Psychosis

Question 1

What is psychosis?

Answer 1

A mental state in which reality is greatly distorted. The person experiences things differently to those around them.

Question 2

What is a delusion?

Answer 2

Fixed false belief which is firmly held despite evidence to the contrary

Goes against normal social and cultural beliefs

Question 3

What are the types of delusions a patient may have?

Answer 3

Grandiose - special powers, wealth, talents etc.

Persecutory - other people conspiring against them

Reference - Random events or others behaviour have special significance

Guilt - belief they have done something shameful

Hypochondrial - belief they have illness

Morbid jealousy - belief spouse is being unfaithful

Question 4

What is a hallucination?

Answer 4

Perception in absence of an external stimuli

Question 5

What types of hallucinations are there?

Answer 5

Visual - seen in organic causes or substance misuse
Auditory
Olfactory
Gustatory (taste)
Somatic - e.g. feeling of insects crawling

Question 6

What are the types of auditory hallucination?

Answer 6

Second person - voice talk to patient

Third person - voices talk among themselves about patient

Running commentary - voice give account of patients actions

Question 7

What are the types of thought disorder?

Answer 7

Broadcasting - internal thoughts can be heard out loud by others

Insertion - thoughts being put into your mind

Withdrawal - thoughts are being removed

Question 8

What is a thought disorganisation?

Answer 8

Impairment in ability to form thoughts from logically connected ideas

Question 9

What are some types of thought disorganisation?

Answer 9

Loosening of associations - loss of normal structure of thought

Tangential disorder - person divert from original thought but never return

Circumstantiality - Thinking proceed slowly with many unnecessary details before getting to the point

Neologisms - Words and phrases devised by patient

Alogia - little information conveyed by speech

Word salad - real words but linked incoherently i.e. talking nonsense

Question 10

What are the organic causes of psychosis?

Answer 10

Illicit drugs especially cannabis 
Medical drugs - steroids, antimalarials, levodopa
Huntingtons
Parkinsons 
Dementia and delirium
Deficiency - B12

Question 11

What are the non-organic causes of psychosis?

Answer 11

Schizophrenia
Depression
Mania
Puerperal psychosis

Question 12

How does schizotypal disorder appear?

Answer 12

No hallucinations or delusions

Eccentric behaviour, suspiciousness and unusual speech

Question 13

What is schizoaffective disorder?

Answer 13

Symptoms of schizophrenia and a mood disorder in the same episode

Question 14

What is persistent delusional disorder?

Answer 14

Single delusion lasting >3months with other areas of thinking well preserved

Question 15

What are the main risk factors for schizophrenia?

Answer 15

Genetic

Cannabis

Question 16

What prodrome may indicate schizophrenia?

Answer 16

Patients show:

• Loss of interest
• Social withdrawal
• Self-neglect
• Depression and anxiety
• Brief psychotic episodes

Question 17

Aside from first rank symptoms, what other symptoms are there of schizophrenia?

Answer 17

• Avolition - decreased motivation towards any goal
• Anhedonia - lack of pleasure from previously liked activities
• Alogia - quantitative and qualitative decrease in speech
• Affect blunted
• Neologisms
• Catatonia

Question 18

What are Schneider’s first rank symptoms for schizophrenia?

Answer 18

• Delusional perception - delusion in response to real perception - e.g. traffic light turn red, I am a genius
• Auditory hallucinations: thought echo, running commentary or 2 people discussing pt. in 3rd person
• Thought interference: insertion, withdrawal or broadcasting
• Passivity phenomenon: body movements and feelings are controlled by external force

Question 19

What is important to consider in the preliminary management of schizophrenia? (before the actual management)

Answer 19

Risk assess

Use mental health act

Question 20

How is schizophrenia managed?

Answer 20

Atypical antipsychotics

• risperidone/olanzapine
• Depot if non-compliant

ECT - if pharmacologically resistant

CVS risk management (pt. at much higher risk due to drugs and often smoke)

CBT and family education

Question 21

What is Charles Bonnet syndrome?

Answer 21

Persistent or recurrent complex hallucinations occurring in clear consciousness - auditory or visual

Background of visual impairment

No neuropsychiatric disturbance

Question 22

What are the risk factors for Charles bonnet syndrome?

Answer 22

Advanced age
Visual impairment - AMDR, glaucoma, cataracts
Social isolation
Sensory deprivation
Early cognitive impairment

Question 23

What is Cotard syndrome?

Answer 23

Believe they or some part of their body is dead
Patients stop eating/drinking as deem it unnecessary

Associated with depression

Question 24

What is De Clarembault syndrome?

Answer 24

Paranoid, amorous delusion - e.g. famous person in love with them

Question 25

What are the factors associated with a poor prognosis with schizophrenia?

Answer 25

Gradual onset
Low IQ
Prodromal phase of social withdrawal

Question 26

What is a pseudohallucination

Answer 26

Hallucination that the patient knows is not real.

It is commonly seen in grief.