Psychosis

Question 1

Define psychosis

Answer 1

Mental disorder in which thoughts, affective response or ability to recognise reality are sufficiently impaired.

Gross interference with ability to deal with reality

Question 2

Classic characteristics of psychosis

Answer 2

hallucinations
delusions
disorder of form of thought
Lack of insight

Question 3

Examples of psychotic experiences

Answer 3

Hallucinations
Ideas of Reference
Delusions
Formal thought disorder
Thought interference
Passivity phenomena
Loss of insight

Question 4

What is a hallucination?

Answer 4

Perception occuring in the absence of an external stimulus with same qualities as normal stimulus (vivid, solid, compelling)

Can occur in any sensory modality

Question 5

Ideas of Reference

Answer 5

Innocuous or coincidental events will be ascribed significant meaning by the person

ex. believing that the news report on the television is commenting on their life or talking directly to them

Question 6

Delusions

Answer 6

A fixed, falsely held belief

Unshakeable conviction

Impervious to logical argument or evidence to the contrary

Question 7

Types of delusions

Answer 7

Primary - arrive fully formed in the consciousness without need for explanation

Secondary - attempts to explain anomalous experiences (eg. hallucinations, passivity experiences, delusions)

Question 8

Content of delusions

Answer 8

Specific content is culturally defined

Persecutor is often recognisable to society/culture as danger or threat (ex. MI5, KGB, ISIS)

Can also be internet, xray, satellites etc.

Feared disease

Question 9

Thought Disorder

Answer 9

Thought cannot be directly observed and must be inferred from patterns of speech

Question 10

Characteristics of thought disorders

Answer 10

Neologisms - insertion nof their own vocabulary

Circumstantiality/Tangentiality - talk around the asked question and eventually get to the point

Clanging and punning

Loosening of associations

Verbigeration/word salad - more extreme when patient is very unwell

Question 11

Features of thought interference

Answer 11

Thought Insertion - thoughts are put into their head

Thought Withdrawal - thoughts are extracted from them

Thought Broadcasting - everyone knows their thoughts

Thought Blocking - cannot complete a frame of thought

Question 12

Loss of insight

Answer 12

Incorrect filtration of information from senses changing the perception of reality

Question 13

Differential diagnosis of pyschotic symptomes

Answer 13

a) Unipolar depression
b) Bipolar disorder
c) Schizoaffective disorder
d) Schizophrenia and other paranoid illnesses
e) Substance abuse
f) Organic conditions - delirium, dementia, brain injury, stroke

Depends on nature of psychiatric symptoms, associated symptoms and history

Question 14

Features of drug induced psychosis (2)

Answer 14

Florid or chronic symptoms

Short lasting if access to psychoactive substance is removed

Note: psychotic symptoms in the context of substance misuse does not necessarily mean drug-induced psychosis

Question 15

Features of depressive psychosis (3)

Answer 15

Mood congruent content of psychotic symptoms

Delusions of worthlessness/guilt/ hypochondriasis/poverty

Hallucinations of accusing/insulting/threatening voices - TYPICALLY 2ND PERSON

Question 16

Features of Mania with psychosis (4)

Answer 16

Mood congruent content

Delusions - grandeur/ special ability/persecution/ religiosity

Hallucinations - auditory

Flight of ideas

Question 17

Delirium

Answer 17

Acute transient disturbance

Question 18

Features of delusions

Answer 18

hallucinations
persecutory delusions
Psychomotor disturbance 
Agitation or irritability
Insomnia 
Clouding of consciousness 
Poor concentration/memory (especially with new info

Question 19

Features of clouding of consciousness

Answer 19

• ranges from subtle to unresponsive
• disorientation in time and place
• fluctuating severity (lucid intervals)
• worse at night