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Psychosis Flashcards

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1
Q

What defines delusions?

A

Delusions are fixed, false beliefs not aligned with cultural norms and not questioned by the patient.

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2
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3
Q

What defense mechanisms are associated with the development of delusions according to Freudian theory, and how do they operate?

A

A:
✔️ Psychotic projection 🔁: Attributing internal impulses to external sources (e.g., feeling watched by others).
✔️ Denial 🚫: Distorting reality (not just memory) to avoid unpleasant facts.
✔️ Reaction formation 🔄: Expressing the opposite of uncomfortable impulses (e.g., homophobia masking same-sex attraction).

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4
Q

What are the diagnostic criteria of delusional disorder?

A

A:
✔️ Presence of one or more delusions lasting ≥1 month
✔️ Delusions are non-bizarre (plausible but false)
✔️ Not better explained by another psychiatric disorder ❌🧠
✔️ Functioning is not markedly impaired outside of the delusion 🧍‍♂️

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5
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6
Q

Are the delusions in delusional disorder typically bizarre or nonbizarre? What does this mean?

A

✔️ Delusions are usually nonbizarre
✔️ They involve situations that can happen in real life (e.g., being followed, infected, loved at a distance)
✔️ These are possible but false beliefs

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7
Q

A patient has been experiencing persecutory delusions at work for over 1 month without other psychotic symptoms or organic cause. What is the most likely diagnosis and why?

A

✔️ Delusional Disorder

❗ Isolated persecutory delusions
⏱️ Duration: >1 month (9 months)
❌ No hallucinations, disorganized thought/speech, or negative symptoms
⚠️ Organic causes (e.g., substance use) ruled out

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8
Q

How is delusional disorder different from schizophrenia?

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9
Q

How does Delusional Disorder differ from Somatic Symptom Disorder?

A

A:
✔️ Delusional Disorder: fixed false belief about a condition (e.g., parasites)
✔️ Somatic Symptom Disorder: excessive focus on real or exaggerated symptoms, not a fixed false belief 🧠📈

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10
Q

How is cognition affected in delusional disorder?

A

Cognition is generally normal except for the delusion

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11
Q

What is the typical functioning level in patients with delusional disorder outside of the delusion itself?

A

A:
✔️ Patients are generally high-functioning and socially appropriate
✔️ Only area of dysfunction is related to the specific delusion 🎯🧍‍♂️

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12
Q

Which common features or options are NOT typically seen in delusional disorder?

A

✔️ Marked functional impairment (not present)
✔️ Prominent hallucinations (not present)
✔️ Gross personality disintegration (not present)

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13
Q

How does a somatic delusion differ from a tactile hallucination and somatic symptom disorder (SSD)?

A

:
✔️ Somatic delusion = False belief about the body
✔️ Tactile hallucination = False perception of touch
SSD eWorry over real physical symptoms (e.g., pain, fatigue)
✔️ Excessive anxiety and health preoccupation
✔️ Time/energy spent on health concerns
✔️ Not a fixed false belief, not hallucination

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14
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15
Q

How do grandiose delusions differ from paranoid and somatic delusions?

A

Grandiose delusions: Exaggerated sense of self-importance or special identity.
✔️ Paranoid delusions: Suspicious or persecutory beliefs (e.g., being watched or targeted). 🔍
✔️ Somatic delusions: False beliefs related to bodily functions or sensations. 🧍‍♂️

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16
Q

How does Folie Simultanée differ from Folie à Deux?

A

Folie Simultanée = “Simultaneous Madness”

✔️ Two (or more) people develop psychosis independently
✔️ They share the same delusion
✔️ Psychosis starts at the same time
✔️ No one “transfers” the delusion — all are primary cases
🧠 Mnemonic: “SIM = Simultaneously Insane Minds”
Folie à Deux = “Madness of Two”

✔️ One person is already psychotic (primary case)
✔️ The other adopts the delusion (secondary case)
✔️ Psychosis is induced by close relationship or influence
✔️ The secondary person is not originally psychotic

🧠 Mnemonic: “À Deux = A Delusion Delivered”
✅ Key Difference:

Folie Simultanée = Independent onset of shared delusion
Folie à Deux = Transferred delusion from one psychotic person to another

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17
Q

What is folie-à-deux and what characterizes this condition?

A

✔️ A shared “ contagious “ psychosis where two people share them
✔️ Usually occurs in people with close, long-standing relationships, mostly family members.

