Psychosis

Question 1

Name the 4 main types of symptom characteristic of psychosis.

Answer 1

1. delusions
2. hallucinations
3. formal thought disorder
4. disorders of the self

Question 2

define ‘delusion’

Answer 2

• fixed belief (usually false) that is firmly held despite evidence to the contrary and that is out of keeping with the person’s sociocultural norms.
• can be further classified into e.g. grandiose, persecutory, hypochondriacal, reference, guilt

Question 3

define ‘hallucination’

Answer 3

• perception in the absence of an external stimulus

- can be in any of the 5 modalities: auditory (most common in psychosis), visual (most common in delirium), olfactory…

Question 4

define ‘formal thought disorder’

Answer 4

impairment in ability to form thoughts from logically connected ideas - speech is incoherent with sentences/phrases/words not following on from each other

Question 5

define ‘disorders of the self’

Answer 5

• impairment of aspects of the self that include distinguishing self and other, continuity in time, self as agent, self as unity of experience and self as private space
• includes symptoms such as though broadcast/insertion/withdrawal

Question 6

suggest possible risk factors for schizophrenia

Answer 6

• FHx
• birth complications: low birthweight, premature labour, asphyxia during birth
• older age of father
• prenatal infections, e.g. maternal influenza A in 2nd trimester
• frequent use of cannabis
• trauma, loss, stress

Question 7

describe 3 possible pathophysiological causes of schizophrenia

Answer 7

1. dysregulation of dopaminergic activity: increased in mesolimbic pathway (+ve symptoms) and decreased in prefrontal cortical pathway (-ve symptoms)
2. structural brain changes: enlarged lateral and 3rd ventricles, decreased volume of hippocampus and amygdala
3. altered glucose metabolism: decreased glucose in prefrontal cortex

Question 8

names examples of -ve symptoms of SZP

Answer 8

i. Avolition (decreased ability to initiate purposeful activity)
ii. Anhedonia (decrease interest and motivation)
iii. Alogia (poverty of speech)
iv. flattened Affect
v. Attention deficits
vi. self-neglect

Question 9

name the 1st rank symptoms of SZP

Answer 9

i. auditory hallucinations: running commentary, 3rd person, audible thoughts
ii. delusional perceptions
iii. thought insertion, withdrawal, broadcasting
iv. somatic passivity
v. made feelings, made impulses, made acts

Question 10

describe the different types of SZP

Answer 10

1. PARANOID SZP: relatively stable delusions, usually paranoid, hallucinations and perceptual disturbances predominate
2. CATATONIC SZP: psychomotor disturbances predominate (may alternate between stupor, automatic obedience, negativism, violent excitement)
3. HEBEPHRENIC SZP: dominated by affective changes, social isolation, irresponsible and unpredictable behaviour
4. SIMPLE SZP: -ve symptoms predominate, insidious progressive dev. of conduct abnormalities, inability to meet demands of society and decline in total performance
5. UNDIFFERENTIATED SZP

Question 11

how would you manage a patient presenting with first episode psychosis?

Answer 11

1. oral antipsychotic (usually atypical) +
2. psychological intervention (family intervention and individual CBT)
3. If unresponsive, trial a different antipsychotic (at least 1 should be a 2nd generation non-clozapine antipsychotic) at adequate dose.
4. Offer clozapine