Psychosis-ILA

Question 1

Name some examples of delusions

Answer 1

Persecutory – outside agency to cause harm
Grandiose – inflated importance / self-esteem
Self-referential – television, tie, etc
Nihilisitic – bowels rotted, already dead etc
Religious – more refers to the content of a delusion, all can contain religious reference
Hypochondriacal – illness, somatisation
Guilt – responsibility for harm

Question 2

What are the risk factors for psychosis?

Answer 2

Chronic cannabis use from a young age

Genetic risk

The highest risk for schizophrenia is being a migrant

Question 3

What are the differentials for psychosis?

Answer 3

Schizophrenia
Charles bonnet syndrome- visual hallucinations of shapes and pictures due to visual impairment
Delusional disorder
Schizotypical disorder
Depressive psychosis
Manic psychosis
Organic (AIDs , Brain injury/tumour, Encephalitis, Epilepsy, Syphilis, Delirium, Dementia, L-dopa, Secondary to drugs)

Question 4

What are schneiders first rank symptoms of schizophrenia?

Answer 4

Running commentary (3rd person auditory hallucination)

Delusional perception- like ideas of reference, believe things have special meaning to them eg a person walks past they must be in the FBI

thought alienation (thought insertion/withdrawal/broadcast/echo)

Passivity (feel that what they do and feel is not in their control and is carried out by an external agent)

Question 5

What are the second rank symptoms?

Answer 5

Delusions (in schizophrenia are normally NOT mood congruent)

Hallucinations in any other modality

Tangentiality or any other thought disorder

Catatonic behaviour – strange behaviour such as sudden excitement, mutism, bizarre postures (posturing), cannot be moved (rigidity) and cant follow actions (negativism)

Negative symptoms – blunting affect and apathy

Question 6

How much of each rank is needed for a diagnosis of schizophrenia?

Answer 6

Criteria is one of first rank or two of second rank

Question 7

Give some examples of positive symptoms

Answer 7

Hallucinations

Delusions

Passivity phenomena

Thought alienation

Disturbance in mood

Question 8

Give some examples of negative symptoms

Answer 8

Blunting of affect

Amotivation

poverty of speech

Poverty of thought

Poor non-verbal communication

Clear deterioration in functioning

self neglect

Lack of insight

Question 9

What are the investigations for psychosis?

Answer 9

Toxicology - urine and blood screen

(also rule out organic cause): FBC, U+E, LFT, TFT, syphilis HIV,, glucose, lipids, prolactin, haematinics. Do BP. Do ECG. Could do CT if evidence of focal neurology.

With antipsychotics we want a baseline before we start the medication, so all patients must have an ECG and bloods.

Need bloods at 3 and 6 months

Question 10

What should the QT interval be?

Answer 10

QTc is prolonged if > 440ms in men or > 460ms in women
QTc > 500 is associated with an increased risk of torsades de pointes
QTc is abnormally short if < 350ms

Question 11

What is the management for psychosis?

Answer 11

First line: atypical anti psychotics.

Second line: haloperidol

Third line: clozapine

CBTP – CBT specifically for psychosis

Zopiclone helps with sleep

Diazepam as hypnotic

Question 12

What is the difference between schizoaffective disorder and psychotic depression?

Answer 12

• schizoaffective has both symptoms of equal intensity

- psychotic depression is mood congruent and occurs at same time

Question 13

Tests before taking anti psychotics

Answer 13

BP, glucose, FBC, cholestrol, prolactin, ECG