Psychosis

Question 1

What is Psychosis?

Answer 1

A description of symptoms rather than a diagnosis

Question 2

What are the core symptoms of psychosis?

Answer 2

Hallucinations
Delusions
Ideas of reference
Formal thought disorder
Thought interference
Loss of insight 
Passivity phenomena

Question 3

What mental disorders can result in psychosis?

Answer 3

Bipolar affective
Schizoaffective
Schizophrenia

Question 4

How can an organic issue result in psychosis?

Answer 4

Damage to the area of the brain that controls perception of reality

Question 5

How can substance use result in psychosis?

Answer 5

Acute use

Or withdrawal

Question 6

What are primary delusions?

Answer 6

Arrive in the consciousness fully formed without need for explanation.

Question 7

What are secondary delusions?

Answer 7

Often an attempt to explain the psychotic experiences e.g. hallucination

Question 8

What is a Capgras delusion?

Answer 8

Belief that people are being switched with identical doubles.

Question 9

What is a Fregoli delusion?

Answer 9

Misidentification delusion

Belief that two separate individuals are in fact the same person just in-disguise.

Question 10

What is a De clerambault delusion?

Answer 10

Belief that a public figure is infatuated with them and communicating with them through media.

Question 11

What is the Othello delusion?

Answer 11

That there significant other is cheating on them

Question 12

How can you see if a patient has a thought disorder?

Answer 12

Unable to directly observe, Can be inferred from patterns of speech.

Question 13

Someone with a thought disorder often has what pattern of speech?

Answer 13

Clanging and punning
Loosening of association
Tangents
Circumferentiality

Question 14

What are the types of thought interference?

Answer 14

Thought insertion
Thought withdrawal
Thought Broadcasting
Thought blocking

Question 15

What is thought insertion?

Answer 15

Thoughts in your head that don’t belong to you

Question 16

What is thought withdrawal?

Answer 16

Information is extracted from your brain by someone

Question 17

What is thought broadcasting?

Answer 17

Every knows what you are thinking all the time

Question 18

What is thought blocking?

Answer 18

Halfway through thinking something when the thought just disappears.

Question 19

What can a psychotic patient have passivity in?

Answer 19

Volition
Affect
Impulse

Question 20

What is passivity of volition?

Answer 20

Someone is controlling their movements

Question 21

What is passivity of affect?

Answer 21

Someone is controlling their feelings

Question 22

What is passivity of Impulse?

Answer 22

Someone is controlling their urges

Question 23

Why does someone with psychosis have loss of insight?

Answer 23

reality testing is broken down so ability to interpret external world is hindered.

Question 24

Why is lack of insight an issue?

Answer 24

Creates disharmony between patient and Dr as they can’t see that they need treatment

Question 25

What should you think about when consulting a patient with psychosis?

Answer 25

Recognise importance of their experience Don't give impression you think it is all in their head Don't jeopardise fragile rapport by being confrontational Don't play along as at some point say you will have to say you believe they are unwell as you will need to treat them.

Question 26

How can you satisfy it is psychotic beliefs in a consultation with a potentially psychotic patient?

Answer 26

"do you think it could be" | "what would you think if your friend came and told you what you just said to me?"

Question 27

What are the commonest causes of psychosis?

Answer 27

Organic Substance misuse paranoid psychoses Mood disorders

Question 28

Delirium

Answer 28

Acute transient disturbance from persons normal cognitive function.

Question 29

What are some common causes of delirium?

Answer 29

``` Infection Inflammation Endocrine Drug use Steroids Hypoglycaemia ```

Question 30

How does someone with delirium present?

Answer 30

Clouding of consciousness Impaired concentration and short term memory Visual hallucinations Persecutory delusions

Question 31

Drug induced psychosis

Answer 31

Very florid acute or insidious onset | Short lasting if drug is removed

Question 32

In a suspected drug induced psychosis what must you take into account?

Answer 32

There is a high incidence of drug misuse in disorders i.e. schizophrenia and Bipolar affective disorder.

Question 33

A patient with depressive psychosis can presents with?

Answer 33

Delusions of worthlessness guilt poverty nihilism Hallucinations of accusatory threatening 2nd person Cottards syndrome - already dead

Question 34

A patient presents with Mania with psychosis.

Answer 34

Delusions of grandeur special purpose and special ability Hallucinations tend to be 2nd person e.g. gods voice Flight of ideas

Question 35

Schizotypal

Answer 35

Eccentric behaviour and anomalies of thinking bt no definite schizophrenic anomalies

Question 36

How does someone with schizotypal disorders present?

Answer 36

Cold inappropriate affect Odd eccentric Socially withdrawn Paranoid or bizarre ideas not quite amounting to true delusion.

Question 37

Persistent Delusional Disorder

Answer 37

Fixed well describe delusions

Question 38

Causes of Delirium

Answer 38

``` IWATCHDEATH I- Infection W - Withdrawal A - Acute causes T - Toxins/drugs C - CNS pathology H - Hypoxia D - Deficiencies E - Endocrine A - Acute vascular T - Trauma H - Heavy metals ```

Question 39

Delirium - Infection

Answer 39

UTI Pneumonia Encephalitis

Question 40

Delirium - Withdrawal

Answer 40

Alcohol | BDZ

Question 41

Delirium - Acute causes

Answer 41

Electrolyte imbalances Dehydration Alkalosis/ Acidosis

Question 42

Delirium - Toxins/Drugs

Answer 42

Opiates Salyciliate Indomethicin

Question 43

Delirium - CNS pathology

Answer 43

``` Stroke TIA Seizures Haemorrhage Infection ```

Question 44

Delirium - Hypoxia

Answer 44

Anaemia Pulmonary or cardiac failure Hypotension

Question 45

Delirium - Deficiencies

Answer 45

Thiamine (alcoholics) | B12

Question 46

Delirium - Endocrine

Answer 46

thyroid Hypo/Hyperglycaemia Adrenal dysfunction Hyperparathyriod

Question 47

Delirium - Acute Vascular

Answer 47

Hypertensive Encephalopathy

Question 48

Delirium - Trauma

Answer 48

Head injury Post operative Hyper/Hypothrmia

Question 49

Delirium - Heavy metals

Answer 49

Lead Mercury Managanese