Psychosis

Question 1

Illusion

Answer 1

Perception triggered by external stimulus (misinterpreted)

E.g. mistaking shadow for person

Question 2

Delusion

Answer 2

False, fixed belief contrary to evidence and rational argument. Cannot be explained by cultural, religious, or educational background

Question 3

Biological causes schizophrenia

Answer 3

Genetics–multiple susceptibility genes
Birth: maternal malnutrition, PET, emergency CS
Substance misuse, esp cannabis, amphetamines, cocaine, LSD
Neurodevel: enlarged ventricles, smaller/lighter brains, no gliosis. Low pre-morbid IQ, poor learning/memory/executive function
NTs: Excess Da in mesolimbic (positive sxs), reduced Da in mesocortical tracts (negative sxs)

Question 4

Psychosocial causes/risk factors schizophrenia

Answer 4

Schizoid personality, schizotypal disorder
Adverse life events
Cognitive behaviors e.g. tendency to jump to conclusions
Fear of madness drives denial and rationalization, and a delusional system to explain persecutory voices
Low socio-economic status
Migrants
Black Afro-Caribbean
High expressed emotion, with highly critical or over-involved relativees

Question 5

Schneider’s first rank symptoms

Answer 5

Thought echo, insertion, withdrawal, broadcasting
Delusions of control, passivity
Delusional perception
3rd person auditory hallucinations
Persistent delusions of other kinds that are culturally inappropriate

Question 6

Dx-schizophrenia

Answer 6

At least one of Schneider’s first rank sxs or two of following (lasting at least 1/12):

• Fleeting/half-formed delusions without clear affective content, persistent over-valued ideas
• Incoherent speech/thought
• Catatonic behavior
• Negative sxs
• Signif and consistent change in overall quality of aspect behavior or interest

Question 7

Schizophrenia prodrome

Answer 7

Low grade sxs e.g. social withdrawal, loss of interest.

No frank psychosis

Question 8

Chronic schizophrenia

Answer 8

Mostly negative sxs

Question 9

Negative sxs

Answer 9

Apathy
Blunted affect
Anhedonia
Social withdrawal
Poverty of speech/thought
Self-neglect
Catatonia

Question 10

Difference between affective disorder with psychotic symptoms and schizoaffective disorder

Answer 10

Schizoaffective=50/50

Affective with psychotic features–e.g. hx depression getting worse and eventually developing psychotic sxs

Question 11

Schizotypal personality disorder

Answer 11

Odd, eccentric

No delusions

Question 12

Delusional disorder

Answer 12

At least one non-bizarre delusion without thought disorder, prominent hallucinations, mood disorder, flattening of affect

Question 13

Hypnagogic hallucinations

Answer 13

When going to sleep

Normal

Question 14

Hypnapompic hallucinations

Answer 14

When waking up

Often normal

Question 15

Ix-schizophrenia

Answer 15

Bloods: U&Es, LFT, Ca, FBC, gluc, VDRL, TFT, PTH, cortisol, tumor markers
Imaging: CT or MRI, CXR as indicated by hx
Urine: drugs, MCS
Others: EEG, 24 hr urinary cortisol, 24hr catecholamines/5-HIAA if suspected pheo, OT assess ADLs, social worker assessment

Question 16

Biological Tx-schizophrenia

Answer 16

1. atypical antipsychotic or long acting benzo to control non-acute anxiety/behavioral disturbance
2. typical antipsych, titrating upwards

Atypicals used to be first line but now a joint decision between doc and pt considering sxs and SEs

Question 17

Atypical anti-psychotics (2nd generation)

Answer 17

Work better on negative sxs than typicals (but positive still more so than negative)
Fewer EPS side effects, more anti-cholinergic SEs than typicals

Olanzapine (SE weight gain)
Risperidone
Quetiapine
Ziprasidone (prolongs QT)
Clozapine (extremely effective esp with negative sxs but can cause agranulocytosis so requires regular monitoring and is only indicated if at least two other antipsychs have failed)

Question 18

Psychological treatment-schizophrenia

Answer 18

Family treatment to reduce expressed emotion, psychoeducation
CBT: less evidence, focus is reality testing. Gently challenge thinking and aid awareness of illogical thinking
Concordance therapy

Question 19

Social treatment schizophrenia

Answer 19

Rehabilitate, including trial at rehab facility
Appropriate housing
Community psych nurse input. Consider OT, PT
Refer to helpful organizations
Carer support

Question 20

Extrapyramidal side effects

Answer 20

Acute dystonia–acute sustained painful muscle spasm
Akathisia–restlessness lower limbs
Parkinsonism
Tardive dyskinesia. Irreversible.

Question 21

Neuroleptic malignant syndrome

Answer 21

Muscle stiffness and rigidity, altered consciousness, autonomic disturbance (fever, tachy, labile BP)
Raised CK and WCC. May get ARF

Question 22

Schizophreniform disorder

Answer 22

Schizophrenia

Question 23

Otehello syndrome

Answer 23

Obsession that spouse/partner is unfaithful

Part of delusional disorder

Question 24

Hallucination

Answer 24

Perception without external stimulus

Question 25

Affect illusion

Answer 25

Perception altered depending on mood state. E.g. frightened kid on Halloween thinks tree branches are attacker

Question 26

Completion illusion

Answer 26

Lack of attention paid | E.g. reading a book when tired and misinterpret

Question 27

Pareidolic illusion

Answer 27

See shapes in other objects | E.g. animals in clouds

Question 28

Functional hallucination

Answer 28

Hallucination in same modality. | E.g. hears voices only when listening to classical music

Question 29

Neologism

Answer 29

New words created by pt

Question 30

Echolalia

Answer 30

Repeats words/phrases back, sometimes continuously or incessantly. Often organic cause

Question 31

Catalepsy

Answer 31

Rigid limbs May have wavy flexibility (can move arms into different positions and they'll stay like that)

Question 32

Cataplexy

Answer 32

Sudden, transient loss of muscle tone

Question 33

Clanging

Answer 33

Words based on sound/rhyming | E.g. "A cat pat on my hat sack, ate the bait and skated"

Question 34

Delusional atmosphere

Answer 34

Feels like something is "going on" but can't say what

Question 35

Derailment

Answer 35

Formal thought disorder. Disjointed thoughts, no meaningful connections

Question 36

Negativism

Answer 36

Catatonic patients do opposite of what asked

Question 37

Cotard's syndrome

Answer 37

Belief that part of body has ceased to exist Seen in psychotic depression

Question 38

Ekbom's syndrome

Answer 38

Delusional parasitosis

Question 39

Fregoli's syndrome

Answer 39

Complete strangers are actually well-known to them...but in disguise.

Question 40

Hebephrenic schizophrenia

Answer 40

``` Aka disorganized Predominantly thought and affective sxs Social withdrawal common Affect often fatuous and child-like Prominent negative sxs May have delusions but not prominent sxs ```

Question 41

Clerambault's phenomenon

Answer 41

Aka erotomania Sufferer, usually single female, becomes delusionally convinced that someone of exalted status (e.g. celebrity) has become infatuated with them Often part of schizophrenic illness

Question 42

Drug for rapid tranquilization

Answer 42

2g IM lorazepam

Question 43

Capgras syndrome

Answer 43

Person close to them replaced by doppleganger Schizophrenia and organic illnesses, e.g. dementia