Psychosis - General

Question 1

What happens in psychosis?

Answer 1

The ability to recognise reality and the ability to communicate with and relate to others are significantly impaired which interferes with the capacity to cope with reality

Question 2

What are the 3 classic characteristics of psychosis?

Answer 2

Hallucinations, delusions and formal thought disorders

Question 3

Psychosis involves the inability to distinguish between what? This is characterised by what?

Answer 3

Subjective experience and reality, characterised by a loss of insight

Question 4

What are the 4 major groups of causes of psychosis?

Answer 4

Organic conditions, substance misuse, affective disorders and dementia praecox

Question 5

What are some organic conditions which can cause psychosis?

Answer 5

Delirium, dementia, brain injury, stroke

Question 6

What are some aspects of substance misuse that can cause psychosis?

Answer 6

Withdrawal, DT, acute intoxication

Question 7

Which affective disorder is most likely to cause psychosis?

Answer 7

Bipolar disorder

Question 8

What is dementia praecox?

Answer 8

Schizophrenia and other paranoid illnesses

Question 9

What is schizoaffective disorder?

Answer 9

A condition which lies somewhere between affective mood disorders and schizophrenia

Question 10

How may a formal thought disorder be evidenced?

Answer 10

As disorganised speech

Question 11

What is a hallucination?

Answer 11

A perception which occurs in the absence of an external stimulus

Question 12

What is an auditory misperception? What can this lead to?

Answer 12

This is when you hear something which is actually occurring but interpret it as something else. This is not a halucination but can lead to secondary delusions.

Question 13

Can a person make hallucinations go away?

Answer 13

No - true hallucinations are not subject to conscious manipulation (i.e. you cannot alter the mind to make them go away)

Question 14

When are visual hallucinations most likely to be seen?

Answer 14

In delirium and sometimes substance misuse

Question 15

What does a haptic hallucination affect?

Answer 15

Deep sensation- feeling like the organs have moved or something has been placed inside them

Question 16

Give some examples of simple auditory hallucinations?

Answer 16

Murmuring, formless sound, bangs

Question 17

Give some examples of complex auditory hallucinations?

Answer 17

Voices, music

Question 18

What is an idea of reference?

Answer 18

When an innocuous or coincidental event will be ascribed as being significant or meaningful by the person

Question 19

In ideas of reference, the patient will believe that these messages are being sent to who?

Answer 19

Them, and no-one else

Question 20

Ideas of reference also include self-referential experiences. What are these?

Answer 20

The belief that external events are related to oneself

Question 21

If an idea of reference is held very strongly, it can become what?

Answer 21

A delusion of reference

Question 22

What is a delusion of reference?

Answer 22

A more strongly held idea of reference

Question 23

Explain briefly the difference between an idea and a delusion of reference?

Answer 23

Someone with an idea of reference may change their mind when evidence dictates they must, while someone with a delusion of reference will believe something refers back to them even in the face of strong evidence to the contrary

Question 24

What is a delusion?

Answer 24

A fixed, firmly held belief with unshakable conviction, despite logical argument or evidence to the contrary

Question 25

Delusions are usually held outwith what?

Answer 25

The social, cultural and educational background of the patient (can be bizarre/impossible)

Question 26

What is a primary delusion?

Answer 26

One that arises out of nothing

Question 27

What is a secondary delusion?

Answer 27

One that is understandable with the addition of some other psychopathological event (i.e. attempts to explain hallucinations/abnormal mood)

Question 28

Punning and loosening of associations are seen in which feature of psychosis?

Answer 28

Formal thought disorder

Question 29

How will the patients speech be in someone with a formal thought disorder?

Answer 29

Difficult to understand and fragmented

Question 30

What are the 4 different types of thought interference?

Answer 30

Though withdrawal, thought insertion, thought broadcasting and thought blocking

Question 31

What is passivity?

Answer 31

Patients believe that their thoughts, feelings or acts are controlled by others

Question 32

Passivity of volition is responsible for what?

Answer 32

Making actions

Question 33

Passivity of affect is responsible for what?

Answer 33

Making feelings

Question 34

Passivity of impulse is responsible for what?

Answer 34

Making urges

Question 35

Somatic passivity is responsible for what?

Answer 35

Making influences on the body

Question 36

Describe the loss of insight seen in psychosis?

Answer 36

To the patient, everything seems as real as it always did and things make sense, but people are telling them they are unwell

Question 37

3rd person auditory hallucinations are most suggestive of which diagnosis? What is another cause?

Answer 37

Most likely schizophrenia, can also be caused by delirium/dementia

Question 38

Describe the clinical course of drug induces psychosis?

Answer 38

Tends to be short lasting if access to the psychoactive substance is removed

Question 39

What should you be aware of if someone presents with psychosis and is under the influence of a substance?

Answer 39

This doesn't mean that the psychosis is definitely caused by the substance. Important co-morbidities of substance misuse are bipolar disorder and schizophrenia.

Question 40

Delusions of worthlessness, guilt, hypochondriasis and poverty are typically features of which differential of psychosis?

Answer 40

Depressive psychosis

Question 41

What type of hallucinations might occur in depressive psychosis?

Answer 41

Typically 2nd person, accusing/insulting/threatening

Question 42

Delusions of grandeur, special abilities, persecution or religiosity as well as auditory hallucinations and flight of ideas might occur in what differential of psychosis?

Answer 42

Mania with psychosis

Question 43

What are some circumstances in which delirium might be seen?

Answer 43

Alcohol withdrawal, infection and hospital inpatients with many different conditions