psychosis "tutorial"

Question 1

what is psychosis

Answer 1

psychosis is a clinical syndrome: a descriptive term that refers to a difficulty in percieving and interpreting reality.

its not a diagnosis and can be caused by multiple diseases.

Question 2

what is the disease most commonly causing psychosis

Answer 2

schizophrenia although sometimes too much weight is put on it, used to be centre of research for psychosis as if its the only thing, this changing now

Question 3

what are some other causes of psychosis other than schitzophrenia

Answer 3

drug induced,

depression with psychotic symptoms
bipolar I

schitzoaffective disorder
delusional disorder

Question 4

what are the three domains of symptoms of psychosis

Answer 4

positive (gain of function) , negative (loss of function) and disorganisation- umbrella term for everything else

Question 5

what are the 2 main types of positive symptoms in psychosis

Answer 5

hallucinations and delusions

Question 6

what is a hallucination

Answer 6

The perception of an experience in the absence of stimulus

Question 7

what is a delusion

Answer 7

a fixed false belief that is not conventional with social/ cultural norms. delusions have a theme/ flavour (means there are types, discussed in other flash)

Question 8

what sensations can there be hallucinations in?

Answer 8

all sensations, auditory, gustatory, olfactory, visual, somatic

Question 9

how do we categorise auditory hallucinations

Answer 9

1) person
1st (echos) second or third person

2) some content types:
running commentary
command hallucinations

Question 10

what are some types of delusions

Answer 10

erotomanic
nihilistic/: guilt related
pathological jealousy
paranoid/ persecutory ( thinking someone wants to hurt you)
reference (thinking someone on tv is talking abt them)
grandiosity (thinking you are specially smart or smth)
passivity experiences : thought insertion, thought broadcasting (believing your thoughts are transmitted to others and they know what ur thinking), thought withdrawal

Question 11

what does it mean that passivity experiences are “first rank “ symptoms

Answer 11

means that they are characteristic of schitzophrenia

Question 12

negative symptoms of psychosis

Answer 12

alogia - slow and little speech

avolition/ apathy - lack of motivation- poor self care

anhedonia/ asocialty - few friends and hobbies - impaired social functioning

affective flattening- unchanging facial expressions, few expressive gestures, poor eye contact, lack of vocal intonations, limited emotional range

Question 13

do positive or negative symptoms arise first in psychosis?

Answer 13

positive, negative at later stages

Question 14

which symptom are these presentations describing:
Unchanging facial expressions
Few expressive gestures
Poor eye contact
Lack of vocal intonations
Limited emotional rang

Answer 14

affective flattening

Question 15

what is it called when someone has Few close friends
Few hobbies/interests
Impaired social functioning

Answer 15

anhedonia/ asocialty

Question 16

what is it called when someone has Paucity/poverty of speech (little content)
Slow to respond to questioning

Answer 16

alogia

Question 17

what is it called when someone presents with Poor self-care
Lack of drive/persistence at work/education
Lack of motivation

Answer 17

Avolition/apathy

Question 18

what are the two categories of disorganisation symptoms

Answer 18

bizzare behaviour and formal thought disorder - disorder of thought FORM- means lack of logical connection between thoughts (not content theoritika)

Question 19

which are the progressive stages of formal (As in form not as in episimo) thought disroder

Answer 19

1circumstantial thought— 2tangential thought—
3flight of ideas—
4derailment/ loosening of association —
5word salad

Question 20

at what age is the peak incidence for psychosis? can it occur at other ages or not rl?

Answer 20

early adolescence/ early 20s (women bit after men) but CAN occur at any age

Question 21

describe the course of psychosis

Answer 21

often chronic and episodic but prognoses vary- 1/3 do well 1/3 relapse 1/3 dont respond

Question 22

explain how morbidity increases in psychotic people

Answer 22

both bc of disorder itself and bc of incr risk of other health cond such as heart disease

Question 23

examples of morbidity

Answer 23

significant impact on education, employment and functioning

Question 24

how does psychosis influence mortality

Answer 24

1) all-cause mortality x2.5 higher—- 15 yrs lost from life expecatncy

2) risk of suicide higher in SCITZOPHRENIA specifically —- 28% od excess mortality in scitz is suicide

Question 25

what is excess mortality in a population for ex in scittz ppl

Answer 25

extra deaths compared to equivalent population without the factor

Question 26

what are the 3 aspects of psychosis management and which one is often the mainstay of treatment

Answer 26

pharmacological!!- mainstay, social and psychological

Question 27

examples of psychological support for psychosis

Answer 27

CBT
newer therapies like avatar therapies

Question 28

illustrate social support for psychosis

Answer 28

supportive environments, structures and routines

housing, benefits

support with budgeting/ employment

Question 29

What neurotransmitter system is most implicated in the mechanism of antipsychotics? can antipsychotics act on other neurotransmitters?

Answer 29

dopamine, but antipsychiotics vcan also act on serotonin, acetylcholine, histamine receptors

Question 30

Which drug actions on dopamine receptors would be most likely to improve psychotic symptoms?
antagonist, partial agonist or agonist

Answer 30

antagonist

Question 31

Andy agrees to take an antipsychotic medication (Risperidone). A few weeks later, his symptoms improve but he develops some movement symptoms;
What are these symptoms and why have they occurred?

Answer 31

Extrapyramidal Side Effects (EPSEs)

Caused by dopamine BLOCKADE in the nigrostriatal (extrapyramidal) dopamine system (parts of the brain that enable us to maintain posture and tone)

Question 32

what does the term extrapyramidal side effects refer to

Answer 32

Umbrella term for side effects outside the traditional pyramidal movement pathway

Question 33

what are some examples of Extrapyramidal Side Effects (EPSEs)

Answer 33

Includes;
Parkinsonism- the quadret of park sympt
Acute dystonic reactions- stiff
Tardive dyskinesia - infections
Akathisia- internal sense of restlessness

Question 34

what is parkinsonism

Answer 34

basic parkinsonian symptoms, tremor, bradykinesia, postural instability ect ( this was in green box so “ for own reference”)

Question 35

what are the management principles for extrapyramidal side effects

Answer 35

Counsel about risk
Use lowest therapeutic dose
Use atypical as first line
Change medication to a more movement sparing agent
Anticholinergic medications can help (e.g. procyclidine)

Question 36

what type of thought disorder is it if ideas are linked by sounds or rhythmic puns

Answer 36

flight of ideas

Question 37

what thought disorder is it when someone says “I like the sky. I’m having pasta for lunch. How are you doing?”

Answer 37

derailment, train of thought has gone off tracks, unrelated train of thoughts, one level before word salad

Question 38

what the difference between tangential and circumstantial thought disorder

Answer 38

in circumstantial althought the responces are longwinded, questions are eventually answered. in tangential they are not

Question 39

what kind of hallucination is it if someone can feel a chip inside their head

Answer 39

tactile

Question 40

what is really important to do with a patient experiencing hallucinations

Answer 40

find out as much as you can about the hallucination, the voice the person, where it comes from, other room ect

Question 41

how do you clinically assess someone who looks like they are having psychotic episode

Answer 41

MSE - mental state examination

Question 42

what are the categories of MSE

Answer 42

speech, insight, mood and affect, thought content, thought form,

perceptions (hallucinations)

cognition