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18
Q

Q: What type of relationship do patients with folie-à-deux usually have?

A

A:
✔️ Close, long-standing relationships (often family)
✔️ Most common pairs: sister-sister, husband-wife, mother-child
✔️ Often live together and have minimal connection with others

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19
Q

Who is the primary patient (active) in folie-à-deux and what are their characteristics?

A

A:
✔️ The first to develop delusions
✔️ Usually chronically ill with a psychotic disorder
✔️ Influences the secondary patient

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20
Q

What are the typical characteristics of the secondary (passive) patient in folie-à-deux?

A

✔️ Easily impressionable and adopts the primary patient’s delusions
✔️ Often less intelligent, gullible, passive, and low self-esteem
✔️ Does not suffer from an independent psychotic disorder

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21
Q

What is the initial and main treatment approach for folie-à-deux?

A

✔️ Separation of the two patients
✔️ Separation often leads to recovery of the secondary patient without further treatment
✔️ The primary patient usually requires additional psychiatric treatment

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22
Q

What are some risk factors for developing folie-à-deux?

A

A:
✔️ Older age
✔️ Low intelligence
✔️ Sensory impairment
✔️ Cerebrovascular disease (not cardiovascular)
✔️ Alcohol abuse (not drug abuse)

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23
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24
Q

Which formal thought disorder is considered a negative symptom in schizophrenia?

