Psychosis

Question 1

What is psychosis?

Answer 1

Mental state where reality is greatly distorted.

Question 2

What are delusions?

Answer 2

Fixed false belief that is firmly held despite contrary evidence and goes against the individual’s normal social and cultural belief system.

Question 3

What are hallucinations?

Answer 3

Perception in the absence of external stimulus.

Question 4

What is a thought disorder?

Answer 4

Impairment in the ability to form thoughts from logically connected ideas.

Question 5

What is the incidence of psychosis in England?

Answer 5

31.7/100,000.

Question 6

What is schizotypal disorder?

Answer 6

Eccentric behaviour, suspiciousness, unusual speech, deviation of thinking, affect similar to schizophrenia. No delusions or hallucinations.

Question 7

What is persistent delusional disorder?

Answer 7

Single or set of delusions for 3 months + where delusion is the main symptoms with thought and function preserved. Delusion is persecutory, grandiose, hypochondriacal. Related to life situation.

Question 8

What is acute and transient psychosis?

Answer 8

Psychotic episode as with schizophrenia by lasts <1 month.

Question 9

What is induced delusional disorder?

Answer 9

Uncommon disorder where 2+ individuals have similar delusions.

Question 10

What is imposee in induced delusional disorders?

Answer 10

One person is dominant and forms the belief during a psychotic episode and imposes it on the other person.

Question 11

What is simultanee type of induced delusional disorder?

Answer 11

Two people have their own psychotic symptoms but influence each other so the delusions line up.

Question 12

What is schizoaffective disorder?

Answer 12

Schizophrenic symptoms + mood disorder symptoms in same illness. Mood symptoms meet criteria for depression or manic episodes + 1 or 2 typical schizophrenic symptoms.

Question 13

What are mood disorders with psychosis?

Answer 13

Psychosis secondary to depression or mania.

Question 14

What is puerperal psychosis?

Answer 14

Acute onset of manic or psychotic episodes after childbirth <2 weeks.

Question 15

What is late paraphrenia?

Answer 15

Late-onset schizophrenia, hallucinations and delusions prominent but thought disorders and catatonic symptoms are rare.

Question 16

What are the organic causes of schizophrenia?

Answer 16

Drugs, iatrogenic, complex partial epilepsy, delirium, dementia, Huntington’s disease, SLE, syphilis, endocrine disturbance, metabolic disorders.

Question 17

Which factors are involved in developing schizophrenia?

Answer 17

Biological and environmental factors.

Question 18

What is the dopamine hypothesis for schizophrenia?

Answer 18

Secondary to over-activity of mesolimbic dopamine pathways in the brain -> drugs block D2 receptors. Drugs that potentiate these pathways cause psychotic symptoms.

Question 19

What is the expressed emotion theory?

Answer 19

Relatives that are over involved or make hostile/critical comments make relapses more likely.

Question 20

What is the stress-vulnerability model?

Answer 20

Schizophrenia is due to environmental factors interacting with genetic predisposition so people need different levels of exposure to environmental factors to become psychotic.

Question 21

What are the biological predisposing factors to schizophrenia?

Answer 21

Genetics, neurochemical (increased dopamine, decreased glutamate, serotonin, GABA), neurodevelopmental (intrauterine infection, premature birth, foetal brain injury, obs complications), aged 15-35 years, very young or very old parents.

Question 22

What are the psychological predisposing factors to schizophrenia?

Answer 22

Family history, childhood abuse.

Question 23

What are the social factors predisposing to schizophrenia?

Answer 23

Substance misuse, low SE status, migrants, urban area living.

Question 24

What are the precipitating factors for schizophrenia? (Biopsychosocial).

Answer 24

Bio - smoking cannabis, psychostimulant use.
Psycho - adverse life events, poor coping style.
Social - adverse life events.

Question 25

What are the perpetuating factors for schizophrenia?

Answer 25

Bio - substance misuse, poor compliance. Psycho - adverse life events. Social - poor social support, expressed emotion.

Question 26

What are the positive symptoms of schizophrenia?

Answer 26

'Delusions Held Firmly Think Psychosis' | = delusions, hallucinations, formal thought disorder, thought interference, passivity phenomenon.

Question 27

What are delusions?

Answer 27

Fixed false belief that's firmly held despite evidence to the contrary and goes against the individual's normal social and cultural belief system.

Question 28

What are ideas of reference?

Answer 28

A patients thinks common events refer to them directly, e.g. newspaper articles.

