Psychosis and schizophrenia

Question 1

psychosis define

Answer 1

a person experiencing things differently from those around them

Question 2

psychosis features

Answer 2

hallucinations (e.g. auditory)
delusions
thought disorganisation
alogia: little information conveyed by speech
tangentiality: answers diverge from topic
clanging
word salad: linking real words incoherently → nonsensical content

Question 3

psychosis sx occurs in many conditions, including:

Answer 3

schizophrenia - most commonly
depression
BPD
puerpal psychosis
brief psychotic disorder (<1 mth of sx)
parkinson’s
huntington’s
steroids
cannabis

Question 4

peak age for 1st episode of psychosis

Answer 4

15-30 years

Question 5

associated conditions of schizophrenia

Answer 5

schizoeffective disorder - severe form of schizophrenia, with mood sx
persistent delusional disorder - without hallucinations

Question 6

psychotic episode features

Answer 6

can be sudden or gradual
not last for set amount of time
usually individual has no insight

Question 7

define hallucination

Answer 7

perception of an object in the absence of an external stimulus
- in any of 5 modalities, auditory most common in psychosis

Question 8

visual hallucination

Answer 8

delirium

Question 9

olfactory hallucination

Answer 9

frontal lobe pathology - medial meningioma

Question 10

define pseudohallucination

Answer 10

‘hearing voices in my head’ -> NOT PSYCHOSIS

Question 11

define delusion

Answer 11

fixed, firmly held belief that is usually false, that cannot be reasoned away, that is held despite evidence to the contrary and is out of keeping with a person’s sociocultural norms
- can be persecutory, grandiose, reference, hypochondriacal

Question 12

define formal thought disorder

Answer 12

a problem of speech which means that each sentence or phase or word does not follow on form the next

Question 13

examples of disorders of the self

Answer 13

the individual can no longer distinguish between himself and world
-> thought broadcast, passivity phenomona, thought insertion

Question 14

3 types of functional psychosis

Answer 14

manic and depression - 2nd erson
schizophrenic - 3rd person

Question 15

define schizophrenia

Answer 15

a disorder characterised by psychotic episodes (positive sx) and negative sx

Question 16

examples of negative sx

Answer 16

autism
flat affect
ambivalence
loosening of associations
amotivation or apathy

Question 17

schneider’s first rank sx schizophrenia

Answer 17

Auditory hallucinations of a specific type:
two or more voices discussing the patient in the third person
thought echo
voices commenting on the patient’s behaviour

Thought disorders
thought insertion
thought withdrawal
thought broadcasting

Passivity phenomena:
bodily sensations being controlled by external influence
actions/impulses/feelings - experiences which are imposed on the individual or influenced by others

Delusional perceptions
a two stage process) where first a normal object is perceived then secondly there is a sudden intense delusional insight into the objects meaning for the patient e.g. ‘The traffic light is green therefore I am the King’.

Question 18

schizophrenia epidemiology

Answer 18

strongest risk factor - family hx
others - black caribbean, migration, urban environment, cannabis use
1% prevalence

Question 19

poor prognostic factors schizophrenia

Answer 19

strong family history
gradual onset
low IQ
prodromal phase of social withdrawal
lack of obvious precipitant

Question 20

schizophrenia management

Answer 20

atypical antipsychotics - 1st line
CBT offered to all
CVD increased - anti-psychotic meds and high smoking rates

Question 21

mental state examination

Answer 21

see geeky medics
1. appearance and behaviour
2. speech
3. mood
4. thought
5. perception
6. cognition
7. insight

Question 22

charles bonnet syndrome definition

Answer 22

characterised by persistent or recurrent complex hallucinations (usually visual or auditory), occurring in clear consciousness. This is generally against a background of visual impairment (although visual impairment is not mandatory for a diagnosis). Insight is usually preserved. This must occur in the absence of any other significant neuropsychiatric disturbance.

Question 23

charles bonnet syndrome risk factors

Answer 23

Advanced age
Peripheral visual impairment
Social isolation
Sensory deprivation
Early cognitive impairment

Question 24

cotard syndrome define

Answer 24

a rare mental disorder where the affected patient believes that they (or in some cases just a part of their body) is either dead or non-existent. This delusion is often difficult to treat and can result in significant problems due to patients stopping eating or drinking as they deem it not necessary

Question 25

cotard syndrome associations

Answer 25

severe depression and psychotic disorders

Question 26

de clerambault’s syndrome definition

Answer 26

a form of paranoid delusion with an amorous quality. The patient, often a single woman, believes that a famous person is in love with her.

Question 27

delusional parasitosis define

Answer 27

a relatively rare condition where a patient has a fixed, false belief (delusion) that they are infested by ‘bugs’ e.g. worms, parasites, mites, bacteria, fungus

Question 28

othello’s syndrome define

Answer 28

pathological jealousy where a person is convinced their partner is cheating on them without any real proof. This is accompanied by socially unacceptable behaviour linked to these claims

Question 29

example of pseudohallucination

Answer 29

hypnagogic hallucination which occurs when transitioning from wakefulness to sleep. These are experienced vivid auditory or visual hallucinations which are fleeting in duration and may occur in anyone. These are pseudohallucinations as the affected person is able to determine that the hallucination was not real

Question 30

sleep paralysis

Answer 30

paralysis of skeletal muscle, can involve hallucinations
if bad can use clonazepam

Question 31

typical antipsychotics s/e

Answer 31

tremor, tardive dyskinesia, bradykinesia, rigidy, akathisia
parkisonism