Psychotic disorders

Question 1

What are hallucinations?

Answer 1

Perception without external stimuli
Similar quality to real percept
Not under voluntary control
In context of clear sensorium

Question 2

What are the characteristics of AH?

Answer 2

Heard clearly through ears (vs in mind/heart), in clear consciousness, w/ no one else around

Question 3

What are delusions?

Answer 3

Usually false beliefs, firmly convicted, held on inadequate grounds, despite evidence to the contrary

Question 4

What are the positive symptoms of schizophrenia?

Answer 4

Delusion, hallucination, bizarre behavior, disorganized speech

Question 5

What are the negative symptoms of schizophrenia?

Answer 5

Anhedonia, alogia, apathy, asocial, attention (poor), affect (flat)

Question 6

What are the cognitive symptoms of schizophrenia?

Answer 6

Impaired attention, executive function, working memory

Question 7

What are the first rank symptoms of schizophrenia?

Answer 7

AH: running commentary, arguing, thought echo
Passivity: thought, affect, behavior
Thought alienation: insertion, withdrawal, broadcast
Somatic hallucination
Delusional perception

Question 8

What are the good prognostic factors of schizophrenia?

Answer 8

Female
Late onset
Acute onset
Trigger
Good premorbid personality & functioning
Few relapses
x negative & cognitive symptoms

Question 9

What is the pathophysiology of schizophrenia?

Answer 9

Dopamine hypothesis

• positive symptoms: hyperactivity of mesolimbic pathway
• negative & cognitive symptoms: underactivity of mesocortical pathway

Question 10

What is schizoaffective disorder?

Answer 10

Mood episode with psychotic symptoms
AND
Psychotic symptoms for 2w w/o mood symptoms

Question 11

How to manage schizophrenia?

Answer 11

Antipsychotic
Individual: CBT, metacognitive training, social skill training, vocational rehab, cognitive remediation
Family: psychoeducation, decrease EE

Question 12

What is brief psychotic disorder?

Answer 12

Psychotic symptoms for 1d-1m

Question 13

How to dx schizophrenia?

Answer 13

2 symptoms: delusion, hallucination, disorganized speech, disorganized/catatonic behavior, negative symptoms
Duration: 6m of disturbance (1m w/ symptoms)
Impaired functioning

Question 14

What is delusional disorder?

Answer 14

Non-bizarre delusion x 1m

Functioning x significantly impaired

Question 15

What medical conditions can cause psychosis?

Answer 15

CNS: vascular, infection (tertiary syphilis), inflammation (MS), neoplasm, degeneration (AD, PD)
Endocrine: thyroid, PTH, Ca, hypopit
Nutritional: B12, folate, niacin, thiamine

Question 16

What substances can cause psychosis?

Answer 16

Medicine: anti-parkinsonian, steroid, BZD, anticholinergic, antihistamine, NSAID
Drugs: ice, cocaine, meth, cannabis, inhalants/solvents, barbiturates

Question 17

What is alogia?

Answer 17

Slowing of thought + lack of spontaneous thought -> poverty of speech

Question 18

How to manage a patient that refuses to comply to treatment & return for follow-up?

Answer 18

CPN for urgent crisis intervention

Risk assessment

Question 19

What resources are available for patients after discharge?

Answer 19

CPN, ICCMW, hostel or half-way home (if x family)

Question 20

What etiological factors can cause relapse of psychosis?

Answer 20

Poor compliance
Stressor
Psychiatric comorbidity
Poor social support
Underlying dementia / cognitive impairment

Question 21

What is the onset of hebephrenic schizophrenia?

Answer 21

Prepubertal

Question 22

What are the RF of schizophrenia?

Answer 22

Advanced paternal age at conception
Late winter early spring births
FH
Live in urban area, immigrant