Psychosis

Question 1

Psychosis is a diagnosis. True or false?

Answer 1

False. It is a description of symptoms

Question 2

Definition

Answer 2

Separation of body and mind.

Inability to distinguish between subjective experience and reality.

Question 3

Hallmark clinical features (7)

Answer 3

Hallucinations 
Ideas of reference 
Delusions 
Thought form disorder
Thought interference 
Passivity phenomena 
Loss of insight

Question 4

Hallucinations

Answer 4

A perception which occurs in the absence of external stimulus.
Experienced as originating in real space (not just thoughts)

Question 5

Ideas of reference

Answer 5

Seeing significant meaning in things where there is no need for meaning
- eg believing that a radio station is broadcasting songs in such a way as to tell you something

Question 6

Ideas of reference - self referential experiences

Answer 6

The belief that external events are related to you

Question 7

Delusions

Answer 7

Fixed, falsely held belief held with unshakable conviction.

May be bizarre/impossible.

Question 8

Delusions - types (7)

Answer 8

Self referential 
Paranoid 
Persecutory 
Grandiose 
Religious 
Misidentification
Guilt 
Nihilistic

Question 9

Which type of delusion is this: inflated self importance and optimism, “I am the second coming of Christ”

Answer 9

Grandiose

Question 10

Which type of delusion is this: “the end of the world is coming”

Answer 10

Nihilistic

Question 11

Which type of delusion is this: “I’m refusing to eat food that my parents have prepared as they are trying to poison me”

Answer 11

Paranoid

Question 12

Which type of delusion is this: Lying in hospital -> family members come to visit but you think they’re strangers “Maybe my parents have been replaced”

Answer 12

Misidentification

Question 13

Thought form disorder

Answer 13

Train of thought is hard to follow
- “my dad has a blue car. blue is the colour of the sea”

Neologisms
- a newly coined word or expression

Tangentiality
- start to answer a question then go off track and ramble about something else

Clanging and punning

Word salad
- i don’t care if its not in your dictionary, its in mine

Question 14

Thought interference - types (4)

Answer 14

Thought insertion
Thought withdrawal
Thought broadcasting
Thought blocking

Question 15

Thought interference - insertion

Answer 15

feel that your thoughts are being put into your head, they are not your own

Question 16

Thought interference - withdrawal

Answer 16

feel that your thoughts are being taken out of your head

extracting information from you

Question 17

Thought interference - broadcasting

Answer 17

“Everyone can know what I’m thinking”

Question 18

Thought interference - blocking

Answer 18

Get halfway through thinking then the thoughts dry up

Question 19

Passivity phenomena

Answer 19

Feeling of being controlled

Not having a sense of own control

Question 20

Loss of insight

Answer 20

Patient does not realise they are unwell

Patient does not consider psychotic symptoms as being “illness”

Question 21

Management

Answer 21

Anti-psychotics

- atypical are first line (since there are not as much side effects)

Question 22

Examples of potential differential diagnoses
(note that diagnosis depends on nature of psychotic experience, associated psychiatric symptoms, natural history of symptoms)

Answer 22

Schizophrenia 
Schizoaffective disorder
Bipolar disorder
Unipolar depression
Substance misuse
Organic conditions - delirium, dementia, brain injury

Question 23

Which type of delusion is this: the belief that external events are related to you

Answer 23

Self-referential

Question 24

Depressive psychosis

Answer 24

Delusions of worthlessness, guilt, hypochondriasis, poverty

Hallucinations

• 2nd person (people talking directly to you)
• eg: “you are worthless”

Question 25

Mania with psychosis

Answer 25

Hallucinations

• 2nd person (people talking directly to you)
• eg: cheery, the voice of God

Delusions
- grandiose

Flight of ideas

Question 26

Delirium

Answer 26

Acute, transient disturbance
Impaired concentration/memory
Persecutory delusions

Question 27

What is puerperal psychosis?

Answer 27

Psychosis which occurs in pregnancy.

Question 28

Puerperal psychosis - clinical features

Answer 28

Acute onset of psychotic symptoms
Manic symptoms / disinhibition
Confusion