Psychosis Tutorial

Question 1

what are first rank symptoms in schizophrenia?

Answer 1

main symptoms which indicate a schizophrenia

Question 2

what are the 3 first rank symptoms in schizophrenia?

Answer 2

passivity
3rd person auditory hallucinations
thought disorder (insertion, withdrawal, broadcasting, echo)

Question 3

other common features of schizophrenia?

Answer 3

delusions and hallucinations are persistent (same theme and type return in every relapse of illness)
can have residual hallucinations/delusions (continue even when person is well)
neologisms (create new words)
negative symptoms (apathy, anhedonia etc)
catatonia

Question 4

who is catatonia seen in?

Answer 4

rare but can be seen in isolated individuals or rapidly progressing illness - e.g post partum psychosis

Question 5

what is catatonia?

Answer 5

complete reduction in activity (moving, eating, drinking etc) seen in the most severe cases of mental illness

Question 6

features of catatonia?

Answer 6

waxy rigidity (person will move if you physically move them without resistance but will just stay in that position indefinitely and wont move themselves)
catatonic agitation (will stay in waxy rigidity state but can then suddenly become active, agitated and potentially violent)

Question 7

how can catatonia be managed?

Answer 7

benzodiazepines can be used in emergency cases of catatonic agitation where they are a danger
responds very well to ECT (can be given in emergency as part of short term detention order without 2nd opinion if needed to save a life)

Question 8

management of schizophrenia?

Answer 8

try 2 different anti psychotics first
if neither works then use clozapine
clozapine = gold standard and works best but has bad side effects (agranulocytosis, myocarditis, weight gain, complete constipaiton etc)

Question 9

give examples of 2 anti psychotics and when they may be a good choice?

Answer 9

olanzapine = good if patient is taking illicit substances but causes weight gain so bad in obese people
aripirazole = better in overweight people as doesnt cause weight gain

Question 10

is medication always needed in schizophrenia?

Answer 10

no

psychological therapy alone can be used if symptoms arent causing any risk or distress