Psychosis

Question 1

Psychosis

Answer 1

A grossly distorted sense of reality, resulting in delusions, hallucinations and thought disorder

Question 2

Perception

Answer 2

Process of making sense of the physical information we receive from the 5 senses

Question 3

Hallucination

Answer 3

A perception occurring in the absence of an external physical stimulus

Question 4

Illusion

Answer 4

A misperception of real external stimuli - can occur in healthy people, associated with inattention or strong emotion

Question 5

Pseudohallucination

Answer 5

Perceptual experience that the patient recognises as having coming from within their own mind, yet beyond conscious control

Question 6

Elementary auditory hallucinations

Answer 6

Simple, unstructured sounds e.g. whirring, buzzing, whistling or single words

Commonly occur in acute organic states

Question 7

Complex auditory hallucinations

Answer 7

Spoken phrases, sentences or dialogue in 1st, 2nd or 3rd person

Question 8

Audible thoughts

Answer 8

1st person auditory hallucination

Person hears their thoughts spoken aloud as they think them

Question 9

Thought echo

Answer 9

1st person auditory hallucination

Person hears their own thoughts as an echoed by a voice after they have thought them

Question 10

Second person auditory hallucinations

Answer 10

Patients hear a voice/voices speaking directly to them

Often persecutory, critical, complimentary or issue commands (command hallucinations)

Often associated with mood disorders with psychotic features, where they are mood congruent

Question 11

Third person auditory hallucinations

Answer 11

Patients hear voices speaking about them or referring to them

Question 12

Autoscopic hallucination

Answer 12

The experience of seeing an image of oneself in an external space

Question 13

Charles Bonnet syndrome

Answer 13

Complex visual hallucinations associated with no other psychiatric symptoms or impairment in consciousness - usually in older adults, associated with a loss of vision

Question 14

Lilliputian hallucinations

Answer 14

Seeing miniature people or animals

Question 15

Somatic hallucinatons

Answer 15

Hallucinations of bodily sensations

Question 16

Tactile (haptic) hallucinations

Answer 16

Experience of the skin being touched, pricked or pinched

Question 17

Formication

Answer 17

Unpleasant sensation of insects crawling on or just below the skin
Associated with long-term cocaine use and alcohol withdrawal

Question 18

Hygric hallucinations

Answer 18

False perception of fluid e.g. ‘I can feel water sloshing in my brain’

Question 19

Visceral hallucinations

Answer 19

False perceptions of internal organs - include deep sensations of organs throbbing, stretching, distending or vibrating

Question 20

Kinaesthetic hallucinations

Answer 20

False perception of joint or muscle sense

Includes feeling sensation of free-falling as you are about to fall asleep

Question 21

Olfactory hallucinations

Answer 21

Often occur with gustatory hallucinations, as the two senses are closely related

Important to rule out epilepsy (especially temporal lobe) and other organic brain diseases

Question 22

Hypnagogic hallucinations

Answer 22

False perceptions in any modality (often auditory or visual) that occur as a person goes to sleep
Not indicative of psychopathology

Question 23

Hypnopompic hallucinations

Answer 23

False perceptions in any modality (often auditory or visual) that occur as a person wakes up
Not indicative of psychopathology

Question 24

Extracampine hallucinations

Answer 24

False perceptions that occur outside of the limits of a person’s normal sensory field e.g. hearing voices from 100 miles away

Question 25

Functional hallucination

Answer 25

When a normal sensory stimulus is required to precipitate a hallucination in the same sensory modality e.g. voices that are only heard when the doorbell rings

Question 26

Reflex hallucination

Answer 26

When a normal sensory stimulates in one modality precipitates a hallucination in another e.g. voices that are only heard when the lights are on

Question 27

Delusion

Answer 27

An unshakeable false belief, not in keeping with the patient's social and cultural background A delusion is to ideation what a hallucination is to perception

Question 28

Delusional atmosphere

Answer 28

Where the world seems subtly altered, uncanny, portentous or sinister. This resolves into a delusion, usually in a revelatory fashion, which seems to explain the unusual feeling of anticipation

Question 29

Delusional intuition

Answer 29

Where delusions arrive 'out of the blue', without external cause

Question 30

Delusional perception

Answer 30

Where a normal percept is interpreted with delusional meaning. For example, a person sees a red car and knows that this means their food is being poisoned by the police

Question 31

Secondary delusions

Answer 31

Secondary delusions (sometimes called delusion-like ideas) are considered to be, at least in principle, understandable in the context of a person's life history, personality, mood state or presence of other psychopathology. For example, a person becomes depressed, suffers very low mood and self-esteem, and subsequently believes they are responsible for some terrible crime which they did not commit.

