Psychotic Disorders And Psychosis

Question 1

What is psychosis

Answer 1

• Delusions
• hallucinations
• formal thought disorder

Question 2

Causes of psychosis

C3 main categories)

Answer 2

Organic
Eg delirium, medication induced, neurological disorder

Schizophrenia
Ie symptoms more than 28 days and no organic cause. First rank symptoms,, persistent hallucinations, and delusions

Other
Schizo affective disorders, delusional disorder, mood disorder etc

Question 3

Investigations of psychosis

Answer 3

Physical
• neurological exam
• bloods- fbc, lft, tft, glucose, lipids,cholesterol 
• urine drug screen * very important *
• ECG

Psychosocial
• collateral history

Question 4

Sneiders first rank symptoms (11)

Think ABC D

Answer 4

1. thought echo
2, voices arguing/discussing patient (3rd person )
3, running commentary
4. Thought withdrawal
5, thought insertion
6, thought broadcasting
7. Externally controlled body (somatic passivity)
8. Made affect (feelings)
9. Made impulses (drives)
10. Made volition (acts)
11. Delusional perception

Question 5

Types of schizophrenia (6)

Answer 5

Paranoid schizophrenia, hebephrenic schizophrenia, simple schizophrenia, catatonic schizophrenia, undifferentiated schizophrenia,, residual schizophrenia

Question 6

Risk factors for schizophrenia

Answer 6

• Pregnancy- pre eclampsia, emergency c section viral infection
• drug abuse
• low socioeconomic status
• urban area
• stressful life experiences- eg migrants
• physical and sexual abuse- particularly in childhood
• ethnicity- afro-carribean men (x4 higher)

Question 7

What is the prodrome

Answer 7

The period of time where the person is developing symptoms but doesn’t fit the criteria for diagnosis yet
• non specific negative symptoms
• emotional distress or agitation without reason
• transient psychotic symptoms

Question 8

What is the most appropriate medication for treatment resistant schizophrenia

Answer 8

Clozapine

Question 9

Antipsychotics are first line for treatment of schizophrenia

Explain difference between first and second generation

Answer 9

• First gen = typical
  Eg chlorpromazine, haloperidol
  Cause generalised dopamine d2 receptor blockade
  Broad range of side effects - extrapyramidal, hyperprolacthaemia, metabolic, anticholinergic, neurological
• second gen = atypical
  Eg olanzapine, risperidone, clozapine (for TRS)
  More selective dopamine blockade
  Also block serotonin 5-ht2 receptors
  Less likely to cause extra pyramidal side effects and hyper prolactinaemia but still can cause the other side effects