Psychotic Symptoms

Question 1

What are psychotic symptoms?

Answer 1

Psychotic symptoms are unusual experiences involving a disturbance in thought and/or perception. These experiences can make it very difficult to understand what is real and what is not.

Question 2

What does psychotic disorders refer to?

Answer 2

Psychotic Disorders refer to a group of disorders that include Psychotic Symptoms as a prominent aspect of their presentation.

Question 3

What do pathognomonic mean?

Answer 3

So characteristics of a disease that it can be used to make a diagnosis

Question 4

Do psychotic symptoms = psychotic disorders?

Answer 4

Psychotic symptoms are NOT pathognomonic of Psychotic Disorders

Question 5

What psychiatric disorders often have psychotic symptoms?

Answer 5

Major depressive disorder with psychotic features

Bipolar disorder with psychotic features

Psychotic symptoms can be found in psychiatric disorders - affective disorders

Question 6

Do psychotic symptoms occur outside of disorders?

Answer 6

Psychotic symptoms can and do occur outside of disorders

Question 7

What might give rise to Psychotic Symptoms?

Answer 7

Stress, mood disorders, schizophrenia spectrum disorders, medical problems and drug induced can all lead to psychosis

• Substance use are quite common cause of psychosis and can cause the onset of schizophrenia
• You can have some complication that can lead to the emergence of psychotic symptoms - a consequence of being medically compromised

Extreme stress can lead to psychosis if the brain is not equipped to deal with extreme stress

Question 8

What are psychotic-like experiences?

Answer 8

Psychotic-like experiences are subtle, subclinical hallucinations and delusions that are quite common in general population and are age-dependent. Approximately 7% prevalence in adults and perhaps as high as 40% in children

Question 9

What is a normative experience with psychosis?

Answer 9

Psychotic symptoms doesn’t always have to be extreme

• You can have mild psychosis and not be diagnosed to have any psychotic symptoms/disorders
• Some psychosis can be normal (hearing someone calling your name in the middle of the night)

Question 10

What is non-clinical psychosis?

Answer 10

Non clinical psychosis - psychotic like experiences

• Hallucinations, people have odd experiences all the time
• Psychotic symptoms that occur outside of a clinical diagnosis

Question 11

What is attenuated psychotic symptoms?

Answer 11

Just on the cusps of transferring into a psychotic disorder - very significant

• Driving people’s behavior, impact on people’s behavior

Question 12

True or False: As the severity of psychosis increases, the portion of the population experiencing these things increases

Answer 12

FALSE.

The portion of the population that experiences psychosis decrease as the severity increases

Question 13

What is fear of clown called?

Answer 13

Coultrophobia

Question 14

What are the three D’s of “abnormal” behavior?

Answer 14

Dysfunction : symptom(s) cause significant dysfunction in psychological, biological, or developmental processes underlying mental functioning
- The symptoms cause problems with thought, emotion, and/or behavior

Distress: symptom(s) cause some form of suffering
- This is very subjective can can only be determined by the person experiencing the symptoms

Deviance refers to behavior that violates social norms or cultural expectations because culture determines what is normal
- This is a hard one because ‘cultural’ is very VERY subjective

Question 15

What are the categories of psychotic symptoms?

Answer 15

• Positive symptoms
• Negative symptoms
• Disorganized thought (evidenced in speech)
• Disorganized or abnormal motor behavior (including catatonia)

Question 16

What are positive symptoms? What does it include?

Answer 16

Positive symptoms refer to an excess or distortion of normal perceptual or cognitive function

• Delusions
• Hallucinations

Question 17

What are negative symptoms? What does it include?

Answer 17

Negative symptoms refer to a diminution or absence of normal behaviors related to motivation, interest or expression

• Avolition
• Anhedonia
• Alogia
• Diminished Emotional Expression

Question 18

What are hallucinations defined as?

Answer 18

Hallucinations are defined as perceptions that occur in a conscious state in the absence of external stimuli which have qualities of real perception, in that they are vivid and substantial

Question 19

What are hypnagoic hallucinations vs hypnopompic hallucinations?

Answer 19

Hypnagogic hallucinations can occur as one is falling asleep

Hypnopompic hallucinations occur when one is waking up

Hypnagogic hallucinations and hypnopompic hallucinations are considered normal phenomena

Question 20

How can hallucinations occur in the sensory modality?

Answer 20

Visual - sight
Auditory - hearing
Olfactory - smell
Gustatory - taste
Tactile - physical sensation

Question 21

What are the 3 things about delusions?

Answer 21

1. certainty - held with absolute conviction
2. Incorrigibility - not changeable by compelling counterargument or proof to the contrary - you can’t change their opinion about it, they will not believe you even with proof, entirely subjective
3. Impossibility or falsity of content - implausible, bizarre or patently untrue

Question 22

What is grandiose delusion?

Answer 22

Special powers, special mission, fame, etc.

Question 23

What persecutory delusion?

Answer 23

Someone is out to get you, spying on you, etc.

Question 24

What is religious delusions?

Answer 24

Involves some connection to religious belief

• Chosen from god

Question 25

What are somatic delusions?

Answer 25

Something is very wrong with your body

Question 26

What are delusions of control?

Answer 26

Some force is controlling you against your will

Question 27

What are delusion of guilt or sin?

Answer 27

You have done something terrible

Question 28

What are delusions of mind being read?

Answer 28

People know what you are thinking

Question 29

What are delusions of reference?

Answer 29

Ordinary events have special meaning for you

Question 30

What are erotomanic delusions?

Answer 30

Another person is in love with you

Question 31

True or False: A single delusion can only be classified as one type?

