Psychosis

Question 1

How long do you need psychotic symptoms of schizophrenia for diagnosis?

Answer 1

> 1 month

Question 2

What are negative symptoms of schizophrenia?

Answer 2

lack of volition, lack of drive, apathy, anhedonia, blunting and flattening of affect, alogia (poverty of speech)

Question 3

What are the physical investigations in schizophrenia?

Answer 3

Standard- FBC, U and E’s, LFT’s, Calcium, glucose, urinary drug screen
History- TFT’s PTH, cortisol, VDRL’s, urinary cortisol, catecholamines, 5HIAA, VMA, CXR, MRI/CT, EEG (TLE)

Question 4

What is management of acute episode of shizophrenia?

Answer 4

SGA - Risperidone, amisulfride, Quitepine, Olanzapine
Plus lung acting Benzodiazepene if aggressive etc

can use non-sedating FGA- Haloperidol

Question 5

What is the long term management of shizophrenia?

ie comorbid depression, and psychological?

Answer 5

Continue antipsychotics at low dose

Comorbid depression treat with tricyclic antidepressants

Psychological- CBT, psychoeducation, family therapy social stuff

Question 6

What is acute and non-transient psychosis?

Answer 6

Acute episode of psychosis which usually occurs within 2 weeks in the context of an acute stressor

ICD-10- normally resolves within 3 months

Question 7

Who is acute transient psychosis more common in?

Answer 7

Females

Personality disorders- Borderline, histioronic, paranoid

Question 8

How do you manage acute transient psychosis?

Answer 8

Give short antipsychotics- and BZ’s may require low dose for 1-2 years to prevent relapse and suicide risk

Question 9

When does peuperium psychosis occur and what are its features?

Answer 9

Occurs up to 2 weeks following birth

Features
Psychosis 
Mania 
Paranoia 
Low mood 
Agitation 
Severe confusion

Question 10

What is the definition of delusional disorder? How long do the delusions have to occur for

Age of onset?

Answer 10

Presence of delusions in the absence of hallucinations, formal thought disorder, mood disorders and flattening of affect. ICD-10 >3 months

Age of onset? 40- 50 year olds

Question 11

What are the risk factors for delusional disorder?

Answer 11

Social isolation 
Low socioeconomic status 
Previous mental health history 
Head injury 
Substance abuse disorders

Question 12

How do you manage delusional disorder? Psychological and pharmacological/

Answer 12

Psychological- reality testing and reframing

Pharmacological-
1. Antipsychotics- 10% that respond develop severe depression so antidepressants ie SSRI’s