Week Ten - Psychosis/Schizophrenia

Question 1

Positive symptoms?

Answer 1

ADDED
Hallucinations 
Delusions 
Bizarre behaviour 
Positive formal thought disorder

Question 2

Negative symptoms?

Answer 2

SUBTRACTED
Disturbances in the logical process of thoughts - speech and behaviour
Alogia
Affective flattening
Avolition-apathy
Anhedonia-asociality
Attentional impairment

Question 3

Disorganisation syndrome?

Answer 3

Includes chaotic speech, thoughts and behaviour

Question 4

5 key features of psychosis?

Answer 4

1. Hallucinations
2. Delusions
3. Disorganised thinking (speech)
4. Grossly disorganised or abnormal behaviour (catatonia)
5. Negative symptoms

Question 5

SCHIZOPHRENIA DSM-5 criteria?

Answer 5

A. Need to have 2 or more of the following - for most of one month - with at least one being one of the top 3
Delusions
Halluncinations
Disorganised speech
Disorganised or atatonic behaviour
Negative symptoms

B. Level of functioning in one or more areas (work, self care) is below the level achieved prior to onset

C. Persists for at least 6 months (including one month of symptoms that meet the first point)

D. Schizoaffective disorder and depressive or bipolar disorder have been ruled out (no depressive or manic episodes have occurred)

E. Not attributable to a substance or another medical condition

Question 6

Delusions?

Answer 6

Strange beliefs that are maintained despite evidence to the contrary

Question 7

Can people with schizophrenia rationalise their delusions?

Answer 7

Some people, particularly high functioning people, can rationalise their delusional beliefs

BUT it may be a constant struggle because while they can rationally see that their belief is not supported by evidence, it just doesn’t ‘feel’ right

Question 8

Hallucinations?

Answer 8

Perception in the absence of sensory stimulation

May be:
Auditory
Visual
Somatic/tactile
Olfactory

Not just like imagining someones voice - like you are hearing actual voices.

Question 9

Disorganization symptoms?

Answer 9

Means disturbances in the logical process of thought - apparent in speech and behaviour

Positive thought disorder
Bizzare behaviour
Inappropriate affect

Question 10

Positive formal thought disorder?

Answer 10

Derailment
Tangentiality (go off on tangents)
Incoherence
Illogicality
Circumstantiality
Pressure of speech
Distractable speech
Clang associations (grouping words together)

Question 11

Bizarre behaviour?

Answer 11

Bizarre clothing and appearance
Bizarre social and sexual behaviour
Aggressive and agitated behaviour
Repetitive or stereotyped behaviour

Question 12

Alogia? (NS)

Answer 12

Poverty of speech

Question 13

Affective blunting? (NS)

Answer 13

unchanged facial expressions, poor eye contact

Question 14

Avolition apathy? (NS)

Answer 14

Poor grooming and hygiene

Question 15

Anhedonia-asociality? (NS)

Answer 15

Decrease in recreational interests and activities, sex interest, intimacy and closeness

Question 16

Factors promoting good prognosis?

Answer 16

Late onset
Obvious precipitating factors
Acute onset
Good premorbid functioning
Married (if male)
Fewer psychotic episodes

Question 17

Factors promoting poor prognosis?

Answer 17

Young onset
No precipitating factors
Insidious onset
Poor premorbid functioning
Withdrawn
single/divorced
negative symptoms
inconsistent use of medication

Question 18

Bio-psycho-social Model of schizophrenia

Answer 18

Genetic (family history - inheritance of certain genes)

Neuro-development (perinatal, obstetric complications)

Environmental/social (childhood trauma, low SES, urban areas, substance use)

Psychological (biases, maladaptive self/schemas)

Question 19

Cognitive Model Schizophrenia?

Answer 19

Distorted information processing
- biases
Jumping to conclusions
- decision making
Bias against disconfirmatory evidence
- difficulty engaging from faulty interpretations
Impaired social cognition
- TOM

Question 20

medications are the?

Answer 20

cornerstone of management

Question 21

First Generation Antipsychotics (FGA)?

Answer 21

oral or depot
none or proven efficacy
80% respond but commonly left with side effects eg muscle problems

Question 22

Second Generation Antipsychotics (SGA)?

Answer 22

ATYPICAL
Blocks D1 not D2 receptor
Positive effects on cognitive symptoms
Weight gain is side effect

Question 23

Third Generation Antipsychotics (TGA)?

Answer 23

Partial against D2 receptors

Minimal weight gain, glucose intolerance

Question 24

Psychs role on schizo?

Answer 24

Provide safe, secure base
Coping mechanisms that reduce stress
CBT

Question 25

CBT of positive symptoms in schizo?

Answer 25

Cognitive therapy of positive symptoms

• belief and cognitive modification for delusions
• focusing of hallucinations
• normalising symptoms

Question 26

CBT of neg symptoms in schizo?

Answer 26

Psychoeducation

Re-engaging with meaningful life goals via activity scheduling

Question 27

Important thing to include in schizo intervention?

Answer 27

Family to reduce expressed emotion