A

Thought blocking – sudden interruption in the flow of thoughts ⛔🧠

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25
What are the diagnostic criteria for schizophrenia regarding symptom number, duration, and exclusion of other causes?
✔️ At least 2 of 5 symptoms, with one from the first 3:  * Delusions  * Hallucinations  * Disorganized speech  * Disorganized behavior or catatonia   Negative symptoms (affective flattening, alogia, av********olition, anhedonia, attention deficits) ✔️ Duration: At least 6 months ✔️ Other causes (e.g., substance use) must be excluded
26
27
Which of the following is not considered a formal thought disorder?
Obsessive thinking is not classified as a formal thought disorder ❌🧠
28
What is the minimum total duration of illness required to diagnose schizophrenia per DSM-5?
A: ✔️ ≥6 months total, including:  – ≥1 month of active-phase symptoms (Criterion A)  – Possible prodromal or residual symptoms during the remaining time
29
What are the five historical subtypes of schizophrenia no longer used in DSM-5?
A: ✔️ Paranoid ✔️ Disorganized ✔️ Catatonic ✔️ Undifferentiated ✔️ Residual
30
What are the negative symptoms of schizophrenia?
A: ✔️ Affective flattening (blunting) 😐 ✔️ Alogia – poverty of speech 🗣️ ✔️ Avolition – apathy, lack of motivation 🛋️ ✔️ Anhedonia – asociality, loss of interest in pleasurable activities 🎭 ✔️ Curbing of interests, diminished purpose & social drive ❌🎯 ✔️ Abulia – diminished initiative and decisiveness 🙇‍♂️
31
What are the possible causes of flat or blunted affect in a patient with schizophrenia, and why can differentiation be clinically challenging? A:
A: ✔️ Schizophrenia itself 🧠: Core negative symptom ✔️ Drug-induced parkinsonism 💊: Side effect of antipsychotics (parkinsonian features can mimic affective flattening) ✔️ Depression 😞: May also reduce emotional expressiveness ⚠️ Differentiating between these causes can be difficult due to overlapping features.
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33
What are the clinical features of affective flattening or blunting in schizophrenia
A: ✔️ Unchanging facial expressions ✔️ Decreased spontaneous movements ✔️ Poor eye contact ✔️ Affective non-responsivity ✔️ Inappropriate affect ✔️ Lack of vocal inflections
34
What features are included under avolition-apathy?
A: ✔️ Poor grooming and hygiene ✔️ Impersistence at work or school ✔️ Physical anergia (low energy)
35
What are the positive prognostic factors in schizophrenia?
✔️ Acute onset ✔️ Female sex ✔️ Living in a developed country
36
What are the poor prognostic factors for schizophrenia?
✔️ Insidious onset ✔️ Childhood or adolescent onset ✔️ Poor premorbid functioning ✔️ Cognitive impairment
37
Which type of hallucinations are more common in drug abuse, particularly cocaine?
Tactile (touch) hallucinations
38
Which type of hallucinations are more common in schezophrenia?
Auditory hallucinations
39
: Can schizophrenia be diagnosed based solely on a mental status exam or a single symptom? Why or why not?
A: ✔️ No, schizophrenia cannot be diagnosed from a single mental status exam
40
Is there any clinical sign or symptom that is pathognomonic for schizophrenia?
❌ No symptom is pathognomonic ✔️ All signs/symptoms can be seen in other psychiatric or neurologic disorders
41
How do hallucinations typically present in schizophrenia?
Hallucinations may be intermittent
42
Is schizophrenia more common in men or women? and the onset ?
Equally prevalent in both genders Men typically have earlier onset than women
43
How does schizophrenia progress over time regarding positive and negative symptoms? 🔄
A: ✔️ Positive symptoms (e.g., delusions, hallucinations) tend to improve over time ✔️ Negative/deficit symptoms (e.g., apathy, social withdrawal) may increased
44
What defines Brief Psychotic Disorder in terms of duration and onset?
A: ✔️ Sudden onset of psychotic symptoms ✔️ Duration: ≥ 1 day but < 1 month ⏱️ ✔️ Full remission with return to premorbid level of functioning 🔁
45
What is the typical course and prognosis of Brief Psychotic Disorder?
Approximately 50% of patients go on to develop chronic or major psychiatric disorders
46
Is it possible to diagnose schizophrenia without hallucinations or delusions?
✔️ Yes — as long as the patient has 2 or more psychotic symptoms (e.g., disorganized speech, behavior, or negative symptoms), lasting ≥6 months with functional decline.
47
❓Is lack of motivation required for the diagnosis of schizophrenia?
❌ No — it is a negative symptom (avolition), but not essential for diagnosis.
48
When does cognitive impairment typically present in patients with schizophrenia?
Cognitive deficits in ✔️ Attention ✔️ Executive function ✔️ Working memory ✔️ Episodic memory are present from the first episode of schizophrenia.
49
Is orientation to person, place, and time and short term memory typically impaired during the acute phase of schizophrenia?
No
50
What is the role of functional impairment in diagnosing schizophrenia?
A: ✔️ It is a core requirement for the diagnosis ✔️ Without functional decline, the diagnosis of schizophrenia cannot be made
51
What is the leading cause of premature death in patients with schizophrenia?
Suicide
52
What is the most important risk factor for suicide in schizophrenia, and how prevalent is it?
A: ✔️ The most crucial risk factor is the presence of a major depressive episode (MDD). ✔️ Up to 80% of schizophrenia patients experience MDD during their lifetime.
53
What is the clinical profile and contributing factors associated with increased suicide risk in schizophrenia?
A: ✔️ High-risk profile: 👦 Young man 🎯 Previously had high expectations 📉 Declined from higher functioning 😞 Realizes goals are unachievable ❌ Lost faith in treatment ✔️ Young man ✔️ Previously high-functioning, now declined 📉 ✔️ Aware of their loss of potential/dreams ✔️ Feels treatment is ineffective ✔️ Contributing factors: 🔊 Command hallucinations 🍷 Drug abuse
