Psychosis Tutorial

Question 1

What is psychosis?

Answer 1

difficulty perceiving and interpreting reality.

It is a clinical syndrome of an underlying disorder

Question 2

What psychotic disorders can cause psychosis?

Answer 2

• Schnizophrenia
• Bipolar
• Schizoaffective disorder
• Substance related
• Delusional disorder
• Medical condition
• Depression with psychotic features

Question 3

What positive sypmtoms are there?

Answer 3

Hallucinations
- Percepts in absence of a stimulus

Delusions
- Fixed, false beliefs ( out of their normal culture/social background )

Question 4

What negative symptoms are there? ( four As )

Answer 4

• Alogia: poverty of speech
• Avolition/apathy : poor self care and motivation lack
• Affective flattening : unchanging mood and expressions + vocal intonations
• Anhedonia/Asociality : few close friends, hobbies

Question 5

What disorganised symptoms are there?

Answer 5

- Bizarre Behaviour :
Bizarre social behaviour
Bizarre clothing/appearance
Aggression/agitation
Repetitive/sterotyped behaviours

- Thought disorder 
Derailment
Circumstantial speech
Pressured speech
Distractibility
Incoherent/illogical speech

Question 6

Describe the epidemiology of psychosis?

Answer 6

• can occur at any age altho more common in early 20s ( due to life events at this time )
• often chronic and episodic, very variable
• morbidity: Substantial, both from disorder itself and increased risk of common health problems e.g. heart disease
  Significant impact on education, employment and functioning
• Mortality:
  Substantial

All-cause mortality 2.5x higher, ~15 years life expectancy lost

High risk of suicide in schizophrenia – 28% of excess mortality

Question 7

What is included in psychiatric history?

Answer 7

• History of Presenting Concern
• Past Psychiatric History
• Background History (Family, Personal, Social)
• Past Medical History and Medicines
• Corroborative History

Question 8

Describe history of presenting concern?

Answer 8

The patient’s description of the presenting problem – nature, severity, onset, course, worsening factors, treatment received
Circumstances leading to arrival to hospital

• why did they come in now

Question 9

Describe past psychiatric history?

Answer 9

• Any known diagnosis?
• Any treatment?
• Known to a community team?
• Any previous admissions to hospital?

Question 10

Describe family history?

Answer 10

• Age of parents, siblings, relationship with them
• Atmosphere at home
  Mental disorder in the family, abuse, alcohol/drugs misuse, suicide
• heritablity of mental disorders

Question 11

Describe the personal history?

Answer 11

• Mother’s pregnancy and birth
• Early development, separation, childhood illness
• Educational and occupational history
• Intimate relationships

Question 12

Describe the social history?

Answer 12

• Living arrangements
• Financial issues
• Alcohol and illicit drug use
• Forensic history

Question 13

Describe why need to take a medical history and medicine history

Answer 13

Medical problems = a cause or consequence of
mental disorder or psychiatric treatment

any regular medications and complience with it

• over the counter?
• Interactions

Question 14

Describe the corrobative history?

Answer 14

Informants: relatives, friends, authority
Confidentiality

• need for consent

Question 15

What is checked in the mental state examination?

Answer 15

• Appearance and Behaviour
• Speech
• Mood
• Thoughts
• Perceptions
• Cognition
• Insight

Question 16

What to look out for in appearance and behaviour- General appearance

Answer 16

• Neglect with self care : alcoholism, drug addiction, dementia, depression, schizophrenia
• Weight loss :anorexia nervosa, depression, cancer, hyperthyroidism, financial issues/homelessness

Question 17

What to look out for in appearance and behaviour- Facial expression?

Answer 17

depressive, anxious,

“wooden” parkinsonian

Question 18

What to look out for in appearance and behaviour- posture?

Answer 18

hunched shoulders, downcast head and eyes – depressive

sitting upright, head erect, hands gripping the chair – anxious

Question 19

What to look out for in appearance and behaviour- movement?

Answer 19

overactive, restless – manic
inactive, slow - depressive
immobile, mute – stupor
tremors, tics, choreiform movements, dystonia, tardive dyskinesia 
mannerisms, stereotypies

Question 20

What to look out for in appearance and behaviour- social behaviour?

Answer 20

disinhibited, overfamiliar
withdrawn, preoccupied
signs of impending violence: raised voice, clenching fists, pointed fingers, intrusion into personal space

Question 21

What to look out for with speech?

Answer 21

Quantity
Rate
Spontaneity
Volume

Question 22

What to look out for with mood?

Answer 22

Subjective
Objective
Predominant mood
Constancy		
Congruity

Question 23

What to look out for with the px’s thoughts?

Answer 23

• Stream
• Form
• Content
• Preoccupations
• Morbid thoughts, suicidality
• Delusions, overvalued ideas
• Obsessional symptoms
• rare folie a deux

Question 24

What are illusions?

Answer 24

Misperception of a REAL external stimulus

Question 25

What are hallucinations?

Answer 25

Perception in absence of external stimulus

true perception + 2) coming from outside the head
pseudohallucination = 1) OR 2)

hypnagogic, hypnopompic

auditory – second person, third person
visual – Charles Bonnet syndrome
olfactory
gustatory
tactile, of deep sensation

Question 26

Why is insight important?

Answer 26

Awareness of oneself as presenting phenomena that other people consider abnormal
Recognition that these phenomena are abnormal
Acceptance that these abnormal phenomena are caused by mental illness
Awareness that treatment is required
Acceptance of the specific treatment recommendations

Question 27

What types of support are available?

Answer 27

• Pharmacological
• Psychological
• Social support

Question 28

Give examples of

Answer 28

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