Schizophrenia and Psychosis

Question 1

branches of psychosis?

Answer 1

dementia praecox (schizophrenia and other paranoid illnesses)
manic depressive psychosis (bipolar and unipolar depression)
- schizoaffetive disorder lies somehwere between dementia praecox and manic depressive
organic conditions (delirium, dementia, brain injury etc)
substance use (intoxication, withdrawal etc)

Question 2

what is psychosis?

Answer 2

mental disorder in which the thoughts, affective response or ability to recognise reality and ability to communicate and relate to others are impaired causing poor capacity to deal with reality
inability to distinguish between subjective internal experience and reality
characterised by lack of insight

Question 3

how does the brain interpret reality in a normal person?

Answer 3

no direct interface, all experiences are filtered by the brain and presented as perceptions of the world
sensory organs aren’t perfect and brain is limited in processing ability

Question 4

examples of psychotic experiences?

Answer 4

hallucinations
ideas of reference
delusions
formal thought disorder
thought interference
passivity phenomena
loss of insight

Question 5

describe a hallucination

Answer 5

experienced as originating in real space, not just in thoughts (not like inner speech)
has same qualities as a normal perception
not subject to conscious manipulation

Question 6

when are hallucinations significant?

Answer 6

only when in the context of other relevant symptoms

- can be induced in most people (e.g by sensory deprivation)

Question 7

what are ideas of reference?

Answer 7

innocuous or coincidental events will ascribed meaning by the person

• e.g thinking there are messages in newspaper/news show about them
• news reader is talking directly to them
• seeing objects arranged in a way to convey a message
• seeing meaning in other people’s gestures
• etc

Question 8

what are self-referential experiences?

Answer 8

the belief that external events are related to oneself

Question 9

what makes a belief delusion?

Answer 9

must be fixed and falsely held with unshakeable conviction
impervious to logical argument or evidence to the contrary
held outwith the usual social cultural and educational background of the patient
may be bizarre or impossible

Question 10

what is a primary delusion?

Answer 10

arrives fully formed in the consciousness without need for explanation

Question 11

what are secondary delusions?

Answer 11

are often attempts to explain anamalous experiences (e.g hallucinations, passivity, depression etc)
- e.g my thoughts are being inserted by the CIA/aliens etc

Question 12

content of delusions?

Answer 12

specific content is culturally defined

persecutor is often culturally recognisable to society/culture as a danger/threat (IRA, FBI, mafia, devil, spirits etc)

Question 13

types of thinking in though disorder?

Answer 13

neologisms - where people have their own vocabulary (drop made up words into conversation)
clanging and punning (“Dr Pell, ding dong bell, go to hell”)
knights move thinking (jumping from thought to thought via some linking word or connection)
circumstantiality/tangentiality
loosening of associations
verbigeration/word salad

Question 14

types of thought interference?

Answer 14

thought insertion
thought withdrawal
thought broadcasting
thought blocking

Question 15

what is passivity?

Answer 15

feeling as though you are being controlled
passivity of
- volition = movement
- affect = feelings
- impulse = urges (e.g walk into traffic)
- somatic passivity = influence on body

Question 16

what can cause loss of insight?

Answer 16

filter which, in most people, filters information from senses and interprets meaning, relevance and connectedness is impaired
therefore to you, everything seems real, things make sense, everything has meaning and you know whats going on

Question 17

features of drug induced psychosis?

Answer 17

may be florid symptoms or chronic symptoms

tend to be short lasting if access to the psychoactive substance is removed

Question 18

features of depressive psychosis?

Answer 18

typified by mood congruent content of psychotic symptoms
hallucinations are typically 2nd person threatening, insulting, accusing voices
delusions of worthlessness/guilt/hypochondriasis/poverty

Question 19

features of mania with psychosis?

Answer 19

typified by mood congruent content of psychotic symptoms
delusions of grandeur/special ability/persecution/religiosity
hallucinations (often 2nd person auditory - e.g Gods voice talking to you)
flight of ideas

Question 20

first rank symptoms in schizophrenia?

Answer 20

suggest schizophrenia in the absence of drug use or organic impairment but are not pathopneumonic

Question 21

core psychotic symptoms of schizophrenia?

Answer 21

delusions
hallucinations
thought interference
passivity

Question 22

at least 1 out of which symptoms must be present for ICD criteria for schizophrenia diagnosis?

Answer 22

either one of:

• thought echo/insertion/withdrawal/broadcasting
• delusions of control, influence or passivity
• hallucinatory voices giving running commentary, or discussing patient
• persistent delusions of other kinds that inappropriate and impossible

Question 23

3 subtypes of schizophrenia?

Answer 23

paranoid - typical, most common, 1st rank syndromes predominate
hebephrenic - immaturity/silliness, do immature or inappropriate things, lots of animation and giggliness etc
catatonic - movement disorder predominated, not really seen any more as it responds so well to treatment

Question 24

other paranoid psychoses?

Answer 24

persistent delusional disorder
- systematised, fixed delusions the major or only feature
schizotypal disorder
- eccentricity and aloofness, social withdrawal, paranoid quasi-delusional ideas, magical thinking and transient auditory hallucinations
- acute/transient psychotic disorder- symptoms lasting <1 month
schizoaffective disorder
- bipolar and schizophrenia either at same time or within 2 weeks of each other

Question 25

positive symptoms?

Answer 25

hallucinations
delusions
passivity
disorder in form of thought

Question 26

negative symptoms?

Answer 26

reduced speech, motivation/drive, interest/pleasure and social interaction

Question 27

what is schizophrenia?

Answer 27

diagnosis based on cluster of symptoms

considered a genetically determined neurodevelopmental vulnerability later triggered by environmental stressors

Question 28

who gets schizophrenia?

Answer 28

slightly more common in males
peak incidence in men = 15-25
peak incidence i females = 25-35
more common in lower socioeconomic class

Question 29

risk factors fro schizophrenia?

Answer 29

genetics (higher chance if MZ twin, both parents or one parent affected, some mutations)
birth complications/perinatal complications
prenatal exposure to viral infections
drug use (cannabis)
urban dwelling
social adversity/deprivation
neurodevelopmental changes (enlarged ventricles, thinner cortices)
neurochemical changes (altered dopamine signalling)

Question 30

Premorbid/prodromal features of people who may go on to develop schizophrenia?

Answer 30

subtle motor,cognitive and social deficits in childhood that become greater as time goes on (e.g delay in speech, walking etc)
can also have odd ideas and experiences, eccentricity, altered affect and odd behaviours

Question 31

bad prognostic indicators in schizophrenia?

Answer 31

poor pre-morbid adjustment
insidious onset
early onset (child/adolescent)
long duration untreated
cognitive impairment
enlarged ventricles

Question 32

good prognostic indicators in schizophrenia?

Answer 32

older age at onset
female
marked mood disturbance especially elation
family history of mood disorder

Question 33

3 general patterns of schizophrenia progression?

Answer 33

dips, the returns to normal level and stays there for long time
dips and returns to normal level several times over time
dips several times but never fully returns to normal so is basically worsening over time

Question 34

possible end outcomes in schizophrenia?

Answer 34

suicide

homicide by schizophrenia patient is rare but take not of anyone with command hallucinations or delusions of jealousy

Question 35

at least 2 out of which symptoms must be present for ICD diagnosis of schizophrenia?

Answer 35

persistent hallucinations in any modality occurring every day for at leas 1 month when accompanied by delusions
neologisms, breaks or interpolations in the train of thought
catatonic behaviour such as excitement, posturing or waxy flexibility, negativism, mutism and stupor
negative symptoms