Psychosis

Question 1

Psychosis definition?

Answer 1

Difficulty perceiving and interpreting reality

Question 2

Positive symptoms?

Answer 2

Hallucinations
Delusions

Question 3

Hallucinations definition?

Answer 3

Perception in absense of stimulus

can occur in auditory, visual, olfactory, gustatory…

Question 4

Passivity experiences? First rank symptoms of delusion

Answer 4

Thoughts are influenced or controlled by an external agent

-Thought broadcasting
-Thought insertion
-Thought withdrawal

Question 5

Negative symptoms of psychosis?

Answer 5

Alogia
Anhedonia/asociality
Avolition/apathy
Affective flattening

Question 6

Alogia?

Answer 6

Poverty of speech
Slow response

Question 7

Anhedonia/asociality?

Answer 7

Withdrawal from friends and hobbies

Question 8

Avolition/apathy?

Answer 8

Poor self control
Lack of drive and motivation

Question 9

Affective flattening?

Answer 9

Unchanging facial expressions, poor eye contact, limited emotional range

Question 10

Disorganisation symptoms of psychosis?

Answer 10

Bizarre behaviour
Formal thought disorder

Question 11

Formal thought disorder? With 5 examples

Answer 11

Lack of logical connection between thoughts

-circumstantial thought
-tangential thought
-flight of ideas
-derailment
-word salad
list in increasing severity

Question 12

Auditory hallucination?

Answer 12

Most common hallucination

-1st (thought echo), 2nd, 3rd person
-running commentary
-command hallucinations

Question 13

Psychosis onset?

Answer 13

Can occur at any age
Peak incidence in adolescence/early 20s
Peak later in women

Question 14

Psychosis course?

Answer 14

Often chronic and episodic

Question 15

Psychosis preceded by?

Answer 15

‘Prodromal’ symptoms (often misdiagnosed as depression)

Question 16

Risk factors for psychosis?

Answer 16

-family history of schizophrenia (polygenic)
-cannabis use
-early life stress

Question 17

Mental state examination points?

Answer 17

-Appearance and Behaviour
-Speech
-Mood and Affect
-Thoughts
-Perceptions
-Cognition
-Insight

Question 18

Appearance and Behaviour in psychosis?

Answer 18

Bizarre or inappropriate clothing
Psychomotor retardation, agitation
Self-neglect or self-harm
Echophenomena - copying what you do
Stupor and mutism (catatonia)

Question 19

Speech MSE?

Answer 19

Rate, rhythm and volume

Question 20

Cognition MSE?

Answer 20

Orientated to time place and person?
Confused?

Question 21

Insight MSE?

Answer 21

Awareness - am I unwell and what do I need?

Question 22

Pseudohallucinations?

Answer 22

Insight typically preserved
Hallucinations distinguishable from true perfection

Question 23

Addenbrooke’s Cognitive Examination? (ACE III)

Answer 23

100 item cognitive assessment that looks at multiple areas of cognition

Question 24

Schizophrenia described as?

Answer 24

Dementia praecox (dementia of the young)
Affects working memory and executive function

Question 25

Neurotransmitter system most implicated in mechanism of antipsychotics?

Answer 25

Dopamine

Question 26

Tactile/somatic hallucinations?

Answer 26

Feeling something

Question 27

Dopamine effect on psychosis?

Answer 27

Increased dopamine activity in mesolimbic dopamine system implicated in causing positive symptoms of psychosis

So want dopamine antagonist

Question 28

Extrapyramidal side effects (EPSE) cause?

Answer 28

Caused by dopamine blockade in nigrostroatal (extrapyramidal) dopamine system (maintaining posture and tone)

Question 29

Extrapyramidal side effects examples?

Answer 29

Parkinsonism
Acute dystonic reactions
Tardive dyskinesia
Akathisia (internal restlessness)

Question 30

Parkinsonism?

Answer 30

-bradykinesia
-postural instability
-rigidity
-slow and shuffling gate (festination, lack of arm swing)
-‘pill-rolling’ tremor

Question 31

EPSE management?

Answer 31

Use low dose, counsel about risk, change medication
anticholinergic medications

Question 32

Atypical vs typical antipsychotics?

Answer 32

Atypical associated with a lower risk of EPSE (due to 5HT-2A antagonism)

Question 33

Other side effects of antipsychotics

Answer 33

CNS
GI (constipation)
Haem- agranulocytosis, neutropenia
Metabolic - increased appetite, diabetes, weight gain
Cardiac - dysarhythmias, long QTc
Pituitary - increased prolactin

Question 34

Long term management?

Answer 34

Community follow-up
Managing effects
Manage comorbidities
Health promotion

Question 35

Antipsychotic (dopamine antagonists) examples?

Answer 35

Risperidone
Aripirazole

Question 36

3 domains of psychosis symptoms?

Answer 36

Positive
Negative
Disorganisation

Question 37

Catatonia?

Answer 37

Stupor and mutism

Question 38

Prodromal symptoms of psychosis?

Answer 38

6–18 months before florid psychotic symptoms emerge
Increasing isolation
Poor self-care
Social withdrawal
Declining academic performance

often precedes psychosis and misdiagnosed as depression

Question 39

Environmental risk factors for psychosis?

Answer 39

Drug use, especially cannabis
Prenatal/birth complications
Maternal infections
Migrant status
Socioeconomic deprivation
Childhood trauma

Question 40

Circumstantial thought disorder?

Answer 40

Longwinded responses but the asked question is eventually answered

Question 41

Tangential thought disorder?

Answer 41

Train of thought goes off on tangents. Tangents are logically connected but the question asked isn’t answered

Question 42

Flight of ideas thought disorder?

Answer 42

Trains of thought loosely connected. May be connected by meaning semantics, sounds, rhyming or puns (clanging/clang associations)

Question 43

Derailment thought disorder?

Answer 43

Train of thought has “gone off track”. Unrelated and unconnected trains of thought

Question 44

Word salad thought disorder?

Answer 44

Complete breakdown of logical connection between thoughts. String of random words; “Brown. Fish. Hello”