5: Psychosis: Schizophrenia, schizoaffective disorders and differentials

Question 1

What is psychosis?

Answer 1

Impaired relationship with reality

Question 2

What are four features of psychosis?

Answer 2

Delusions

Hallucinations

Disordered thinking

Passivity

Question 3

Is psychosis a disease?

Answer 3

No

Symptom

Question 4

In psychosis, our thoughts (match / differ from) reality.

Answer 4

thoughts do not match reality

Question 5

What is a delusion?

Answer 5

Irrational, deeply held belief about yourself or others

Question 6

What are some examples of delusions?

Answer 6

Thought insertion - your thoughts are not your own, they’re someone else’s

Thought withdrawal - someone else is removing thoughts from your mind

Thought control - someone is controlling your thoughts

Thought broadcasting - other people can tell what you’re thinking

Delusions of grandeur - you’re someone famous, Jesus etc…

Question 7

What is a delusion of reference?

Answer 7

Irrational idea that a person, object or idea is more personally significant than it actually is

Question 8

Do patients with psychosis know that they are ill?

What is this sign called?

Answer 8

No

Lack of insight

Question 9

What is thought disorder?

Answer 9

A feature of psychosis which include:

difficulty ordering thoughts, words or phrases

poverty of speech i.e not being able to muster anything to say

irrelevancies, tangents

illogical ideas

repetition of particular words or phrases

Question 10

What is a hallucination?

Answer 10

Perception which occurs in the absence of an external stimulus

Question 11

What are some forms that hallucinations can take?

Answer 11

Visual

Auditory

Olfactory

Gustatory (taste)

Tactile (touch)

Question 12

Delusions that your thoughts, actions or perceptions are being controlled by someone else are also known as delusions of ___.

Answer 12

passivity

Question 13

What type of delusion involves attachment of personal significance to events by a patient?

Answer 13

Ideas of reference

Question 14

Patients may have ___ beliefs about hallucinations they have experienced.

Answer 14

delusional beliefs

e.g “my visions are being transmitted to me by the Mafia” - thought insertion delusion ABOUT a hallucination the patient has experienced

Question 15

The content of delusions is often related to the ___ beliefs of the patient.

Answer 15

cultural beliefs

religious, popular culture, current events etc.

Question 16

What is a neologism?

What symptom of psychosis is it an example of?

Answer 16

Newly invented word or phrase

Thought disorder

Question 17

What is tangentiality?

Answer 17

Tendency to go off on unrelated strings of thought instead of holding to the same subject

Question 18

What is Knight’s move thinking?

Answer 18

Tendency to jump from one subject to an unrelated one

compared to a knight jumping around a chessboard

Question 19

What is word salad?

Answer 19

Strings of seemingly unrelated words or phrases

Question 20

Give some examples of thought disorder.

Answer 20

Neologisms - new words or phrases

Word salad

Tangentiality

Knight’s move thinking

Clanging and punning - relating words by sound rather than meaning

Question 21

Delusions that another party is controlling your thoughts, behaviour or perceptions are known as ___ delusions.

Answer 21

passivity delusions

Question 22

To confirm that a patient’s beliefs are psychotic, you need to challenge them with logic and reason.

What can you lose by doing this?

Answer 22

Patient relationship, rapport

so you need to be careful

Question 23

Apart from schizophrenia, what other conditions may cause psychotic symptoms?

Answer 23

Acute: delirium, dementia, stroke

Substance use: intoxication, withdrawal, delirium tremens

Mood disorders: dementia, bipolar, schizoaffective disorder

Question 24

Auditory delusions of schizophrenia often refer to the patient from which point of view?

Answer 24

Third person

(He/she/they are x, y, z)

It’s like you’re being talked about by other people

Question 25

**Auditory delusions** of depressive disorders often refer to the patient from which point of view?

Answer 25

**2nd person** (You) Self-criticism

Question 26

Patients with **acute psychotic symptoms** caused by an underlying substance abuse problem, delirium or head injury will not have schizophrenia or schizoaffective disorder. True or false?

Answer 26

**False** May be underlying

Question 27

**Name** **two examples of schizoaffective disorders.**

Answer 27

**Depressive psychosis** **Mania with psychosis**

Question 28

What types of **delusions** and **hallucinations** do patients with **depressive psychosis** experience?

Answer 28

**Delusions of guilt, worthlessness, poverty** - downer delusions **2nd person auditory delusions** - hearing putdowns, criticisms etc.

Question 29

What type of a) **delusions** b) **hallucinations** c) **thought disorders** do patients with **manic psychosis** experience?

Answer 29

**a) Delusions of grandeur, reference, superhuman powers** **b) 3rd person auditory delusions** e.g God's voice **c) Flight of ideas** - tangentiality, clanging and punning, neologisms

Question 30

What **acute psychiatric disorder**, common in the elderly, can present as **psychosis**?

Answer 30

**Delirium**

Question 31

Which **psychiatric manual** is used to diagnose **schizophrenia** and related disorders?

Answer 31

**ICD-10**

Question 32

What are **Schneider's First Rank** symptoms?

Answer 32

**Symptoms used to diagnose schizophrenia** i.e delusions, hallucinations, thought disorder and passivity

Question 33

Based on ICD-10, how **long** must a patient be experiencing symptoms for before they can be diagnosed with **schizophrenia**?

Answer 33

**1 month**

Question 34

What are three important **subtypes** of **schizophrenia?**

Answer 34

**Paranoid schizophrenia** - characterised by paranoid delusions of persecution, threat etc. **Hebephrenic** or **disorganised** - seen more in ***young patients***, characterised by disordered thoughts **Catatonic** - characterised by anhedonia, anergia, slowed movements

Question 35

**Schizophrenia** is often described in terms of **positive and negative symptoms.** What is included under each heading?

Answer 35

**Positive** - the addition of something e.g delusions, hallucinations, disordered thinking, passivity **Negative** - loss of something e.g amotivation, anergia, mutism, flattened affect

Question 36

**Schizophrenia** has a ___ period, with minor cognitive and behavioural symptoms.

Answer 36

**prodromal period** weeks - months before onset

Question 37

What is a person's **lifetime risk** of developing **schizophrenia**?

Answer 37

**1%**

Question 38

**Schizophrenia** is more common in **(men / women)**.

Answer 38

**men**

Question 39

At what age range does **schizophrenia** present in a) **men** b) **women**?

Answer 39

**a) 15 - 25** **b) 25 - 35** remember than it's more common in males AND they present earlier

Question 40

How do we know that **schizophrenia** has a **genetic** component?

Answer 40

**Concordance in twin studies**

Question 41

What **maternal** factors seem to have an effect on the child's risk of developing **schizophrenia**?

Answer 41

**Viral infection** **Complicated birth** **Fx of psychiatric illness**

Question 42

The use of **which drug** increases your risk of developing **schizophrenia**?

Answer 42

**Cannabis**

Question 43

**Cannabis** is a ___ drug which seems to increase your risk of developing schizophrenia. In which groups especially?

Answer 43

**hallucinogenic drug** **adolescents** - developing brains

Question 44

Living **where** increases your chances of developing **schizophrenia**?

Answer 44

**Urban areas** e.g large cities

Question 45

What is the **course** of **schizophrenia**?

Answer 45

May be **relapsing and remitting** or **progressively deteriorating**, depends

Question 46

What is the **suicide risk** in patients with **schizophrenia**?

Answer 46

**10 - 15%**

Question 47

How common is **homicide** by the hands of patients with **schizophrenia**?

Answer 47

**Relatively uncommon**