psychosis

Question 1

psychosis definition

Answer 1

any mental disorder characterised by delusions &/or hallucinations, w/ or w/o insight into their pathological nature

Question 2

schizophrenia lifetime prevalence & onset

Answer 2

around 1% of the population; onset between 20-24 years but women tend to have 2nd peak around 40 years

Question 3

schizophrenia in men vs women

Answer 3

clinical symptoms of schizophrenia tend to be more severe in men, w/ women having better long term outcomes

Question 4

DSM-5 psychotic disorders

Answer 4

schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder, schizotypal (personality) disorder, brief psychotic disorder, other (substance/medication induced psychotic disorder, psychotic disorder due to another medical condition, catatonia/catatonia associated w/ another mental disorder & catatonia due to another medical condition, unspecified catatonia, etc.)

Question 5

negative symptoms of schizophrenia

Answer 5

negative symptoms reflect an absence / deficit of normally present behaviours

flat affect, blunted emotional expressiveness, alogia (decrease in thought & speech productivity), avolition (decrease in goal-directed behaviour, motivation/will)

Question 6

positive symptoms of schizophrenia

Answer 6

reflect an excess or distortion in normal repertoire of behaviour & experiences

delusions, hallucinations

Question 7

DSM-5 diagnostic criterion A - symptoms of schizophrenia spectrum disorders

Answer 7

(1) delusions
(2) hallucination
(3) disorganised thought & speech, incl. cognitive derailment, loosening of associations in which ideas slide from one track to a new unrelated one

(4) grossly disorganised/abnormal behaviour, incl.
(4. i) childlike silliness to unpredictable agitation
(4. ii) problems in goal-oriented behaviour that compromise daily activities
(4. iii) catatonic behaviour (marked decrease in reactivity to environment), incl. negativism (saying ‘no’ to everything), bizarre postures, mutism, stupor, catatonic excitement (excess motor behaviour that can sometimes be harmful), echoing speech

(5) negative symptoms incl.
(5. i) alogia
(5. ii) anhedonia (decrease in ability to experience pleasure)
(5. iii) asociality (apparent lack of interest in engaging in social interaction)
(5. iv) blunted affect

Question 8

DSM-5 schizophrenia diagnostic criteria

Answer 8

(1) 2 or more symptoms of delusions, hallucinations, disorganised thought/speech
(2) symptoms lasting at least 1 month, w/ continuous signs of disturbance for at least 6 months
(3) symptoms not caused by substance misuse or medical condition

Question 9

schizophrenia vs MDD or bipolar disorder - differential diagnosis

Answer 9

if psychotic symptoms (delusions & hallucinations) are present w/ MDD or bipolar disorder, they occur during depressive or manic episodes

Question 10

schizophrenia vs delusional disorder - differential diagnosis

Answer 10

besides delusions, there are no other symptoms of schizophrenia present

Question 11

schizophrenia vs OCD - differential diagnosis

Answer 11

OCD characterised by prominent obsessions & compulsions

Question 12

schizophrenia vs PTSD - differential diagnosis

Answer 12

w/ PTSD, traumatic event in past is relived or reacted to

Question 13

DSM-5 diagnostic criterion B

Answer 13

social & occupational dysfunction: for a significant portion of time since onset of disturbance, level of functioning in 1 or more areas (work, interpersonal relations, self-care) is markedly below level achieved prior to onset OR, if in children/adolescents, failure to achieve expected level of functioning

Question 14

DSM-5 delusional disorder diagnostic criteria

Answer 14

(1) presence of 1 or more delusions (subtypes: erotomania, grandiose, jealous, persecutory, somatic, mixed) lasting 1 month or longer
(2) criterion A for schizophrenia has never been met

Question 15

typical pattern of schizophrenia course

Answer 15

prodromal period, acute episode, resolution

Question 16

prodromal period

Answer 16

1st phase of common schizophrenia course involving transient &/or attenuated psychotic symptoms, memory & concentration problems, unusual behaviour & ideas, disturbed communication & affect, social withdrawal, apathy, reduced interest / pleasure in daily activities

Question 17

acute episode

Answer 17

2nd phase of common schizophrenia course involving hallucinations, delusions, behavioural disturbances, agitation, & distress

Question 18

resolution (schizophrenia)

Answer 18

final phase of common schizophrenia course in which symptoms diminish & often disappear; negative symptoms sometimes remain; may later be interrupted by more acute episodes

Question 19

greatest risk factor for developing schizophrenia

Answer 19

family history; associated w/ more severe clinical expression of positive & negative symptoms

Question 20

prenatal causal factors that, when present in early neurodevelopment, increase risk of later schizophrenia development

Answer 20

malnutrition, stress in mother during foetal development, premature birth, nicotine use in mother, prenatal exposure to viral infections

Question 21

stress-vulnerability model in relation to schizophrenia

Answer 21

SVM emphasises interaction between vulnerabilities (genetics, birth complications, environmental factors) & stress (drugs, major life events)

stress may be a vulnerability factor: psychotic patients react more intensely to daily stress

onset & relapse in schizophrenia associated w/ significant life events

Question 22

cognitive model of positive symptoms of schizophrenia

Answer 22

suggests that basic cognitive dysfunctions are appraised as external, leading to development / maintenance of positive symptoms

Question 23

psychological factors associated w/ schizophrenia

Answer 23

cognitive deficits, dysfunctional beliefs & attributions, difficulty conveying & recognising emotions, impaired theory of mind

Question 24

psychodynamic perspective of schizophrenia development

Answer 24

intrapsychic conflicts between ego & reality cause a split & hyperactive id

Question 25

social-environmental risk factors for developing schizophrenia

Answer 25

(1) living in dense, urban neighbourhoods (2) inequality - poor people living in wealthier neighbourhoods tend to do worse than those living in neighbourhoods where most people have a similar income (3) people from migrant groups (esp. of African & African-Caribbean descent) living in the UK = much more likely than white British population to be diagnosed w/ schizophrenia