Psychosis

Question 1

what is psychosis

Answer 1

a state of being out of touch with reality.

Question 2

What are the different diagnoses under psychosis

Answer 2

Schizophrenia
Schizoaffective disorder
Delusional disorder
Schizophreniform disorder
breif psychotic disorder

Question 3

what are positive symptoms and examples

Answer 3

Excess of normal functioning

• Hallucinations
• Delusions
• Disorganised thought (speech)

Question 4

what are negative symptoms and examples

Answer 4

Absence of normal functioning

• emotionless flat affect
• withdrawal

Question 5

emotions and feelings in schizophrenia

Answer 5

Schizoaffective disorder
low motivation, low energy, anhedonia (cant recognise own emotions- flat affect), depression, anxiety, irritability, elation

Question 6

thoughts and percetions

Answer 6

: hallucinations, unusual beliefs (delusions), disorganised thinking, poor concentration.

Question 7

behaviours

Answer 7

withdrawal from others, isolation, reduced speech (poverty of content), irritability, aggression, impulsivity.

Question 8

What are hallucinations

Answer 8

Hearing voices (auditor) are the most common form of hallucinations Present in about 70% of individuals with schizophrenia.
The perception of something present which isn’t actually, alien to themselves (very often inside their head- theories to account for this)
Related to:
- Reality monitoring difficulty distinguishing self from others
- Disconnection between speech generating and speech perception brain regions.
Visual hallucinations: coincide with auditory- seeing the face of someone in a ghosty way.
Voices unpleasant- highly critical, orders, more than one- commenting.
Brain regions which are activated in auditory hallucinations include Brocas and Wernickes area- speech centres of the brain, inner speech is misattributed to an external source.

Question 9

Disorganised thinkinging (speech)

Answer 9

• Actually a communication disorder
• Word salad- don’t really make sense.
• Derailment (knights move thinking) – make associations between topics.
• Tangentiality- going off on a tangent
• Clanging- rhyming or alliteration
• Neologisms
  Incoherent to the listener. Emotionally important topics brings it out.

Question 10

delusions

Answer 10

beliefs.
- Paranoid delusions
- delusions of grandeu

Question 11

Bipolar disorder

Answer 11

Spectrum of bipolar disorders (Akiskal et al., 2000)
Major depressive episode.
Manic episode.
Hypomanic episode
Mixed episode
Euthymic phase- normal.
Mania : Elation, irritability/ anger, decreased sleep, increased goal directed activity, risk taking behaviour, impulsivity, pressure of speech, energy and drive, flight of ideas, distractibility, grandiosity, psychotic symptoms (hallucinations, paranoid delusions).
Bipolar is not two ends of a spectrum. Mixed episodes are common and positive and negative mood fluctuate independently over time (Johnson et al 2011).

Question 12

Prevalence

Answer 12

• 1% lifetime risk for a diagnosis or bipolar. 3% for any psychotic disorder.

Question 13

Risk factors

Answer 13

disadvantaged urban areas.

Question 14

age of onset

Answer 14

late teens early 20s

men seem to have earlier onset (<25)

Question 15

Problems with diagnosis

Answer 15

Poor reliability and validity 
•	Disagreement between clinicians
•	Don’t always cluster together
•	Doesn’t predict course or prognosis
•	Does not predict response to particular treatments

Tells us nothing about the cause

Question 16

Alternative to diagnosis

Answer 16

Symptom based approach- try to develop explanatory models and treatment for specific symptoms.

Question 17

Psychological models

Continuum model

Answer 17

Psychosis might actually be on a continuum more common than think
- Hallucinatios 10-15% (Tein, 1991)
- Delusions 12% (van Os et al 2000)
- Paranoai 12.6% (poulton et al 2000)
Bipolar spectrum 6.4% (Judd and Akiskal, 2000)

Question 18

Stress vulnerability model

Answer 18

Zobin Stuart and Condray (1992)
Underlying vulnerability may be biological or psychological
environmental stress combines with vulnerability to produce problems

Question 19

Cognitive processes

A and D

Answer 19

problems with attention and distractability associated with negative symptoms of thought disorder (Green, 1992)

Question 20

Cogntiive processes (TOM)

Answer 20

Frith, 1994) theory of mind deficits associated with paranoid delusions

Question 21

cognitive processes (bias)

Answer 21

jumping to conclusion bias especially associated with delusions (Dud;ey et al., 1997)

Question 22

Cognitive processes (monitor)

Answer 22

Source monitoring deficits, especially associated with hallucinations (bentall and Slade, 1985)

Question 23

Trauma

Answer 23

Vanesse et al (2012) Wide range of stressors and trauma associated with psychosis: sexual abuse, assault, bullying,

Question 24

PTSD

Answer 24

(morrison, Frame, and Larkin, 2003) PTSD is highly assicated 20% of individuals also have PTSD- highlighting association with trauma.

Question 25

expressed emotion

Answer 25

Hostile or critical. over involved - protective and pity.

HIgh levels of ee leads to worse outcome, career burnout and risk of relapse (Brown et al., 1962_

Question 26

ee an relapse

Answer 26

(Kavanagh 1992) EE is a robust predictor of relapse.

Question 27

Race

Answer 27

(Fernando, 1995) Racial discrimination

Question 28

URBAN

Answer 28

(Freeman, 1994)