Answer 31

False A single delusion can be more than one type

Question 32

What does diminished emotional expression refer to?

Answer 32

Refers to loss of emotional expressiveness. The person's face may be unresponsive or expressionless, and speech may lack vitality or warmth

Question 33

What is alogia?

Answer 33

Sometimes called poverty of speech. The person has little say and is not able to expand on their statements. A doctor examining the patient must be able to distinguish between alogia and unwillingness to speak.

Question 34

What is avolition?

Answer 34

An inability to begin or stay with goal-directed activities. They may sit in one location for long periods of time or show little interest in joining group activities.

Question 35

What is anhedonia?

Answer 35

refers to the loss of one's capacity for enjoyment or pleasure.

Question 36

True or False: The severity of negative symptoms actually predict how the people will fair with their prognosis

Answer 36

TRUE

Question 37

What does disorganized thought refer to?

Answer 37

Disorganized Thought, often called “Thought Disorder”, refers to incomprehensible language, either in speech or writing, that is presumed to reflect thinking. This is perhaps the most prominent of all psychotic symptoms…. It also poses the most difficulty for making a diagnosis! - As soon as you interact with someone with a thought disorder you know

Question 38

What are common forms of a thought disorder?

Answer 38

- Loose associations - Derailment - "Word salad" - Neologisms - Perservations - Clang

Question 39

What are loose associations? Example:

Answer 39

A rapid shift from one topic to a vaguely related alternative topic. This may make following the persons statements difficult or may result in complete incoherence. “I sometimes see shadows in the shower. Hair is wet. It’s dark under my bed.”

Question 40

What is derailment? Example?

Answer 40

A single, often unimportant, word in a sentence becomes the focus or topic of the next sentence “The shopping cart got stuck. Cartwheels are really fun! I have 4 things in my Amazon cart”

Question 41

What is "word salad"? Example?

Answer 41

Things that are said cannot be understood because there is no grammatical structure to the language. “Cranky is a bird catching running ceiling”

Question 42

What is neologisms? Example?

Answer 42

Made-up words that typically have only meaning to the individual who uses them. I.e. “My housemates make me very uncomfortable because they are ‘crudic’ “ (this was the word created to describe people that did not have good manners

Question 43

What are perseverations? Example?

Answer 43

Repetition of words, statements or themes over and over. The answer to every question revolves around the same words, phrases or themes

Question 44

What is clang? Example?

Answer 44

Rhyming words to construct a sentence that may be understandable or incoherent. I.e. “The dog in the fog is a bog”

Question 45

What does disorganized behavior include?

Answer 45

Includes such behaviors as agitation; age-inappropriate silliness; inability to maintain personal hygiene; dressing inappropriately for the weather; sexual self-stimulation in public; shouting at people, etc.

Question 46

What does catatonic behavior refer to? What is catalepsy and negativism?

Answer 46

Refers to disturbances of movement, whether remaining motionless for long periods of time OR excessive and purposeless movement. - Catalepsy: The person’s body has a kind of waxy flexibility and can be repositioned by others - Negativism: The person maintains postural rigidity and resists being moved by others. A catatonic patient may assume bizarre postures or imitate the movements of other people. This symptom is so unique that the newest edition of the DSM includes Catatonia as a separate diagnosis

Question 47

True or False: There will be a symptom that is more "prominent" than others in psychiatric disorders?

Answer 47

TRUE In individuals diagnosed with a psychiatric disorder, there is often considerable overlap between symptoms! - It is very rare to see a patient with only a single type of psychotic symptom. In most cases, there will be a symptom that is more “prominent” than others - Prominent symptoms are typically those that have the most impact on behavior and functioning

Question 48

What are the two types of clinical assessments for psychosis?

Answer 48

Clinician Administered - a mental health professional directly asks questions and observes a patient's responses during an interview Self-report – the person fills out a questionnaire or survey to provide information about their own symptoms or experiences, without direct interaction with a clinician The key differences lies in who is actively gathering the information, with clinician-administered assessments generally considered more reliable for certain situations but potentially missing subjective details that self- report captures?

Question 49

What are the advantages of clinician administered assessments?

Answer 49

Greater control over the assessment: The clinician can clarify questions, probe for details, and observe non-verbal cues, potentially leading to a more accurate understanding of the person's situation Useful for complex cases: People may have difficulty self-reporting symptoms due to cognitive impairments, language barriers, or a lack of insight Standardized approach: Typically rely on a structured interview protocols, ensuring consistency across evaluations

Question 50

What are the advantages of self-report assessments?

Answer 50

Privacy and comfort: People may feel more comfortable disclosing sensitive information on a self-report questionnaire, potentially leading to more honest answers Cost-effective: Self-report questionnaires can be administered to a large number of individuals quickly and efficiently Individualize perspectives: Self-report captures a person’s unique subjective experience and perspective on their symptoms and experiences

Question 51

What is the dimensional assessment of psychosis?

Answer 51

We can see what the major symptoms that someone is experiencing

Question 52

What does the Scale for the Assessment of Positive Symptoms (SAPS)?

Answer 52

Assesses the full range of positive symptoms including hallucinations, delusions, bizarre behavior and thought disorder

Question 53

What does the Positive and Negative Symptom Scale (PANSS) assess?

Answer 53

Generally considered the "Gold Standard" because it comprehensively assesses positive and negative symptoms. ALso includes an assessment of general psychopathology - Merged the best parts of the SAPS and the SANS and would evaluate the overlapping disorders, you can administer this test when giving someone a new medication and test before and after to see how things change.