence of both symptoms typical of schizophrenia AND affective disorder
• any specific episode may be schizo-manic or schizo-depressed

Question 6

Describe the psychosis seen in delirium:

• acute/chronic?
• what happens to consciousness? How does this change over time? When is it worse?
• describe the hallucinations? - when are these worse?
• describe the delusions?
• describe four other symptoms seen in addition to psychosis?

Answer 6

• Acute transient disturbance
• clouding of consciousness: subtle drowsiness to unresponsive, fluctuating severity over time, disorientation to T.P.P, worse at night
• Visual hallucinations/illusions +/- auditory that are often threatening: these are worse at night (visual are clearer and more frightening) Visual hallucination indicate organic disease
• Persecutory delusions
• ALSO: impaired conc/memory; irritability; insomnia; psychomotor disturbance (agitation or retardation)

Question 7

What are some good ways of challenging delusions?

Answer 7

• What would you say if someone said to you that this isn’t true?
• Can you explain to me how this is possible?