Psychosis

Question 1

Dopamine theory - cause of positive symptoms

Some brain changes - not sensitive or specific

3 common symptoms of psychosis

Answer 1

Overactive dopamine system, especially in the mesolimbic area, causes positive symptoms

Larger lateral ventricles
Reduced volume of the frontal lobe, hippocampus

Altered perceptions - hallucinations
Altered beliefs - delusions
Altered flow of thoughts - thought disorder

Question 2

Delusions:

Define

Difference between primary and secondary delusions?

Answer 2

False, unshakeable belief.
Not keeping with the person’s social/cultural background.
Not amendable with evidence.

Delusional perception vs arising from another pathological experience (e.g. to explain the experience of auditory hallucinations)

Question 3

Delusions - Types:

3 seen in schizo - define:

• Persecution
• Reference
• Passivity

Answer 3

Thinking people are out to hurt them

A false beliefs that random or irrelevant occurrences in the world directly relates to a person.

Their body, actions, thoughts and feelings are being controlled by someone else.

Question 4

Delusions - Types:

> Grandiose

> Hypochondriacal

> Nihilistic - linked with depression

Answer 4

Individuals have inflated idea of significance and importance - (e.g. believing they are the soon of God)

Unusual or excessive recurring concern about one’s health

Delusional belief of being dead, decomposed or annihilated, having lost one’s own internal organs or even not existing entirely as a human being.

Question 5

Delusions - Types:

> Delusional misidentification

> Erotomania - seen more in females

Answer 5

Patients misidentify familiar person, objects, or self, and believe that they have been replaced or transformed.

The belief that someone is in love with them - usually someone in a position of power and influence.

Question 6

Hallucinations - Define

5 types

Answer 6

Auditory:

• Simple sounds
• Musical
• Voices

Visual
Somatic
Olfactory
Gustatory

Question 7

Disorder of thought:

What does disorder of ‘ego-integrity” of thought?

Define:

• thought insertion
• thought withdrawal
• thought broadcasting

Answer 7

Patients percieve/feel that their thoughts are no longer their own/contained, but vulnerable to direct external interference.

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Having thoughts that are not their own

Thoughts are ‘removed’ by an outside influence

Thoughts are available to everyone or to specific people

Question 8

Thoughts:

Define:

• Poverty of thoughts
• Poverty of affect

What do they both lead to?

Answer 8

Global reduction in the quality of thought

Reduction in someone’s emotional response

Social withdrawal
Lack of motivation
Reduced self-care
Blunting of effect

Question 9

DDx of Psychosis:

Psychiatric causes - 3

Organic causes:

• Neurodegenerative - 2
• Structural - 2
• Acute - 2
• Endocrine - 1
• Pregnancy - 1

Answer 9

Schizophrenia 
Mood disorders - BD, severe, D, schizoaffective disorder 
Delusional disorder 
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Dementia, PD, or meds for it 

Temporal lobe epilepsy

Delirium and encephalitis

Thyrotoxicosis

Post-partum psychosis

Question 10

DDx of Psychosis:

Medicine used for inflammation

Recreational drugs

Answer 10

Steroids

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Alcohol and alcohol withdrawal
Cocaine
Cannabis
Amphetamines