Psychosis

Question 1

Define psychosis

Answer 1

An inability to distinguish between subjective experience and reality

(it is a description of symptoms rather than a diagnosis)

Question 2

What are the main symptoms of psychosis?

Answer 2

Hallucinations

Delusions

Ideas of reference

Formal thought disorder

Thought interference

Passivity phenomena

Question 3

What type of auditory hallucinations occur in mood disorders and what type occurs in schizophrenia?

Answer 3

2nd person - mood disorders
(voices directly address the patient)

3rd person - schizophrenia
(voices are talking about the patient/ form a running commentary)

Question 4

What are somatic hallucinations?

Answer 4

Hallucinations to do with bodily sensations

E.g insects crawling under the skin

Question 5

What are ideas of reference?

Answer 5

innocuous or coincidental events have significant meaning for the patient

E.g seeing meaning in people’s gestures

E.g thinking objects have been arranged in a specific way to convey hidden meanings

Question 6

What are hallucinations?

Answer 6

Perceptions which occur in the absence of external stimuli

Question 7

What are delusions?

Answer 7

Fixed and falsely held beliefs which are unaffected by evidence suggesting otherwise

Question 8

What are the typical themes of the delusions which occur in depression, mania and schizophrenia?

Answer 8

Depression; disease, nihilism, poverty, guilt

Mania; grandiosity, religion, persecution

Schizophrenia; love, religion, control, persecution

Question 9

What is the difference between primary and secondary delusions?

Answer 9

Primary delusions = any type of delusion e.g paranoid, persecution, grandiosity e.t.c

Secondary delusions = attempts to explain anomalous experiences (e.g delusions as a result of hallucinations)
E.g “My thoughts aren’t my own they are coming from outside me”

Question 10

What are self referential experiences?

Answer 10

The belief that external events are related to oneself

Question 11

What are neologisms?

Answer 11

New words the patient makes up

Question 12

What is meant by clanging and punning?

Answer 12

Making associations between words which sound the same rather than by their meaning

E.g Dr Pell, ding dong bell, go to hell.

Question 13

What is meant by Knight’s move thinking?

Answer 13

When the logical sequence of ideas is lost, resulting in the jumping from one topic to another with no obvious links

Question 14

What are the different types of thought interference?

Answer 14

Thought insertion

Thought withdrawal

Thought broadcasting

Thought blocking

Question 15

What is passivity phenomena?

Answer 15

The patient feels that their behaviour is being controlled by someone else/ an external influence or that they are experiencing the feelings/ actions of someone other than themselves.

Question 16

What is the differential diagnosis for psychosis?

Answer 16

Drug induced psychosis

Dilirium

Depressive psychosis

Mania - bipolar disorder

Schizophrenia

Question 17

What is the management for psychosis?

Answer 17

Antipsychotics

..duh

Question 18

What are some risk factors for schizophrenia

Answer 18

Strongest risk factor is FH

Birth complications

Drug use

Urban living

Social adversity and deprivation

Question 19

When is the typical age of onset for schizophrenia?

Answer 19

Mid-twenties for men

Late twenties for women

(more common in men)

Question 20

What are 5 subtypes of schizophrenia?

Answer 20

Paranoid

Hebephrenic

Catatonic

Residual

Simple

Question 21

What are good prognostic indicators for schizophrenia?

Answer 21

Older age of onset

Female gender

Marked mood disturbance, especially elation

FH of mood disorders

Question 22

What are poor prognostic indicators for schizophrenia?

Answer 22

Early onset

Long duration of untreated psychosis

Cognitive impairment

Enlarged ventricles

Question 23

What are some of the positive symptoms of schizophrenia?

Answer 23

Hallucinations (usually 3rd person auditory)

Delusions (usually persecutory)

Passivity phenomena

Thought interference

Question 24

What are some of the negative symptoms of schizophrenia?

Answer 24

Reduced speech

Reduced movement

Reduced interest and pleasure

Reduced social interaction

Blunting of affect

Question 25

How is schizophrenia managed?

Answer 25

Antipsychotics CBT CVS risk factor modification

Question 26

Neurobiology of schizophrenia

Answer 26

Enlarged ventricles and thinned cortices Reduced volume of the frontotemporal lobe Reduced activation of the prefrontal areas on specific tasks (e.g executive functions) Gene alterations Altered dopamine signalling

Question 27

What are the most common causes of visual hallucinations?

Answer 27

Delirium and substance misuse

Question 28

If a patient is experiencing auditory hallucinations, what questions should you ask to gain a further understanding about the nature of the hallucinations?

Answer 28

"Do you think the voices are your own thoughts?" "Do the voices come from inside your head or from outside your head and body?"

Question 29

What is meant by 'overvalued ideas'?

Answer 29

These are not delusions They are ideas which are overvalued but the patient has insight and can recognise they may not be true

Question 30

Describe mood in schizophrenia

Answer 30

Euthymic Depression may follow an episode

Question 31

What is meant by poverty of speech, a type of thought disorder?

Answer 31

Minimal verbal communication

Question 32

What is meant by perseveration, a type of thought disorder?

Answer 32

Inability to switch ideas along with social context

Question 33

What is meant by circumstantiality, a type of thought disorder?

Answer 33

Inability to answer questions without unnecessary and excessive detail The patient will go off on tangents, but will come back to answer the question eventually

Question 34

Subcortical dopamine hyperactivity accounts for which symptoms of psychosis?

Answer 34

Positive symptoms

Question 35

Mesocortical dopamine hypoactivity accounts for which symptoms of psychosis?

Answer 35

Negative symptoms

Question 36

What are the features of catatonic schizophrenia?

Answer 36

Stupor Mutism Waxy flexibility (unresponsive to stimuli and immobilised for long periods of time)

Question 37

Schizophrenia involves overactivity of what pathways in the brain?

Answer 37

Dopamine pathways

Question 38

What is tangentiality, a type of thought disorder?

Answer 38

The patient goes off on tangents and doesn't return to the original topic/ question

Question 39

What is an illusion?

Answer 39

Misconception/ misinterpretation of a real stimulus