Psychosis

Question 1

What is psychosis?

Answer 1

The presence of hallucinations or delusions

A SYMPTOM, NOT A DIAGNOSIS

Question 2

What are hallucinations?

Answer 2

Perception without a stimulus, can be in any sensory modality

Question 3

What are visual hallucinations usually caused by?

Answer 3

A problem with the brain or eyes (organic)

Question 4

What are considered ‘normal’ hallucinations?

Answer 4

Hypnogogic or hypnopompic hallucinations

Going to sleep/waking up

Question 5

What is a delusion?

Answer 5

An abnormal and unshakeable belief, outside of cultural norms

Question 6

How do schizophrenic auditory hallucinations normally present?

Answer 6

Either as a thought echo (speaking thoughts aloud) or as a running commentary.
Refer to the patient in third person, converse about the patient.

Question 7

What are passivity experiences?

Answer 7

Patient believing an external force is causing an action/feeling

Question 8

What beliefs may be held about thoughts?

Answer 8

That they are being taken out of the mind (withdrawal), made known to others (broadcast), or implanted by others (insertion)

Question 9

What is delusional perception?

Answer 9

Attribution of a new (usually self-referential) meaning to a normally perceived object

Question 10

What are somatic hallucinations?

Answer 10

Mimicking feelings from within the body

Eg: there’s something in my stomach

Question 11

What are the positive symptoms of schizophrenia?

Answer 11

Delusions, hallucinations, thought disorders, lack of insight

Question 12

What are the negative symptoms of schizophrenia?

Answer 12

Underactivity, low motivation, social withdrawal, emotional flattening, self neglect

Question 13

What is required for a diagnosis of schizophrenia?

Answer 13

One or more of:
Thought echo/insertion/withdrawal/broadcast
Delusions of control/influence/passivity relating to body movements, thoughts, actions, or sensations. Delusional perception.
Hallucinatory voices giving running commentary/discussing the patient/coming from some part of the body
Persistent delusions
OR 2+ of persistent hallucinations accompanied by delusions, breaks/interpolations in train of thought leading to incoherence/irrelevant speech, catatonic behaviour, negative symptoms (apathy, paucity of speech, blunt/incongruous emotional response)

Question 14

What is paranoid schizophrenia?

Answer 14

Delusions/hallucinations are prominent

Question 15

What is hebephrenic schizophrenia?

Answer 15

Sustained flattening/shallowness or incongruity/inappropriateness of affect, aimless and disjointed behaviour, thought disorder affecting speech.
Hallucinations/delusions do NOT dominate

Question 16

What is simple schizophrenia?

Answer 16

Loss of drive and interest
Aimlessness, idleness
Self absorbed attitude and social withdrawal
Marked decline in social/academic/work performance
No hallucinations/delusions

Question 17

What is undifferentiated schizophrenia?

Answer 17

Insufficient symptoms/too many symptoms to meet/fit one criteria

Question 18

What is the pathology of schizophrenia?

Answer 18

Large ventricles (possible atrophy), brain changes including limbic system (reduced hippocampal formation, parahippocampal gyrus, amygdala, prefrontal cortex)
Mesolimbic pathway (ventral tegmental area to limbic structures and nucleus accumbens)
Mesocortical pathway (ventral tegmental area to frontal cortex and cingulate cortex)

Question 19

How is schizophrenia treated?

Answer 19

Typical antipsychotics:
block D2 receptors in CNS dopaminergic pathways, main action on mesolimbic and mesocortical pathways
Atypical:
Low affinity for D2 receptors, minor side effects as quickly dissociate away

Question 20

Where are D2 receptors?

Answer 20

The striatum, pituitary gland, and substantia nigra

Question 21

What are good prognostic factors for psychosis?

Answer 21

Absence of family history
Good premorbid function
Acute onset
Mood disturbance
Prompt treatment
Maintenance of initiative and emotion