Session 11 - Psychosis

Question 1

What is psychosis?

Answer 1

The presence of hallucinations or delusions

Describes symptoms, is not a diagnosis itself

Question 2

What are hallucinations?

Answer 2

Perception without a stimulus
Can be in any sensory modality
Visual hallucinations are usually organic (caused by problem with brain or eyes)

Question 3

When are hallucinations experienced in the normal population?

Answer 3

Immediately before falling asleep - Hypnogogic

Immediately before waking up - hypnopompic

Question 4

What is a delusion?

Answer 4

Abnormal belief, outside of cultural norms, unshakeable

Question 5

What are the symptoms of schizophrenia?

Answer 5

Auditory hallucinations
Passivity experiences
Thought withdrawal, broadcast or insertion
Delusional perceptions
Somatic hallucinations

Thought disorder
Lack of insight
Under-activity
Low motivation
Social withdrawal
Self neglect
Emotional flattening

Question 6

Give examples of auditory hallucinations.

Answer 6

Thought echo - hearing thoughts aloud

Running commentary - voices referring to the patient in third person and conversing with each other about the patient

Question 7

What are passivity experiences?

Answer 7

Patient believes that an action or feeling is caused by an external force

E.g. ‘MI5 have been moving my leg’

Question 8

What is thought withdrawal, broadcast and insertion?

Answer 8

Thought withdrawal - thoughts are being taken out of the mind

Thought broadcast - thoughts are being made known to others e.g. via radio

Thought insertion - thoughts implanted by others

Question 9

What is delusional perception?

Answer 9

Attribution of new meaning, usually in the sense of self-reference, to a normally perceived object.

E.g. ‘the traffic lights went red and i knew this was a sign that the aliens were going to land soon’

Question 10

What are somatic hallucinations?

Answer 10

Mimics feelings from inside the body

Question 11

What are the different types of schizophrenia?

Answer 11

Paranoid schizophrenia
Simple schizophrenia
Hebephrenic schizophrenia
Undifferentiated schizophrenia
Catatonic schizophrenia

Question 12

Describe paranoid schizophrenia.

Answer 12

Delusions or hallucinations prominent

Question 13

Describe simple schizophrenia.

Answer 13

Loss of drive and interest, aimlessness, social withdrawal.
Marked decline in social, academic or work performance.
No hallucinations/delusions.

Often mistaken for depression.

Question 14

Describe hebephrenic schizophrenia.

Answer 14

Aimless and disjointed behaviour or thought disorder affecting speech.
Hallucinations/delusions must not dominate.

Question 15

Describe undifferentiated schizophrenia.

Answer 15

Insufficient symptoms to meet criteria of any subtypes or so many symptoms that fit into more than one criteria.

Question 16

What pathways are affected in schizophrenia?

Answer 16

Dopamine pathway
Mesolimbic pathway
Mesocortical pathway

Question 17

Where does the mesolimbic pathway run from and to?

Answer 17

From: ventral tegmental area
To: limbic structures (amygdala, septal area, hippocampal formation) and nucleus accumbens

Question 18

Where does the mesocortical pathway run from and to?

Answer 18

From: ventral tegmental area
To: frontal cortex and cingulate cortex

Question 19

What macroscopic brain changes are seen in schizophrenia?

Answer 19

Enlarged ventricles
Reduced hippocampal formation
Reduced amygdala
Reduced parahippocampal gyrus
Reduced prefrontal cortex

Question 20

Where does the nigrostriatal pathway run from and to?

Answer 20

From: substantia nigra pars compacta
To: striatum (caudate nucleus and putamen)

Question 21

What is catatonia?

Answer 21

More than two weeks with one or more of:

• stupor/mutism
• excitement
• posturing
• negativism
• rigidity
• waxy flexibility
• command automatism

Probably due to less GABA binding so loss of inhibitory effect.

Question 22

Why is mortality twice as high in schizophrenics than the general population?

Answer 22

Higher incidence of CVS disease, respiratory disease and cancer 
Suicide risk 9x higher
Death from violent incidents 2x higher
Substance misuse problems
Higher rates of cigarette smoking

Question 23

What is drug induced psychosis?

Answer 23

Psychosis induced by psychoactive substances.

E.g. methamphetamine, cannabis, cocaine, ecstasy etc.