Psychosis

Question 1

Positive symptoms

Answer 1

• Delusions or hallucinations ± insight
• Disorganised or abnormal motor behaviours (including catatonia
• Formal thought disorder

Question 2

Negative symptoms

Answer 2

• Diminished emotional expression (affective flattening)
• Anhedonia = loss of enjoyment or pleasure
• Avolition = decrease in initiation and motivation
• Alogia = poverty of speech
• Asociality = lack of motivation to engage in social interactions

Question 3

Psychosis Ix

Answer 3

• FBC
• Electrolytes
• Cr
• Glucose
• Urinalysis
• Drug screen
• TSH
• B12
• Baseline: LFT, lipids, HbA1c and ECG

Question 4

Acute Mangement

Answer 4

• Ensure safety: self, patient and others
• Decrease stimulation
• IM medications: benzodiazepine and antipsychotic
• Physical restraints can be needed
• Avoid: antidepressants or stimulants

Question 5

Delusions of reference

Answer 5

random events given particular importance to the person

Question 6

Grandiose

Answer 6

overestimation of one’s abilities

Question 7

Erotomaniac

Answer 7

belief that another person is in love with the individual

Question 8

Nihilistic

Answer 8

conviction that all is loss and everything is hopeless

Question 9

Guilt

Answer 9

ungrounded feeling of remorse or extreme guilt

Question 10

Sin

Answer 10

fixed false belief that failed or defiled religious commandments

Question 11

Somatic

Answer 11

belief that body function or appearance is grossly abnormal

Question 12

Poverty/impoverishment

Answer 12

belief that financial savings are lost

Question 13

Theft

Answer 13

belief that belongings have been stolen

Question 14

DSM-5 Schizophrenia

Answer 14

a. Two or more of the following
i. Delusions
ii. Hallucinations
iii. Disorganized speech
iv. Grossly disorganised or catatonic behaviour
v. Negative symptoms

b. Level of functioning in >one major area (eg work, relationships, self-care) is markedly below previous level

c. Continuous signs of disturbance for at least 6/12

Not better explained by another diagnosis

Question 15

Epidemiology fo schizophrenia

Answer 15

• Prevalence: 0.3-0.7, M:F = 1:1. Higher risk in Māori.
• Onset: females = late 20s, second peak in midlife, males = early to mid 20s
• Suicide risk: 5-6% die, 20% attempt

Question 16

Aetiology of schizoprenia

Answer 16

• Multifactorial
• Genetics
• Neurochemisty/neurodevelopment
• Epigenetic/enviroment

Question 17

Dopamine hypothesis

Answer 17

o Excessive activity in Mesolimbic = positive symptoms
o Decreased dopamine in mesocortical, PFC, NAc and reward circuits = negative sx

o GABA, glutamate and Ach dysfunction also involved

Question 18

Biological management of schizophrenia

Answer 18

• Antipsychotic
• Adjuct: mood stabilisers, ECT

Question 19

Psychological management of schizophrenia

Answer 19

• Psychotherapy
• Psycho-education
• Relapse prevention
• Assertive community treatment
• Social skill training, employment programs, disability benefits
• Housing: group homes, boarding home, transitional housing

Question 20

Social management of schizophrenia

Answer 20

• Focus on recovery: occupational rehab and supported employment
• Reduce environmental stressors: housing and finances
• Advocacy against stigma and discrimination
• Cultural and spiritual connection

Question 21

Schizophreniform disorder

Answer 21

a. Two or more of the following, each present for a significant portion of time during 1 month period
i. Delusions
ii. Hallucinations
iii. Disorganized speech
iv. Grossly disorganised or catatonic behaviour
v. Negative symptoms

If symptoms last >6/12 becomes schizophrenia

Question 22

Schizophreniform disorder Tx

Answer 22

Similar to acute schizophrenia

Question 23

Schizophreniform disorder prognosis

Answer 23

better than schizophrenia. 1/3 recover <6/12, 2/3  schizophrenia

Question 24

Brief Psychotic Disorder

Answer 24

• an episode lasts for ≥1 day and <1/12 with full return to premorbid level of functioning
• Specifiers: with/without marked stressors, with postpartum onset, with catatonia etc
• Can occur after a stressful event or postpartum

Question 25

Brief psychotic disorder Tx and prognosis

Answer 25

Treatment: secure/safe environment, antipsychotics, and anxiolytics Prognosis: good, self-limiting, should return to pre-morbid function within 1/12

Question 26

Schizoaffective disorder

Answer 26

a. an uninterrupted period of illness during which there is a major mood episode concurrent with Criterion A of schizophrenia b. Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode during the lifetime duration of the illness c. symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the active and residual periods of the illness d. The disturbance is not attributable to the effects of a substance or another medical condition

Question 27

Schizoaffective disorder tx and prognosis

Answer 27

Treatment: antipsychotics, mood stabilizers, and antidepressants Prognosis: between that of schizophrenia and of mood disorder

Question 28

Delusional disorder

Answer 28

a. the presence of one (or more) delusions with a duration of 1 mo or longer b. criterion A for schizophrenia has never been met (hallucinations, if present, are not prominent and are related to the delusional theme) c. Functioning is not impaired, behaviour not bizzar (unless impact of delusion) d. Manic or depressive episodes have been brief in comparison to delusional periods e. Not attributable to substances, medical condition or other mental disorder Treatment: antipsychotics, psychotherapy, and antidepressants Prognosis: may respond to AP, most patients refuse --> chronic course; some high functioning vs --> schizophrenia