Though disorders

Question 1

Define psychosis

Answer 1

A distortion or loss of contact with reality without any clouding of conciousness
3% of the population will experience a psychotic episode at some point their lifetime
15% of major depressive episodes have psychotic symptoms

Question 2

Briefly classify psychotic disorders

Answer 2

Brief psychotic disorder
- >1day but <1month

Shizophreniform disorder
1-6 monnths

Schizophrenia

• > 6 months
• responsible for approxiamtly 60% of psychosis

Shizoaffective disorder
->2wwks of psychosis with prominent mood symptoms

Post partum psychosis
-within 6 weeks of delivery

Pyschosis associated with medical condition

• CNS pathology
• encephalitis
• metabolic derangements
• usually associated with features of delirium

Question 3

Discuss IX of psychosis

Answer 3

First onset psychosis of any age required full medical workup
First onset is medical until proven otherwise

History taking

• find quitest are possible
• sit side by side not face to face with as much physical space as possible
• ensure access to the exit
• avoid too much eye contact
• acknowledge viewpoint without reinforcing the delusion

Exam depends on patient compliance

Bloods 
-FBC
-U&E
-TFT
-CMP
-Urine drug screen
\+-CT head
\+- LP
B12 folate

Question 4

Describe shizophrenia

Answer 4

Pervasive psychiatric disorder with an underlying biological cause which exerts its effect on pereception thinking and emotion

Significant genetic factors and brain abnormalities with psychosoical stressors as precipitating or exacerbating factors

• Dopamine over activity is thought to cause the positive symptoms of the disease
• diminished activity in the prefrontal cortex related to serotonin transmission is associated with the -ve symptoms.

Age of onset

• 15-25
• rare after 45
• 50% have abnormal pre-morbid personality
• gradual onset over months

Question 5

Discuss criteria for shizophrenia

Answer 5

Involves at least 2 of

1) delusions
2) hallucinations
3) grossly disorganised or catatonic behaviour
4) disorganised speech
5) negative symptoms
- lack of motivation
- poor self care
- blunted affect
- reduced speech output
- social withdrawal

Duration
>6months
-a rapid deterioration in social function suggest another cause

Shizoaffective and mood disorder exclusiosn
Exclusion of substance abuse/medical cause

Question 6

Discuss features of shizophrenia on MSE

Answer 6

Appearance

• neglected and dischevelled
• mannerisms
• tics
• steriotypes (repeated purposless movememtns)
• restless agitated or psychomotor retardation
• apparent response to auditory hallucinations

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Emotion

• inappropriate affect
• emotional blunting

Perceptions

• hallucinations occur in clear conciousness
• not related to acutal occurrences
• auditory more common than visual

Thought Content

• Loosening of asscoiateds - absence of logical though progression
• may give concrete answers
• though blocking (sudden cessation of though or speech)
• tangential ( getting off the track)
• circumstantial (digressive but able to return to the subject)
• Neologisms

Content

• thought insertion or withdrawal
• delusions (often bizarre, or paranoid)