54
What is the lifetime prevalence of suicidality among patients with schizophrenia?
About 34.5% of patients with schizophrenia experience suicidality.
55
What percentage of schizophrenia patients attempt suicide and what percent die by suicide?
Between 10% and 13% of patients die by suicide ⚠️ ✔️ 20–50% make suicide attempts 💉 ✔️ 34.5% have lifetime suicidality 💭
56
When during the course of illness does suicide most often occur in schizophrenia?
A: ✔️ Typically in the first few years after onset ✔️ Onset is usually in adolescence or early adulthood 🧠📉
57
Why is suicide in schizophrenia often difficult to predict?
A: ✔️ Tendency is often unpredictable ✔️ May occur without prior verbal warning
58
What is the most crucial risk factor for suicide in schizophrenia?
A: ✔️ Presence of a major depressive episode ✔️ Affects up to 80% of patients at some point
59
Is suicide in schizophrenia most frequently caused by command hallucinations?
❌ No – the most crucial factor is a major depressive episode, not command hallucinations
60
Q: How does antipsychotic treatment affect the relapse rate in schizophrenia within one year?
✔️ Patients on antipsychotic treatment have a 16-23% relapse rate within one year. ✔️ Patients off treatment have a significantly higher relapse rate of 53-72% within one year.
61
Which chronic physical illnesses are more common in patients with schizophrenia compared to the general population?
✔️ HIV infection ✔️ Chronic Obstructive Pulmonary Disease (COPD) ✔️ Obesity
62
Is suicide more frequent among hospitalized schizophrenic patients?
❌ No – hospitalized patients are usually lower-functioning and older, and are not the highest-risk group ➤ Suicide is often unexpected, even after outpatient contact
63
Q: Why is this patient diagnosed with schizophrenia rather than schizoaffective or delusional disorder?
A: ✔️ Meets Criteria for schizophrenia (e.g., delusions, hallucinations) ✔️ No concurrent major mood episode → rules out schizoaffective disorder ✔️ Functional impairment + broad symptom profile → rules out delusional disorder
64
What pharmacologic strategy may help with co-occurring major depression in schizophrenia?
Use of adjunctive antidepressants may improve depressive symptoms
65
Which antipsychotic medication is particularly effective in reducing suicidality in schizophrenia?
Clozapine
66
What are the diagnostic criteria for catatonia and how many symptoms are required for diagnosis?
Catatonia is diagnosed when 3 or more of the following symptoms are present: 🧍 Catalepsy 🕯️ Waxy flexibility 😶 Stupor 😡 Agitation 🤐 Mutism 🚫 Negativism 🧘 Posturing 🤹 Mannerism 🔁 Stereotypies 😬 Grimacing 🗣️ Echolalia 🤸 Echopraxia
67
What are the essential components of treating catatonia, and why is each important?
✔️ Close surveillance 👀:     ⚠️ To monitor for life-threatening complications such as dehydration, malnutrition, or pulmonary embolism. ✔️ Electroconvulsive therapy (ECT) ⚡:     🧠 Most effective treatment for resolving catatonic symptoms, especially when unresponsive to benzodiazepines.
68
What test and treatment modification are indicated when olfactory hallucinations suggest an organic cause (e.g., temporal lobe epilepsy) instead of schizophrenia?
A: ✔️ EEG may reveal abnormal waveforms, suggesting temporal lobe epilepsy (TLE). ✔️ Olfactory hallucinations are more characteristic of TLE than primary schizophrenia. ✔️ If confirmed, replace antipsychotics with anticonvulsants (e.g., phenytoin), which can resolve the hallucinations. | A:
69
What consistent structural brain changes are observed on CT scans of patients with schizophrenia?
A: ✔️ Lateral ventricular enlargement 🧠⬆️ ✔️ Third ventricular enlargement 🧠⬆️ ✔️ Reduction in cortical volume 🧠⬇️
70
During which stage of schizophrenia are reductions in cortical gray matter volume typically observed?
A: ✔️ Earliest stages of the disease ✔️ Suggests that brain changes may precede or coincide with symptom onset
71
What is the required duration of symptoms for a diagnosis of schizophreniform disorder?
Symptoms must last ≥1 month but < 6 months
72
What makes schizophreniform disorder different from schizophrenia?
A: ✔️ Shorter duration (1–6 months) ✔️ Functional impairment is not required ✔️ Otherwise, symptom profile is identical
73
Is functional impairment required to diagnose schizophreniform disorder?
❌ No – functional impairment is not required ✔️ This differentiates it from schizophrenia, which does require functional decline
74
Q: What is postpartum psychosis, and when does it typically occur?
✔️ Postpartum psychosis is a psychotic disorder occurring in women shortly after childbirth. 🧠👶 ✔️ Symptoms typically begin within 2–3 weeks and almost always within 8 weeks of delivery. ⏳
75
What are the typical prodromal symptoms preceding florid psychotic features in postpartum psychosis
A: ✔️ Prodromal signs include: Insomnia 😵‍💫 Restlessness 😬 Agitation 😠 Mood lability 😢😄 Mild cognitive deficits 🧩
76
Q: What is the underlying psychiatric nature of postpartum psychosis according to robust data?
A: ✔️ It is essentially an episode of a mood disorder: Most commonly bipolar disorder Less commonly major depressive disorder 🌪️🌓
77
What are two common clinical associations found in women with postpartum psychosis?
A: ✔️ 50–60% are first-time mothers 👩‍🍼 ✔️ ~50% have deliveries involving nonpsychiatric perinatal complications 🚑
78
What is the prognosis and progression of schizophreniform disorder, and what happens if symptoms persist? A:
A: ✔️ 60–80% progress to schizophrenia ✔️ If symptoms persist beyond 6 months → diagnosis changes to: Schizophrenia or Schizoaffective disorder (if mood symptoms dominate) ✔️ Some patients fully recover within the 6-month window 🩺
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Psychiatry Qbank (4 decks)

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