Question 29

What are hallucinations?

Answer 29

Perception in the absence of external stimulus.

Question 30

What is the normal hallucination form in schizophrenia?

Answer 30

Third person auditory, sometimes running commentary.

Question 31

What is formal thought disorder?

Answer 31

Abnormalities in the way thoughts are linked together.

Question 32

What is thought interference?

Answer 32

Thought insertion, withdrawal, or broadcast.

Question 33

What is passivity phenomenon?

Answer 33

The belief that actions, feelings, or emotions are being controlled by an external force.

Question 34

What are the negative symptoms of schizophrenia?

Answer 34

Avolition, asocial behavious, anhedonia, alogia, affect blunted, attention.

Question 35

What is avolition?

Answer 35

Decreased motivation and reduce ability to initiate and persist in goal-directed behaviour.

Question 36

What is alogia?

Answer 36

Poverty of speech.

Question 37

What is paranoid schizophrenia?

Answer 37

Positive symptoms of hallucinations and delusions.

Question 38

What is hebephrenic schizophrenia?

Answer 38

Thought disorganisation, early onset 15-25 years, poorer prognosis.

Question 39

What is catatonic schizophrenia?

Answer 39

1+ catatonic symptoms (abnormality of tone, posture, movement from disturbed mental state - excessive or decreased motor activity).

Question 40

What is undifferentiated schizophrenia?

Answer 40

Meets schizophrenic criteria but no particular type.

Question 41

What is post-schizophrenic depression?

Answer 41

Depression predominates with schizophrenic illness in past 12 months, some symptoms persist.

Question 42

What is residual schizophrenia?

Answer 42

1 year of chronic negative symptoms after clear-cut psychotic episode.

Question 43

What is simple schizophrenia?

Answer 43

Rare form with negative symptoms and no psychotic symptoms.

Question 44

What are the ICD-10 criteria for diagnosing schizophrenia?

Answer 44

One of group A + 2 or more from group B for 1 or more months. No organic brain disease. Group A - thought echo/insertion/withdrawal/broadcast; delusions of control, influence, passivity phenomenon; running commentary auditory hallucinations; bizarre persistent delusions Group B - hallucinations in other modalities that are persistent; thought disorganisation; catatonic symptoms; negative symptoms.

Question 45

What are the features of schizophrenia on MSE?

Answer 45

Appearance - normal or inappropriate with poor self-care (-ve). Behaviour - preoccupied, restless, noisy, suspicious (+ve) or withdrawn, poor eye contact and apathy (-ve). Speech - reflect thought disorder, interruptions to flow of thought, poverty of speech (-ve). Mood - incongruity of affect or mood changes (depression, anxiety, irritability) or flattened (-ve). Thoughts - delusion, thought insertion/withdrawal/broadcast, formal thought disorder (+ve). Perception - hallucinations (+ve). Cognition - normal orientation or attention and concentration impaired (+ve) or cognitive deficits (-ve). Insight - poor. Risk - needs assessing.

Question 46

What are the investigations needed for schizophrenia?

Answer 46

Bloods - FBC, TFTs, glucose, HbA1c, serum Ca, U+Es, LFTs, cholesterol, vitamin B12, folate. Urine drug test. ECG to check QT interval. CT to rule out organic causes. EEG to rule out temporal lobe epilepsy.

Question 47

What is the management plan for schizophrenia? (Summary of all aspects).

Answer 47

Early intervention in psychosis team used in first presentation to reduce duration of untreated psychosis. Bio - antipsychotics,adjuvants, ECT. Psycho - CBT, art therapy, social skills training. Social - support groups, peer groups, supported employment programmes.

Question 48

What are the poor prognostic factors for schizophrenia?

Answer 48

Strong family history, gradual onset, decreased IQ, premorbid history of social withdrawal, no obvious precipitant.

Question 49

What are the pharmacological steps to managing schizophrenia?

Answer 49

Antipsychotics - atypical first line then clozapine third line for treatment-resistant schizophrenia. Adjuvants - benzodiazpines for short-term behavioural relief. ECT - if resistant to all or catatonic.

Question 50

What are the psychological steps in managing schizophrenia?

Answer 50

CBT to reduce residual symptoms. Family intervention for persisting symptoms. Art therapy to alleviate negative symptoms. Social skills training for interpersonal, self-care, and coping skills.

Question 51

What are the social steps in managing schizophrenia?

Answer 51

Support groups. | Peer groups - support worker has recovered from psychosis and schizophrenia is stable.