Psychosis and Schizophrenia

Question 1

What is a hallucination?

Answer 1

A perception that happens in the absence of a stimulus e.g. hearing a sound that nobody else hears

Question 2

What is an illusion?

Answer 2

A false perception of a real stimulus

Question 3

What is a persecutory delusion?

Answer 3

a belief that they are being attacked/harrassed/obstructed in pursuit of their goals

Question 4

What is a delusion of grandiose?

Answer 4

An unshakeable belief that they are superior e.g. a god/messiah

Question 5

What is a delusion of erotomanic/De Clerambault’s syndrome?

Answer 5

A belief that another person of a higher status is in love with them e.g. a doctor or a royal family member

Question 6

What is Othello syndrome?

Answer 6

A belief that their partner is cheating on them. Can have high forensic risk (violence and stalking)

Question 7

What is Cotard’s syndrome?

Answer 7

A nihilistic delusion without other psychotic symptoms. They believe they are dead, rotting or have lost body parts.

Question 8

What is Ekbom’s syndrome?

Answer 8

Belief that they are infested with parasites despite no evidence of this. Self harm of exoriation.

Question 9

What is Fregoli’s syndrome? (persecutory delusion)

Answer 9

They believe multiple people are actually one individual in disguise who is persecuting them

Question 10

What is Capgras syndrome? (persecutory)

Answer 10

They believe a relative has been replaced by an imposter

Question 11

What is Folie a Deux?

Answer 11

Induced delusion disorder
Dominant partner has a delusion and this is then enforced into the other partner. The non-dominant partner recovers after separation but the dominant partner will need the treatment.

Question 12

What is psychosis?

Answer 12

A state of mind where one feels out of touch with reality. They experience hallucinations and delusions. It can be caused by several disorders, both psychiatric and organic. e.g. delirium

Question 13

What is Schizophrenia?

Answer 13

Splitting of the mind from reality due to an excess of dopamine

Question 14

What are the subtypes of schizophrenia?

Answer 14

1. Catatonic
2. Paranoid
3. Hebephrenic
4. Simple

Question 15

What is the most common type of schizophrenia?

Answer 15

Paranoid

Question 16

What is the criteria for schizophrenia diagnosis?

Answer 16

1 or more of delusions, 3rd person hallucinations and passivity/thought insertion

2 or more of:
- hallucinations
- negative symptoms
- loosening of associations
- catatonia

LASTING FOR MORE THAN A MONTH AND ORGANIC CAUSES RULED OUT

Question 17

Examples of first generation antipsychotics

Answer 17

• haloperidol
• zuclopenthixol
• flupentixol

Question 18

Examples of 2nd generation of antipsychotics

Answer 18

olanzapine
risperidone
quetiapine

Question 19

Which type of antipsychotic has the highest risk of extra pyramidal side effects?

Answer 19

1st generation e.g. haloperidol

Question 20

What are acute extra pyramidal side effects?

Answer 20

acute dystonia - spasms and torticollis, oculogyric crisis

parkinsonism - tremor, rigidity

akathisia - restlessness

Question 21

What are examples of chronic EPSEs?

Answer 21

• tardive dyskinesia
  
  • Choreoathetoid movements

Question 22

Common side effects of 2nd generation antipsychotics e.g. risperidone

Answer 22

• weight gain
• hyperglycaemia
• dyslipidaemia

Question 23

Why is Clozipine only used for patients with treatment resistance?

Answer 23

It has serious side effects including:
- Myocarditis
- Agranulocytosis
- Hypersalivation
- Reduced seizure threshold

Question 24

What observations are monitored if someone is taking Clozapine?

Answer 24

FBC - agranulocytosis
Calcium - hyperparathyroidism
U+Es , LFTs
Weight/BMI
Blood pressure
ECG for QTc monitoring

Question 25

What are negative symptoms?

Answer 25

A cluster of symptoms that often occur in chronic schizophrenia including poverty of speech, flat affect, poor motivation, poor attention and neglect

Question 26

What are positive symptoms?

Answer 26

A cluster of psychotic symptoms including hallucinations and delusions.

Question 27

Thought insertion - what is it?

Answer 27

Thoughts which are not believed to be the subject’s own infiltrate their mind. They often have bizarre explanations of how it’s happened.

Question 28

What are ideas of reference?

Answer 28

The belief that innocuous events have direct personal significance to the subject (e.g.believing something on the TV is a direct message to them).

Question 29

What is meant by thought withdrawal?

Answer 29

The subject believes their thoughts have been removed from their mind by an external agency

Question 30

What is meant by thought broadcast?

Answer 30

The subject believes their thoughts are being shared with others (e.g. being broadcast on the radio)

Question 31

What is meant by Perseveration?

Answer 31

The repetition of a particular response (phrase, word, or gesture) despite the absence or cessation of the stimulus. Often seen in organic brain disorders.

Question 32

What is thought echo?

Answer 32

The subject experiences his own thoughts as if they were being spoken aloud. The repetition may be subtly or grossly changed.

Question 33

What are 5 factors that are associated with a poor prognosis in Schizophrenia?

Answer 33

1. strong family history
2. gradual onset
3. low IQ
4. prodromal phase of social withdrawal
5. lack of obvious precipitant

Question 34

First rank symptoms of Schizophrenia

Answer 34

1. Thought disorder (thought broadcast/thought insertion/thought withdrawal)
2. Third person auditory hallucinations, usually running commentary. Thought echo - hearing your thoughts aloud as if they are a voice outside your head.
3. Passivity phenomena e.g. “have you ever felt that you were being controlled by some outside force?”
4. Delusions - fixed unshakable belief outside of societal social norms

Question 35

When a patient develops mania due to their SSRI, which drugs should they be cross tapered back to?

Answer 35

One of the following antipsychotics:
- Haloperidol
- Olanzapine
- Quetiapine
- Risperidone