Psychosis and the MSE

Question 1

Define delusion

Answer 1

A stubborn belief that cannot be shaken despite contradiction from reality

Question 2

Define hallucination

Answer 2

Seeing things that don’t exist

Question 3

What is the difference between a delusion and a hallucination?

Answer 3

Hallucinations involve external stimuli whereas delusions arise internally

Question 4

Are delusions or hallucinations present in schizophrenia?

Answer 4

Both

Question 5

What are the positive symptoms of schizophrenia?

Answer 5

Hallucinations

Delusions

Question 6

What are the negative symptoms of schizophrenia?

Answer 6

Alogia
Avolition
Anhedonia
Affective flattering

Question 7

What is alogia?

Answer 7

Poverty of speech

Question 8

What is avolition?

Answer 8

Poor self care eg hygiene, lack of motivation etc

Question 9

What is affective flattering?

Answer 9

Unchanged facial expressions and no expressive gestures

Question 10

At what ages is psychosis most likely to develop?

Answer 10

Transition from childhood and adolescence

Question 11

What are main components of a psych history?

Answer 11

History of presenting concern
Past psych history
Background history (family, personal, social)
Past medical history
Medications

Question 12

Which medicine can be brought over the counter for depression and can interfere with other medication?

Answer 12

St John’s wort

Question 13

What acronym is used to remember the mental state exam?

Answer 13

ASEPTIC
Appearance and behaviour
Speech
Emotion/mood
Perceptions
Thoughts
Insight
Cognition

Question 14

What is examined in the appearance and behaviour section of the MSE?

Answer 14

General appearance
Facial expressions (depression, anxiety)
Posture (hunched shoulders? head looking down? gripping the chair?)
Movements (overactive, restless, immobile, slow, mannerisms etc)
Social behaviour
Eye contact

Question 15

What is examined in the speech section of the MSE?

Answer 15

Quantity
Rate
Spontaneity
Volume

Question 16

What is examined in the thoughts section of the MSE?

Answer 16

Stream
Form
Content
Preoccupations
Morbid thought- always ask if they are suicidal
Delusions

Question 17

What is folie a deux?

Answer 17

When 2 people play into the delusion

Question 18

What is examined in the perceptions section of the MSE?

Answer 18

Illusions
Hallucinations
Distortions

Question 19

Define illusion?

Answer 19

Misperception of an external stimulus

Question 20

Define pseudo hallucination

Answer 20

When there is self awareness about the hallucination

Question 21

What is examined in the cognition section of the MSE?

Answer 21

Consciousness
Orientation
Attention and concentration
Memory
Language functioning

Question 22

What is examined in the insight section of the MSE?

Answer 22

Awareness of whether they are presenting with something other people would consider abnormal
Do they accept that this abnormal behaviour is caused by mental illness
Do they accept specific treatment options

Question 23

What are the different types of delusions?

Answer 23

Persecutory
Control
Reference
Mind reading
Grandiosity
Religious
Guilt/sin
Somatic
Thought broadcasting
Thought insertion
Thought withdrawal

Question 24

What is congreuncy?

Answer 24

Whether things match up eg do their facial expressions match their speech, does their body language match their thoughts

Question 25

What is lability?

Answer 25

How often they change eg their tone of speech, their body language, their flow of thoughts

Question 26

What are the 2 types of hallucinations?

Answer 26

Visual and auditory

Question 27

What are some risk factors in developing psychosis?

Answer 27

``` Family history of schizophrenia Childhood trauma Previous psychiatric history of conditions eg anxiety Cannabis use Prenatal and birth complications Socioeconomic deprivation ```

Question 28

What are some of the prodromal symptoms of psychosis?

Answer 28

Change in social behaviour | Impairments in functioning

Question 29

What are some other sources for patient information you may use?

Answer 29

``` Family Friends Workplace Place of eduction GP records Mental health service records ```

Question 30

What is the main underlying pharmacology of anitpsychotics?

Answer 30

They are usually dopamine receptor antagonists or partial agonists, they work because psychosis is caused by excess dopamine in the brain

Question 31

What neurotransmitter causes psychosis and what level of it?

Answer 31

High levels of dopamine

Question 32

What are the EPSEs of dopamine blockade?

Answer 32

Parkinsonism: Rigidity Slow/shuffling gait Lack of arm swing Dystonia= increased motor tone that can occur shortly after starting medication, is frightening Tardive dyskinesia= repeated oral/facial/buccal/lingual movements Akathisia= inner restlessness where you feel compelled to move but moving doesn’t alleviate anything, most commonly affects the legs

Question 33

What do ESPEs stand for in terms of psychosis?

Answer 33

Extra pyramidal side effects (that are caused by dopamine blockade)

Question 34

How are ESPEs avoided?

Answer 34

By giving atypical antipsychotics as first line treatment instead of dopamine antagonists

Question 35

What are other side effects of antipsychotics besides ESPEs?

Answer 35

Gastrointestinal eg constipation Haematological eg agranulocytosis and neutropenia Metabolic eg increased appetite, weight gain, diabetes Pituitary eg increased prolactin release (release is usually suppressed by dopamine) Cardiac eg dysrhythmia

Question 36

What does psychological management for psychosis involve?

Answer 36

CBT and new therapies like avatar therapy

Question 37

What does social support for psychotic patients involve?

Answer 37

Supportive environments, housing, benefits, support with budgeting and employment