Question 32

Primary delusions

Answer 32

Do not occur in response to any previous psychopathological state - their genesis is un-understandable

Question 33

Partial delusion

Answer 33

Beliefs that were previously held with delusional intensity, but then become held with less conviction. Occurs when patients start recovering after receiving treatment

Question 34

Overvalued idea

Answer 34

A plausible belief that a patient becomes preoccupied with to an unreasonable extent . The pursuit of the idea causes considerable distress to the patient or those living around them

Question 35

Persecutory delusion

Answer 35

False belief that one is being harmed, threatened, cheated, harassed or is a victim of a conspiracy

Question 36

Grandiose delusion

Answer 36

False belief that one is exceptionally powerful (including having ‘mystical powers’), talented or important

Question 37

Delusions of reference

Answer 37

False belief that certain objects, people or events have intense personal significance and refer specifically to oneself, e.g. believing that a television newsreader is talking directly about one

Question 38

Religious delusions

Answer 38

False belief pertaining to a religious theme, often grandiose in nature, e.g. believing that one is a special messenger from God

Question 39

Delusions of love (erotomania)

Answer 39

False belief that another person is in love with one (commoner in women).

Question 40

de Clerambault syndrome

Answer 40

``` A woman (usually) believes that a man, frequently older and of higher status, is in love with her ```

Question 41

Delusions of infidelity (morbid jealousy, Othello syndrome)

Answer 41

False belief that one’s lover has been unfaithful. Note that morbid jealousy may also take the form of an overvalued idea, that is, non-psychotic jealousy

Question 42

Capgras syndrome

Answer 42

Belief that a familiar person has been replaced by an exact double – an impostor

Question 43

Fregoli syndrome

Answer 43

Belief that a complete stranger is actually a familiar person already known to one

Question 44

Nihilistic delusions

Answer 44

False belief that oneself, others or the world is non-existent or about to end. In severe cases, negation is carried to the extreme with patients claiming that nothing, including themselves, exists

Question 45

Somatic delusions

Answer 45

False belief concerning one’s body and its functioning, e.g. that one’s bowels are rotting. Also called hypochondriacal delusions (to be distinguished from the overvalued ideas seen in hypochondriacal disorder)

Question 46

Ekbom's syndrome

Answer 46

False belief that one is infested with small but visible organisms. May also occur secondary to tactile hallucinations, e.g. formication

Question 47

Delusions of control (passivity or 'made' experiences)

Answer 47

False belief that one’s thoughts, feelings, actions or impulses are controlled or ‘made’ by an external agency, e.g. believing that one was made to break a window by demons

Question 48

Thought insertion

Answer 48

Belief that thoughts or ideas are being implanted in one’s head by an external agency

Question 49

Thought withdrawal

Answer 49

Belief that one’s thoughts or ideas are being extracted from one’s head by an external agency

Question 50

Thought broadcasting

Answer 50

Belief that one’s thoughts are being diffused or broadcast to others such that they know what one is thinking

Question 51

Loosening of association (derailment/knight's move thinking)

Answer 51

When the patient’s train of thought shifts sud- denly from one very loosely or unrelated idea to the next Characteristic of schizophrenia

Question 52

Word salad

Answer 52

Most extreme form of loosening of association. Speech becomes a mixture of incoherent words and phrases

Question 53

Thought blocking

Answer 53

A sudden cessation to the flow of thought, often in mid-sentence. Patients have no recall of what they were saying or thinking

Question 54

Neologisms

Answer 54

New words created by the patient

Question 55

Perseveration

Answer 55

When an initially correct response is inappropriately repeated Highly suggestive of organic brain disease

Question 56

Echolalia

Answer 56

When patients senselessly repeat words or phrases spoken around them by others

Question 57

Negative symptoms

Answer 57

Indicate a clinical deficit Include marked apathy, poverty of thought and speech, blunting of affect, social isolation, poor self-care and cognitive deficits

Question 58

Catatonic rigidity

Answer 58

Maintaining a fixed position and rigidly resisting all attempts to be moved

Question 59

Catatonic posturing

Answer 59

Adopting an unusual or bizarre position that is then maintained for some time

Question 60

Catatonic negativism

Answer 60

A seemingly motiveless resistance to all instructions or attempts to be moved; patients may do the opposite of what is asked

Question 61

Catatonic waxy flexibility (flexibilitas cerea)

Answer 61

Patients can be ‘moulded’ like wax into a position that is then maintained

Question 62

Catatonic excitement

