Psychosis

Question 1

What is psychosis

Answer 1

severe impairment of thoughts and cognitions that contact is lost with reality

Question 2

Causes of psychosis

Answer 2

Schizophrenia
depression
Bipolar
Drugs and alcohol

Question 3

What are schizophrenia first rank symptoms

Answer 3

• Auditory hallucinations
• Thought possesion
• Loss of control
• Delusions of perception

Question 4

What are considered positive symptoms of schizophrenia

Answer 4

Delusions

Question 5

What is considered mani

Answer 5

• Mania is sustained >7 days
• If hospitalisation is required
• Marked impairment in social or occupational functioning
• Psychotic features

Question 6

What are considered negative symptoms of schizophrenia

Answer 6

Blunted mood
Reduced speech
Poor self care
Low motivation

Question 7

What are features of psychosis

Answer 7

• Delusions of grandeur
• Hallucinations: auditory more common in schizophrenia and depression
• Nihilistic: more common in depression

Question 8

What criteria must you meet to diagnose depression

Answer 8

ICD10:
○ Mild = 4 symptoms (2 core)
○ Moderate = 5-6 symptoms (2 core)
○ Severe = ≥7 symptoms (3 core)
● If  psychotic symptoms -> severe depression

Question 9

What is the treatment of depression

Answer 9

• Medications: SSRIs, TCAs, MAOs
• Talking therapy: CBT/counselling
• ECT

Question 10

Features of Bipolar

Answer 10

• Good mood spells last multiple days not change in a day
• Delusions of Self-grandeur
• risky behaviour(Risk Assess?)
• little sleep/nutritional intake.
• Pressure/fast speech (think MSE).
• Mania vs Hypomania?

Question 11

What is the treatment of schizophrenia

Answer 11

• Antipsychotics, olanzapine most common (5-HT and D2 antagonist)
• Clozapine for treatment resistant schizophrenia (what is risk?)

Question 12

What is the treatment for bipolar

Answer 12

lithium

Question 13

What are the common features of auditory hallucinations in a schizophrenic patient

Answer 13

• two or more voices discussing the patient in the third person
• thought echo
• voices commenting on the patient’s behaviour

Question 14

What is passivity phenomena

Answer 14

• bodily sensations being controlled by external influence

actions/impulses/feelings - experiences which are imposed on the individual or influenced by others

Question 15

What are the negative symptoms of schizophrenia

Answer 15

• incongruity/blunting of affect
• anhedonia
• alogia (poverty of speech)
• avolition (poor motivation)

Question 16

Non first rank features of schizophrenia

Answer 16

impaired insight
incongruity/blunting of affect (inappropriate emotion for circumstances)
decreased speech
neologisms: made-up words
catatonia

Question 17

What is type 1 bipolar disorder

Answer 17

mania and depression (most common)

Question 18

What is type 2 bipolar

Answer 18

hypomania and depression

Question 19

What is the management of bipolar

Answer 19

• Mood stabeliser: lithium

- address co-morbidities - there is a 2-3 times increased risk of diabetes, cardiovascular disease and COPD

Question 20

How to treat mania in bipolar

Answer 20

consider stopping antidepressant if the patient takes one; antipsychotic therapy e.g. olanzapine or haloperidol

Question 21

How to treat depression in bipolar

Answer 21

talking therapies (see above); fluoxetine is the antidepressant of choice

Question 22

When & where to refer

Answer 22

• hypomania: routine referral to the community mental health team (CMHT)
• mania or severe depression: urgent referral to the CMHT