Psychosis

Question 1

Which illnesses may psychosis occur within?

Answer 1

depression
bipolar disorder
peurperal psychosis
drug abuse
alcohol abuse
neurolocal illness
medications

Question 2

how many patients present with psychosis between the ages of 16 and 30

Answer 2

80%

Question 3

which sex is more likely to present at an older age?

Answer 3

females

Question 4

Which ethnicities have a higher incidence?

Answer 4

afro-caribbean and minority ethnic groups

Question 5

What are the psychotic symptoms?

Answer 5

hallucinations
delusions
overvalued ideas
thought disorder
expression
passivity
catatonia
stupor
psychomotor retardation
flight of ideas
pressure of speech
incongruity or blunting of affect

Question 6

what types of hallucinations may be experienced?

Answer 6

o Hypnopompic
o Hypnogogic
o Reflex hallucination e.g. when you write, I can hear your pen pressing on my heart
o Extracampine
o Auditory  2nd persons, 3rd person, running commentary,

Question 7

What are delusions?

Answer 7

o False, unshakeable idea or belief which is out of keeping with the patient’s educational, cultural and social background. It is held with extraordinary conviction and subjective certainty. A phenomenon outside normal experience

Question 8

What is an overvalued idea?

Answer 8

o A false or exaggerated belief sustained beyond logic or reason but with less rigidity than a delusion and often being less patently unbelievable

Question 9

What are the types of thought disorder?

Answer 9

o	Thought alienation
	Thought insertion
	Thought withdrawal
	Thought broadcast
	Thought echo
	Thought block

Question 10

What are the types of behaviour and thinking seen in psychosis and what do they mean?

Answer 10

o Concrete thinking - lack of abstract thinking, occurs in adults with organic brain disease or schizophrenia (is normal in children!!)
o Loosening of association - there is a lack of logical association between succeeding thoughts, gives rise to incoherent speech. Impossible to follow a patient’s train of thought
o Circumstantiality - irrelevant wandering in conversation, talking at great length around the point until eventually getting to the point.
o Perseveration - repetition of a word, theme, phrase or action beyond the point at which it was relevant or appropriate.
o Confabulation - giving false account to fill a gap in memory

Question 11

What are the types of passivity in psychosis and what do they mean?

Answer 11

o Somatic passivity  delusional belief that one is passive recipient of bodily sensations from an external agency
o Made/act/feeling/drive  object in question is experience or carried out by the person but is considered as alien or imposed.
o Clouding of consciousness  lowered level of consciousness marked by loss of perception or comprehension of the environment, with loss of abiity to respond properly to external stimuli

Question 12

What is catatonia?

Answer 12

o	State of excited or inhibited motor activity in absence of mood disorder or neurological disease, includes a number of other terms:
	Waxy flexibility
	Echolalia
	Echopraxia
	Logoclonia
	Negativism
	Palilalia
	Verbigeration

Question 13

What is stupor?

Answer 13

o More or less complete loss of activity with no response to stimuli, may mark progression of motor retardation

Question 14

What is the management of psychosis?

Answer 14

• Admission to a psychiatric unit is often required at the outset (may need detention under MHA)
• Rapid tranquilisation if very risky and very distressed

Question 15

What does NICE recommend for the treatment of catatonia?

Answer 15

Electroconvulsive therapy (ECT)