Psychosis

Question 1

What are the hallmark symptoms of psychosis?

Answer 1

Delusions
Hallucinations
Thought Disorder
Lack of insight

Question 2

What are some of the investigations and results for organic causes of psychosis?

Answer 2

FBC may show macrocytosis indicating alcohol abuse
Syphilis and HIV serology
Urine screen for drugs of abuse

Question 3

What are some of the specific symptoms for schzophrenia?

Answer 3

Thought echo/insertion etc.
Delusions of somatic passivity i.e. being controlled by an external force
Auditory hallucinations
Delusional perceptions
External control of emotions

Question 4

Give some examples of typical antipsychotics?

Answer 4

Haloperidol
Chlorpromazine
flupentixol

Question 5

Give some examples of atypical antipsychotics?

Answer 5

Olanzapine and amisulpride

Question 6

What is an oculogyric crisis and how can it be reversed?

Answer 6

An acute dystonia that is not being able to move your eyes

It can result from typical antipsychotics and can be reversed with antimuscarinics (procyclidine)

Question 7

What is the biggest risk for atypical antipsychotics?

Answer 7

Development of metabolic syndrome

Question 8

What are some of the typical antipsychotic side effects?

Answer 8

Dopamine effects:
-Tardive dyskinesias e.g. facial twitch
-Parkinsonism - revesibel with anticholinergics
-Akathisia (restless legs) - reversible with anticholinergic effects e.g. constipation
Sedation
Blockage of alpha receptors - postural hypotension

Question 9

What is the main side effect with clozapine?

Answer 9

Agranulocytosis causing neutropenia

Question 10

How often should bloods be checked for clozapine?

Answer 10

Should do bloods weekly for the first 18 weeks then can reduce afterwards if no neutropenia

Question 11

What is schizotypal disorder?

Answer 11

A personality disorder characterised by eccentric behaviour and anomolies of thinking

Question 12

How can schizotypal disorder be treated?

Answer 12

With risperidone (atypical antipsychotic)

Question 13

What is schizoaffective disorder?

Answer 13

Combination of affective disorder and schizophrenia

Question 14

What is delusional disorder?

Answer 14

Delusions present for at least 3 months with no underlying cause

Question 15

What is the management of delusional disorder?

Answer 15

This involves SSRIs and antipsychotics as well as antipsychotics

Question 16

What SSRI should be used in depression following MI?

Answer 16

Sertraline

Question 17

What is puerperal psychosis?

Answer 17

This is post natal psychosis that evolves in the first few weeks following pregnancy
This involves racing thoughts, confusion, feelings of paranoia
This is a psychiatric emergency and should be managed in perinatal psychiatry service
Risk factors are previous history of mental health/ family history

Question 18

What are the first rank symptoms of schizophrenia?

Answer 18

Thought echo/insertion etc.
Delusions of somatic passivity i.e. being controlled by an external force
Auditory hallucinations
Delusional perceptions

Question 19

What are the diagnostic guidelines for schizophrenia?

Answer 19

At least 1 first rank symptom
The symptoms must have been present for greater than 6 months
Must be impairment in work or home functioning

Question 20

What are the ICD subtypes of schizophrenia?

Answer 20

Paranoid - commonet subtype where hallucinations and delusions are prominent
Hebephrenic - onset 15-25, poor prognosis, fluctuating affect with fleeting hallucinations and delusions
Catatonic - characterised by stupor, posturing and negativism

Question 21

What is affective psychoses?

Answer 21

This is depression/bipolar that can occur in psychosis

Can occur in schizophrenics and is known as schizoaffective disorder

Question 22

What is the treatment of schizoaffective disorder?

Answer 22

Treatment with Antipsychotics e.g. olzanzapine and a mood stabiliser e.g. lithium

Question 23

What is schizotypal and how is it treated?

Answer 23

Schiotypal is a personality disorder which can express partial schizophrenia. It is usually not treated with medication and treated with dialectical behavioural therapy

Question 24

What is the early intervention service?

Answer 24

They aim to identify, assess and treat people having their first episode of psychosis. This do this through:

• Reducing amount of time psychosis is untreated
• Attempting to get individual back into work
• Reduce loss of life trajectory