Psychosis

Question 1

What does psychosis mean?

Answer 1

No accepted definition

Being out of touch with reality / experiencing a different reality
Lack of insight
“The dreamer awake”

Question 2

What are 4 main psychotic symptoms?

Answer 2

Delusions
Hallucinations
Formal thought disorder
Disorders of the self

Question 3

What are hallucinations?

Answer 3

Perceptions in the absence of an external stimulus

Can be in any of the 5 sensory modalities

Question 4

Are true hallucinations in the external or internal space (in your head) ?

Answer 4

External space

Question 5

What is the most common type of hallucinations psychosis?

Answer 5

Auditory is the commonest

Tactile

Question 6

Visual hallucinations often accompany…

Answer 6

Delirium

Question 7

Olfactory hallucinations should make you think of what?

Answer 7

Frontal lobe pathology

Question 8

What is a delusion?

Answer 8

A fixed firmly held belief that is usually false, that is held despite evidence to contrary, that cannot be reasoned away and that is out of keeping with their sociocultural norms

Question 9

What examples of delusion classifications are there?

Answer 9

Grandiose, persecutory, hypochondriacal, reference, guilt, erotomanic

Question 10

When questioning delusions what approach should be taken?

Answer 10

Gently probing in attitude of interested skepticism around the evidence for the beliefs and the patient’s attitude for alternative explanations

Question 11

Describe formal thought disorder

Answer 11

When speech, and therefore thought incoherent

Each sentence does not follow on from the next or even each phrase or word.

Similar to flight of ideas but here the ideas are related

Question 12

What are some examples of specific thought disorders?

Answer 12

Derailment, poverty of speech, thought blocking, perseveration, tangentiality

Question 13

What does disorders of the self mean?

Answer 13

Those aspects of the self that include distinguishing self from other, continuity in time, self as agent, self as unity of experience and self as private space are altered.

Question 14

Disorders of the self include symptoms such as..

Answer 14

Thought insertion
Thought broadcasting
Thought withdrawal

Question 15

What is the differential diagnosis?

Answer 15

Delirium
Epilepsy - TLE
Space occupying lesion 
Dementia 
Endocrine - Cushings, hyperthyroidism 
Drug induced - steroids, L-dopa, stimulants, hallucinogens, alcohol 
Hypercalcaemia 
Hypoglycaemia 

Functional psychosis

Question 16

What is schizophrenia?

Answer 16

A disorder or group of disorders characterised by positive symptoms (delusions, hallucinations, formal thought disorder) and negative symptoms (lack of will, interest, isolation…)

These may occur separately or together in same patient

Question 17

Give some examples of negative symptoms seen in schizophrenia

Answer 17

Amotivation 
Apathy 
Flat affect
Alogia (poverty of speech) 
Social withdrawal 
Self neglect 
Autism

Question 18

What are first rank symptoms of schizophrenia?

Answer 18

Auditory hallucinations 
Somatic hallucinations 
TW, TB, TI 
Delusional perception 
Passivity experiences

Question 19

Can first rank symptoms occur in other disorders?

Answer 19

Yes they can occur in mania or delirium

Question 20

What are the different types of schizophrenia?

Answer 20

Paranoid
Hebephrenic
Catatonic 
Simple 
Undifferentiated

Question 21

What are some characteristics of auditory hallucinations seen in schizophrenia?

Answer 21

Running commentary e.g “he’s brushing his teeth, he’s sitting down”

Voices referred to the patient in third person and conversing with each other about the patient

Question 22

What are passivity experiences?

Answer 22

Believing an action or feeling is caused by an external force

Question 23

What does delusional perception mean?

Answer 23

Attributing a new meaning, usually in the sense of self reference, to a normally perceived object

Question 24

What is the prevalence of schizophrenia?

Answer 24

1% of population

Question 25

What age is the typical onset of schizophrenia?

Answer 25

Typically 20s

Question 26

What is drug induced psychosis?

Answer 26

Psychosis induced by a psychoactive substance.

Methamphetamine, cannabis, cocaine, amphetamines, LSD, ecstasy, ketamine

ICD-10 onset of psychotic symptoms during or within 2 weeks of substance use. Persistence of the psychotic symptoms for more than 48 hours. Duration not exceeding six months.

Question 27

People with schizophrenia have an increased suicide risk. By how much?

Answer 27

9x higher than general population