Answer 62

Agitated, excited and seemingly purposeless motor activity, not influenced by external stimuli

Question 63

Catatonic stupor

Answer 63

A presentation of akinesis (lack of voluntary movement), mutism and extreme unresponsiveness in an otherwise alert patient (there may be slight clouding of consciousness)

Question 64

Echopraxia

Answer 64

Patients senselessly repeat or imitate the actions of those around them. Associated with echolalia – also occurs in patients with frontal lobe damage

Question 65

Mannerisms

Answer 65

Apparently goal-directed movements (e.g. waving, saluting) that are performed repeatedly or at socially inappropriate times

Question 66

Stereotypies

Answer 66

A complex movement that does not appear to be goal-directed (e.g. rocking to and fro, gyrating)

Question 67

Tics

Answer 67

Sudden, involuntary, rapid, recurrent, non-rhythmic motor movements or vocalizations

Question 68

Differential diagnosis for the psychotic patient

Answer 68

Psychotic disorders • Schizophrenia • Schizophrenia-like psychotic disorders • Schizoaffective disorder • Delusional disorder Mood disorders • Manic episode with psychotic features • Depressive episode, severe, with psychotic features Secondary to a general medical condition Secondary to psychoactive substance use Dementia/delirium Personality disorder (schizotypal, borderline, schizoid, paranoid) Neurodevelopmental disorder (autistic spectrum)

Question 69

ICD-10 diagnostic guidelines for schizophrenia (4,5)

Answer 69

One or more of the following symptoms: a. Thought echo, insertion, withdrawal or broadcast b. Delusions of control or passivity; delusional perception c. Hallucinatory voices giving a running commentary; discussing the patient among themselves or ‘originating’ from some part of the body d. Bizarre delusions OR Two or more of the following symptoms: e. Other hallucinations that either occur every day for weeks or that are associated with fleeting delusions or sustained overvalued ideas f. Thought disorganization (loosening of association, incoherence, neologisms) g. Catatonic symptoms h. Negative symptoms i. Change in personal behaviour (loss of interest, aimlessness, social withdrawal)

Question 70

How long do symptoms need to be present to diagnose schizophrenia?

Answer 70

Symptoms should be present for most of the time during at least 1 month

Question 71

Schneider's first rank symptoms of schizophrenia (3+3+3+2)

Answer 71

1. Made phenomena - Made affect (emotion) - Made impulse (drive) - Made volition (acts) 2. Disruptions of thought - Thought insertion - Thought withdrawal - Thought broadcast 3. Types of auditory hallucinations - Voices giving a running commentary on the patient - Hearing thoughts spoken out loud - Voices in the third person criticising or discussing the person 4. Somatic passivity 5 . Delusional perception

Question 72

Paranoid schizophrenia

Answer 72

Dominated by the presence of delusions and hallucinations (positive symptoms). Negative and catatonic symptoms as well as thought disorganization are not prominent. The prognosis is usually better and the onset of illness later than the other subtypes.

Question 73

Hebephrenic (disorganised) schizophrenia

Answer 73

Characterized by thought disorganization, disturbed behaviour and inappropriate or flat affect. Delusions and hallucination are fleeting or not prominent. Onset of illness is earlier (15 to 25 years of age) and the prognosis poorer than paranoid schizophrenia

Question 74

Catatonic schizophrenia

Answer 74

A rare form characterized by one or more catatonic (psychomotor) symptoms

Question 75

Residual schizophrenia

Answer 75

1 year of predominantly | chronic negative symptoms which must have been preceded by at least one clear cut psychotic episode in the past

Question 76

Delusional disorder

Answer 76

The development of a single or set of delusions for the period of at least 3 months is the most prominent or only symptom

Question 77

Folie a deux

Answer 77

When a non-psychotic patient with close emotional ties to another person suffering from delusions (usually a dominant figure) begins to share those delusional ideas themselves. The delusions in the non-psychotic patient tend to resolve when the two are separated

Question 78

Medical conditions that can cause psychotic symptoms

Answer 78

-Cerebral: neoplasm, infarct, trauma, infection, inflammation -Endocrinological: thyroid, parathyroid, adrenal -Epilepsy (especially temporal lobe) -Huntington's disease -SLE -Vitamin B12, niacin (pellagra) and thiamine deficiency (Wernicke's encephalopathy) Acute intermittent porphyria

Question 79

Substance-related causes of psychotic symptoms

Answer 79

- Alcohol - Cannabis - 'Legal highs' - Amphetamines - Cocaine - Hallucinogens - Inhalants/solvents Prescribed: - Antiparkinsonian drugs - Corticosteroids - Anticholinergics

Question 80

Schizophrenia-like psychotic disorder

Answer 80

ICD-10: acute and transient psychotic disorder DSM-IV: schizophreniform disorder or brief psychotic disorder If symptoms have been going on for