Psychosis

Question 1

What is schizophrenia and how is it characterised?

Answer 1

Group of brain disorders characterised by disorders of thought, behaviour, perception and emotion

Question 2

What is the one pathognomonic symptom of schizophrenia?

Answer 2

There isn’t one!

Having more than one symptom increases the risk

Question 3

There is a strong genetic link to schizophrenia. True/False?

Answer 3

True

Question 4

List 3 “positive” symptoms of schizophrenia

Answer 4

Delusions
Hallucinations
Thought disorder

Question 5

List 4 “negative” symptoms of schizophrenia

Answer 5

Apathy
Lack of volition
Social withdrawal
Cognitive impairment

Question 6

Positive symptoms are harder to treat than negative symptoms in schizophrenia. True/False?

Answer 6

False

Positive symptoms are often easier to treat

Question 7

According to Schneider’s first rank symptoms for schizophrenia, list some thought disorders

Answer 7

Thoughts spoken out loud
Running commentary
3rd person voices talking
Thought withdrawal, broadcasting or insertion

Question 8

What is passivity phenomena?

Answer 8

Experience where acts/emotions/feelings are being controlled by an external party

Question 9

A patient must have Schneider’s first rank symptoms to be diagnosed with schizophrenia. True/False?

Answer 9

False

They are not pathognomonic and can be seen in other psychoses

Question 10

What is a delusion?

Answer 10

A fixed belief that cannot be changed by logical thought or evidence

Question 11

What is a hallucination?

Answer 11

Perceptual, fantastical experience that is believed to be real without evidence

Question 12

List the different modalities by which hallucinations can occur

Answer 12

Auditory (most common)
Visual
Olfactory
Gustatory
Tactile
Kinaesthetic

Question 13

Which type of auditory hallucination - 1st, 2nd or 3rd person - is more typical of schizophrenia?

Answer 13

3rd person

Question 14

What is meant by “word salad”?

Answer 14

Mish mash of words that together don’t make sense

Question 15

What is meant by thought withdrawal?

Answer 15

Belief that thoughts are being removed by an external party - a delusional explanation for thought blocking

Question 16

What is meant by thought broadcasting?

Answer 16

Belief that people understand your thoughts without you having to voice them

Question 17

List features of emotional disorder that can occur in psychoses such as schizophrenia

Answer 17

Blunted affect
Incongruent mood
Apathy
Lack of motivation
Anhedonia

Question 18

What is the main motor disorder that may occur in schizophrenia?

Answer 18

Catatonia

Question 19

What is catatonia?

Answer 19

State of increased tone of muscles at rest, abolished by voluntary activity

Question 20

What are the main treatments for catatonia?

Answer 20

ECT

Benzodiazepines

Question 21

What is the peak incidence of schizophrenia for men and women?

Answer 21

Men: 15-25
Women: 25-35

Question 22

List factors that indicate good prognosis for schizophrenia

Answer 22

Older age of onset
Being female
Mood disturbance (elation especially)
Family history of mood disorder

Question 23

List factors that indicate poor prognosis for schizophrenia

Answer 23

Long duration of untreated psychosis
Insidious early onset
Cognitive impairment
Enlarged brain ventricles

Question 24

Psychosis is a diagnosis. True/False?

Answer 24

False

Description of symptoms rather than diagnosis

Question 25

What is psychosis?

Answer 25

Inability to distinguish subjective experience from reality, characterised by lack of insight

Question 26

List psychotic experiences

Answer 26

``` Hallucinations Delusions Thought disorders Emotional disturbance Physical disruption ```

Question 27

List the main differential diagnoses of psychosis

Answer 27

``` Schizophrenia Schizoaffective disorder Drug toxicity Mania Depression Delusional disorder Puerperal psychosis Delirium Dementia ```

Question 28

What is meant by flight of ideas?

Answer 28

Jumping from topic to topic by associating words together inappropriately

Question 29

How does tangential thinking differ from circumstantial thinking?

Answer 29

Tangential: wander off from topic/question and never return Circumstantial: excessive detail relating to topic, eventually return to topic

Question 30

What is meant by self-referential experience?

Answer 30

Belief that environment is reacting to you, i.e. external events are related to oneself e.g. tv/radio is talking to you specifically

Question 31

List some common drugs that can cause psychosis

Answer 31

``` Steroids Cannabis Amphetamine Cocaine Tobacco Alcohol Opioids ```

Question 32

How is depressive psychosis classically typified?

Answer 32

Mood congruent with psychosis - delusions of guilt/pessimism on top of depressed mood

Question 33

What is a grandiose delusion?

Answer 33

Delusion where one thinks they are vastly superior and have superhuman like qualities

Question 34

What is schizoaffective disorder?

Answer 34

Mixed picture of schizophrenia + bipolar disorder where someone displays schizophrenia but their mood is also affected

Question 35

At what time of day is delirium typically worse at?

Answer 35

Night

Question 36

What are the 3 main cortical changes that occur in schizophrenia?

Answer 36

Reduced frontal lobe volume Reduced frontal lobe grey matter Enlarged ventricles

Question 37

Which neurotransmitter causes a psychotic state when in excess?

Answer 37

Dopamine

Question 38

List the 3 main dopaminergic pathways in the brain

Answer 38

Nigrostriatal Mesolimbic Tuberoinfundibular

Question 39

Which dopaminergic pathway is typically involved in schizophrenia?

Answer 39

Mesolimbic system

Question 40

Name some dopamine antagonists (anti-psychotics) that can be used for schizophrenia

Answer 40

Haloperidol Raclopride Clozapine

Question 41

Subcortical dopamine hyperactivity/hypoactivity leads to psychosis

Answer 41

Subcortical dopamine hyperactivity leads to psychosis

Question 42

What is the benefit of atypical antipsychotics over typical antipsychotics?

Answer 42

Less likely to induce extra-pyramidal side effects | Better efficacy

Question 43

List some atypical antipsychotics

Answer 43

Clozapine Aripiprazole Risperidone

Question 44

What is the fatal side effect of clozapine that makes it a 3rd line agent for psychosis?

Answer 44

Agranulocytosis