Psychosis - Neurobiology & Clinical Features

Question 1

What is psychosis?

Answer 1

A severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality.

Characterised by loss of reality & loss of insight.

Question 2

What is an hallucination?

Answer 2

A perception in the absence of a stimulus

Question 3

What are 2nd and 3rd person voices?

Answer 3

2nd person - voice/person talking to you

3rd person - voice talking about you

Question 4

Why do Ps have delusions in relation to their hallucinations?

Answer 4

Is an attempt to rationalise what is happening to them and make sense of their perceptions in light of the reality they know.

Question 5

What is a delusion?

Answer 5

Where a patient has an unshakeable belief in something that is untrue.

A belief that is fixed, false and not in keeping with socio-cultural milieu.

• Cannot be shaken by evidence to the contrary
• Not shared by others of similarity

Question 6

What are First Rank Symptoms pathogenic of?

Answer 6

Schizophrenia

Question 7

What are the First Rank Symptoms identified in Ps with schizophrenia?

Answer 7

Auditory hallucinations
Somatic hallucinations
Thought insertion / withdrawal or broadcast
Passivity phenomena
Delusional perception

Question 8

What is it termed when a patient has a belief that one’s thoughts or actions are influenced or controlled by an external agent - e.g. they observe their arm moving but feel like it is being controlled by a third party?

Answer 8

Passivity phenomena

Question 9

What type of auditory hallucinations can you have?

Answer 9

Thoughts being spoken aloud

Third person hallucinations

Running commentary

Question 10

What is it called when a patient has a feeling of being touched without anyone touching them?

Answer 10

Somatic hallucinations

Question 11

What is it called when patients believe someone else is planting thoughts in their head?

Answer 11

Thought insertion

Question 12

What is thought withdrawal?

Answer 12

Patient feels that their thoughts are being taken out of their mind.

Question 13

What is thought broadcasting?

Answer 13

Patients feel that their thoughts are being broadcast for everyone to hear

Question 14

Which symptoms are deemed to be positive symptoms of mental illness?

Answer 14

Hallucinations
Delusions
Disordered thoughts

Question 15

Which symptoms are deemed to be negative symptoms?

Answer 15

Flat affect
Poor motivation
Loss of social skills / social withdrawal
Poverty of thought
Increased self neglect

Question 16

What is flat affect?

Answer 16

A negative symptom of schizophrenia - P doesn’t how emotions in their expressions

Question 17

What are the cognitive symptoms of mental illness?

Answer 17

Poor attention
Poor memory
Poor planning ability

Question 18

Does everyone agree that psychosis has a negative impact to society?

Answer 18

No - some ppl argue that psychosis is linked to creativity and for a limited number of people they can function in life, even though they are suffering with psychosis.

Question 19

What are the primary features of psychosis? How long do these symptoms need to persist?

Answer 19

Delusions
Hallucinations
Conceptual disorganisation
Negative symptoms
Cognitive disorder

At least 1 week duration of any of these with significant severity

Question 20

What types of delusion are there?

Answer 20

Primary (delusional perception)
Secondary
Persecutory - out to get me
Reference - everyone looking at you and talking about you
Grandiose

And lots more

Question 21

What is termed when thought processes are confused, disconnected or disorganised - can tell this from the P’s speech.

Is observed and not known by the individual (who thinks they are thinking normally).

Answer 21

Conceptual Disorganisation

Question 22

What are other terms for conceptual disorganisation?

Answer 22

Loosening of associations
Knight’s move thought
Schizophrenic thought disorder
Disorder of form of thought
Formal though disorder

Question 23

Which type of hallucination is most commonest in psychosis?

Answer 23

Auditory hallucinations

Question 24

What do we think auditory hallucinations are caused by?

Answer 24

When we speak the brain recognises our voice as our own and dials back certain parts of the brain in response. Recognition of “self” mechanisms.

Scientists believe that dysfunction with this recognition of self and failure to recognise a voice as one’s own is what causes auditory hallucinations.

Question 25

What percentage of schizophrenic patients experience auditory hallucinations?

Answer 25

60-70%

Question 26

What percentage of patients make suicide attempts who have auditory hallucinations?

Answer 26

25%

Question 27

What have scientist detected regarding white matter tracts in Ps who have hallucinations?

Answer 27

That Ps who were prone to developing hallucinations had differences in their white matter tracts which connect the speech areas.

Question 28

Why do we think schizophrenia occurs?

Answer 28

Healthy Ps - attenuate the somatosensory cortex when they plan movements that they make.

Schizophrenic Ps dont attenuate the somatosensory cortex in the same way = their cortex is activated as if it was an external stimuli.

Question 29

What did monozygotic twins show regarding genetic risk of schizophrenia?

Answer 29

That if you had an identical twin with psychosis you have a 50% chance of developing it too

Question 30

What is the interplay between genetic and environmental causes of psychosis?

Answer 30

50% genetic causes

50% environmental causes

Question 31

Which main factors can adversely affect normal development?

Answer 31

Obstetric complications
Childhood trauma
Immigration status
Cannabis use

Question 32

What is the most common age to develop psychosis?

Answer 32

18-24 years

Question 33

What role do glutamate and GABA have with psychosis?

Answer 33

Young = lots of glutamate because you are learning new stuff & lots of new connections are being made.

13+ = GABA increases and Glutamate decreases - this is because you are learning less and the GABA increases as it is involved in fine tuning and pruning.

By 18-24 - these levels should be stage and there should be a good balance between glutamate and GABA levels.

However - in psychosis the Ps dont have a good balance = psychotic symptoms

Question 34

What is the stage called before any symptoms of psychosis are seen?

Answer 34

Premorbid stage

Question 35

What is the stage called bwhen some abnormalities are starting to be seen, but no formal psychosis diagnosis can be made?

Answer 35

Prodromal stage

Question 36

What are the three possible outcomes that can result from the prodromal phase?

Answer 36

Can have full remission of prodromal symptoms

Can have maintained symptoms that remain sub-threshold of psychosis (quirkiness)

Can have progression to full psychosis