Psychosis

Question 1

Define psychosis

Answer 1

difficulty perceiving and interpreting reality

Question 2

list some Psychotic disorders

Answer 2

schizoaffective disorder, bipolar, schizophrenia, depression with psychotic features, delusional disorder

Question 3

What are the three symptom domains in psychosis?

Answer 3

positive symptoms, negative symptoms, disorganisation

Question 4

what are the positive signs associated with psychosis?

Answer 4

hallucinations and delusions

Question 5

what are the negative signs associated with psychosis?

Answer 5

alogia, apathy, anhedonia, affective flattening

Question 6

what is alogia?

Answer 6

“poverty of speech”

Question 7

what is anhedonia?

Answer 7

reduced ability to experience pleasure

Question 8

what is affective flattening?

Answer 8

lack of emotional response to the given situation

Question 9

what are the disorganisation symptoms associated with psychosis?

Answer 9

bizarre behaviour and thought disorder

Question 10

define thought insertion

Answer 10

belief that thoughts are placed in ones head

Question 11

define thought broadcasting

Answer 11

belief that ones thoughts can be heard by others

Question 12

Define thought withdrawal

Answer 12

belief that others are taking thoughts out of ones head

Question 13

What classes as thought disorder?

Answer 13

derailment, circumstantial speech, pressure speech, distractibility, incoherent/ illogical speech

Question 14

what is meant by the term derailment in the context of psychosis?

Answer 14

A person who experiences derailment uses words and phrases that have a loose association with the original topic in a conversation

Question 15

what is meant by the term circumstantial speech in the context of psychosis?

Answer 15

Circumstantiality is defined as circuitous and non-direct thinking or speech that digresses from the main point of a conversation.

Question 16

what is meant by the term pressured speech in the context of psychosis?

Answer 16

Pressure of speech usually refers to the improperly verbalized speech which is a feature of hypomanic and manic illness.

Question 17

What are hallucinations?

Answer 17

percepts in the absence of a stimulus

Question 18

what are delusions?

Answer 18

fixed, false beliefs out of keeping with social/cultural background

Question 19

what is the risk of suicide in schizophrenia?

Answer 19

28% of excess mortality

Question 20

What are illusions?

Answer 20

misperception of a real external stimulus

Question 21

What is a hypnagogic hallucination?

Answer 21

visual, auditory, or tactile hallucinations at sleep onset

Question 22

what is a hypnopompic hallucination?

Answer 22

visual, auditory or tactile hallucinations at waking

Question 23

What is Charles Bonnet Syndrome?

Answer 23

Triad of visual hallucinations, ocular pathology causing bilateral visual deterioration and preserved cognitive status

Question 24

describe the pattern of hallucinations experienced in Charles Bonnet syndrome

Answer 24

may be elementary or highly organised and complex, persistent or intermittent

Question 25

what are the six key aspects of cognition?

Answer 25

consciousness, orientation, attention and concentration, memory, language functioning, visuospatial functioning

Question 26

What is meant by 'prodromal symptoms of schizophrenia' ?

Answer 26

symptoms that occur between early manifestations of the disease.

Question 27

What prodromal symptoms occur in schizophrenia?

Answer 27

changes in social behaviour, like social withdrawal, and impairments in functioning, often precede onset

Question 28

How heritable is schizophrenia?

Answer 28

Highly heritable, MZ twins show 46% concordance

Question 29

How polygenic is schizophrenia?

Answer 29

High polygenic, lots of genes of small effect sizes

Question 30

What are the environmental risk factors for schizophrenia?

Answer 30

Drug use, especially cannabis. Prenatal/ birth complications, maternal infections, migrant status, socioeconomic deprivation, childhood trauma

Question 31

What is formal thought disorder?

Answer 31

Problem with content and form (what patients say and how)

Question 32

What are the two types of thought disorder?

Answer 32

Content-thought disorder and formal thought disorder

Question 33

What are the cognitive impairments associated with schizophrenia?

Answer 33

Working memory impairments, lower scores in cognitive testing from childhood, poorer educational attainment.

Question 34

What are the pharmacological treatment options for psychosis?

Answer 34

Antipsychotic medications

Question 35

What are the physiological treatment options for psychosis?

Answer 35

CBT for psychosis, avatar therapy

Question 36

What social support is available to support people with psychosis?

Answer 36

Supportive environments, structures and routines, housing and benefits, support with budgeting and employment

Question 37

What neurotransmitter is most implicated in antipsychotic mechanism?

Answer 37

Dopamine, but also act of serotonin, acetylcholine and histamine neurotransmitters

Question 38

Increased activity in which neurotransmitter is implicated in causing reality distortion in psychosis?

Answer 38

Dopamine

Question 39

What affect can antipsychotics have on the extrapyramidal system? What side effects does this cause?

Answer 39

Can cause post-synaptic dopamine blockade in the extrapyramidal system resulting in side effects such as Parkinsonism, acute dystonia, tardive dyskinesia, akathasia

Question 40

What are the symptoms associated with Parkinsonism?

Answer 40

Rigidity, slow and shuffling gait, lack of arm swing in gait, pill-rolling tremor

Question 41

What are the symptoms of dystonia?

Answer 41

Increased motor tone (sustained abnormal posture)

Question 42

What medication can cause dystonia?

Answer 42

Can occur shortly after taking dopamine antagonist

Question 43

When can dystonia be fatal?

Answer 43

Laryngeal dystonia e.g. spasmodic torticollis

Question 44

What is tardive dyskinesia?

Answer 44

Repeated oral/ facial/ buccal/ lingual movements, initially subtle but can progress

Question 45

What can cause an increased risk of tardive dyskinesia?

Answer 45

Long-term antipsychotics, being female

Question 46

What is akathisia?

Answer 46

Inner restlessness causing a compelling feeling to move but does little to alleviate

Question 47

What is the first line treatment for psychosis?

Answer 47

Avoid typical antipsychotics at first, anticholinergic medications can help