Schizophrenia and Psychosis

Question 1

Psychosis
- Four symptoms

Answer 1

Psychosis
- Four symptoms

1. Hallucinations
2. Delusions
3. Formal thought disorder
4. Fragmentation of the boundaries of self

Question 2

Hallucination pathophysiology
- Auditory
- Visual
- Olfactory

Answer 2

Hallucinations

• Auditory
  1. Psychosis
  2. 2nd or 3rd person
• Visual
  1. Common in delirium
• Olfactory
  1. Frontal lobe pathology

Question 3

Delusion
- Definition

Answer 3

Delusion
- Definition

1. Fixed, firm belief
2. Cannot be reasoned away
3. Despite evidence to contrary
4. Out of sociocultural norms

Question 4

Formal thought disorder
- Universal characteristic

Answer 4

Formal thought disorder
- Universal characteristic:

Speech does not follow.
- words
- phrases
- sentences

Question 5

Disorders of the self
- Examples

Answer 5

Disorders of the self
- Examples

1. Self vs other
2. Self through time
3. Self as agent
   —
4. Passivity phenomena
5. Thought insertion
6. Thought broadcast

Question 6

Schizophrenia
- History

Answer 6

Schizophrenia
- History

1. Bleuler
   - ‘Split mind’
   - Not a coherent whole
2. Kraepelin
   - Dementia praecox
   - ‘Young dementia’

Question 7

Schizophrenia
- Functional psychosis

Answer 7

Schizophrenia
- Functional psychosis

1. Bizarre
2. Persecutory
3. 3rd person

Question 8

Schizophrenia
- Definition
- 5 As

Answer 8

Schizophrenia
- Definition

1. Disorder/group
2. Characterised by psychotic episodes
3. Negative symptoms

A1 - Autism (own world)
A2 - Affect flatness (incongruous)
A3 - Ambivalence
A4 - Associations loosen
A5 - Apathy/amotivation

Question 9

Schizophrenia
- First Rank Symptoms

Answer 9

Schizophrenia
- First Rank Symptoms

1. Thought broadcast
2. Auditory hallucination
   - 3rd person
   - Running commentary
3. Physical hallucination
   - passivity
4. Thought broadcasting, withdrawal, insertion
5. Delusional thinking

Question 10

Schizophrenia
- Prevalence
- Mortality

Answer 10

Schizophrenia

• Prevalence
  1%
• Mortality
  Increased 10-20 years
• Illicit drugs
  Stimulants
  Cannabis

Question 11

Schizophrenia
- Mx setting

Answer 11

Schizophrenia
- Mx setting

1. Risk
2. Insight
3. Behaviour

Question 12

Schizophrenia
- Assessment for management

Answer 12

Schizophrenia
- Assessment for management

1. Bio
   - Bloods, CT
   - Compliance
2. Psycho
   - MSE
   - Collateral
3. Social
   - Housing
   - Carers

Question 13

Schizophrenia
- Mx framework

Answer 13

Schizophrenia
- Mx framework

1. Bio
   - Antipsychotics
2. Psycho
   - Counselling
   - Family therapy
3. Social
   - Debts, benefits, housing
   - CPN, SW

Question 14

Psychosis
- Differentials

Answer 14

Psychosis
- Differentials

1. Drug induced
   - Cannabis
   - Amphetamines
2. Schizophrenia
   - 1x very convincing (eg. 3rd person, or bizarre)

• 2: 2nd person auditory + delusions (non-bizarre)

3. Mood disorder
   - Depression with psychosis
   - Bipolar with psychosis
4. Schizoaffective disorder
   - Both sets of symptoms simultaneously
   eg. Depression always with psychosis
5. EUPD
   - ‘Borderline’ on psychosis
   - Transient auditory hallucinations
   - Pseudohallucinations
   - Transient delusions

Question 15

Schizophrenia Ix

1. Delusions
2. Hallucinations

Answer 15

Schizophrenia Ix

1. Delusions
   - Is there any thing heavily on your mind?
   - Do other people seem to try to disagree with you about what you’re saying?
2. Hallucinations
   - Do you ever hear someone speaking when there doesn’t seem to be anyone there?
   - Do you ever talk to people that other people don’t seem to see?

Question 16

Psychotic disorders
- Psychological interventions

Answer 16

Psychotic disorders
- Psychological interventions

1. CBT - P
   - Reality testing
2. Family interventions
   - Countering ‘high expressed emotion’
3. Social intervention
   - balanced structure of activities
   - avoid over or under simulation