Schizophrenia and other psychoses

Question 1

What are the classic characteristics of psychosis?

Answer 1

hallucinations; delusions and disorder of the form of thought with lack of insight

Question 2

What is hallucination?

Answer 2

a perception which occurs in the absence of an external stimulus

Question 3

How is a hallucination experienced?

Answer 3

as originating in real space not just in thoughts; same qualities as normal perception and not subject to any conscious manipulation

Question 4

When are hallucinations significant?

Answer 4

only in the context of other relevant symptoms

Question 5

What is seen in the brain activity of those experiencing auditory hallucinations?

Answer 5

pattern is very similar to that in normal volunteers geneerating inner speech except supplementary motor area and hippocampus

Question 6

What is the function of the supplementary motor area in the context of hallucinations?

Answer 6

monitors self geenerated actions

Question 7

What is the function of the parahippocampal gyrus in the context of hallucinations?

Answer 7

detects mismatch between perceived and expected activity

Question 8

What is the core problem pathophysiologically in auditory hallucinations?

Answer 8

self-generated inner speech is not recognised as such and so is attributed to external reality

Question 9

What are the types of auditory hallucination?

Answer 9

second person; third person and though echo

Question 10

What is though echo?

Answer 10

patient experiences his own thoughts spoken or repeated outloud

Question 11

What are visual hallucinations often associated with?

Answer 11

altered consciousness or organic impairment

Question 12

What is passivity phenomenon?

Answer 12

behaviour is experienced as being controlled by an external agency rather than by the individual

Question 13

What is thought insertion?

Answer 13

“people can put thoughts into my head”

Question 14

Waht is thought withdrawal?

Answer 14

“people are taking my thoughts away”

Question 15

What is thought broadcasting?

Answer 15

“everyone knows my thoughts”

Question 16

What are teh typical themes of delusion in depression?

Answer 16

disease; nihilism; poverty; sin and guilt

Question 17

what are the typical themes of delusion in schizophrenia?

Answer 17

control; persecution; reference; religion; love

Question 18

What are teh typical themes of delusion in mania?

Answer 18

grandiosity; persecution; religion

Question 19

What determines the specific content of a delusion?

Answer 19

cultural norms eg. someone in japan will probbaly not be worried about MI5

Question 20

What is usually the origin of delusions?

Answer 20

secondary- an attempt to explain anomalous expereinces eg hallucinations, passiviity expereinces

Question 21

What are self-referential expereinces?

Answer 21

belief that external events are related to oneself

Question 22

Give examples of self-referential experiences?

Answer 22

TV or radio are transmitting messages for me or newspapers contain hidden codes

Question 23

What is the differential diagnosis of psychotic symptoms?

Answer 23

schizophrenia; psychoactive substance use; mania; depression; delirium; dementia; other organic cause

Question 24

What is delusional perception?

Answer 24

a fully formed delusion which arises from a real/ genuine perception

Question 25

What are the core psychotic symptoms of schizophrenia?

Answer 25

auditory hallucinations; passivity phenomena; delusional perception

Question 26

What are the characterstics of auditory hallucinationsin SZ?

Answer 26

thought echo; 3rd person; in form of running commentary

Question 27

What are the negatvie symptoms of SZ?

Answer 27

reduced amount of speech; motivation; interest/pleasure; social interaction; restricted range of afffect

Question 28

What is seen premorbidly in patients who develop SZ?

Answer 28

subtle motor, cognitive and social deficits in childhood that become greater as time goes on

Question 29

What are the prodromal ymptoms of SZ?

Answer 29

gradual onset with non-specific- odd ideas and expereinces, eccentrciity, altered affect

Question 30

What is the most common outcome of SZ?

Answer 30

multiple epsidoes with signficant chronic progressive impairment

Question 31

How many patients with SZ have only one epsidoe with no-minimal impairment?

Answer 31

20%

Question 32

What are the bad prognostic indicators in SZ?

Answer 32

poor pre-morbid adjustment; insidious onset; early onset; cognitivie impairment; enlarged ventricles

Question 33

What are the good prognostic indicators in SZ?

Answer 33

older age of onset; female gender; marked mood disturbance esp. elation; family history

Question 34

What is the biggest known risk factor for dveloping SZ?

Answer 34

positive family history

Question 35

What is seen during pregnancy or birth complications of those who go on to develop SZ?

Answer 35

higher rates of perinatal complications= prematurity; prolonged labour; fetal distress; hypoxia; 2nd trimester viral infections or malnutrition

Question 36

What is seen in the brain with SZ?

Answer 36

enlarged lateral ventricles; reduced frontotempral volume; reduced activation of prefrontal areas on specific tasks

Question 37

What test do SZ patients tend to do badly in and why?

Answer 37

Stroop test- involves prefrontal areas

Question 38

What supports the dopamine hypothesis in SZ?

Answer 38

drugs which release dopamine or D2 receptor agonists a psychotic state or make SZ worse

Question 39

What are the functions of the D2 receptor family ?

Answer 39

inhibit adenyly cyclase; inhibit voltage-activated calcium channels and open K channels

Question 40

What are the genes implicated in SZ?

Answer 40

neuregulin; dysbindin; DISC-1

Question 41

What may precipitate onset/relapse of SZ?

Answer 41

stresss

Question 42

How can you indentify drug-induced psychosis from other causes of psychosis?

Answer 42

if stop drug; psychosis improves within days

Question 43

What is depressive psychosis typified by?

Answer 43

mood congruent content of psychotic symptoms

Question 44

What are the features of delirium?

Answer 44

clouding of consciousness- disorentation in time, place and person; fluctuating severity; worse at night; impaired conc. /memory

Question 45

What are the psychotic symptoms of delirium?

Answer 45

visual hallucinations +/- audtiory; persecutory delusions; psychomotor distubrnace

Question 46

What do 3rd person auditory hallucinations suggest?

Answer 46

SZ

Question 47

Give examples of typical antipsychotics?

Answer 47

chlorpromazine; haloperidol

Question 48

How is antipsychotic action and D2 receptor blockade related?

Answer 48

strong correlation between average dose rewuired and D2 receptor binding activity

Question 49

What problsm does D2 blockade cause?

Answer 49

EPSE; hypereprolactinaemia

Question 50

What is the treatment fro acute dystonic reaction?

Answer 50

IV anticholinergics

Question 51

What problems can 5HT-2 blockade cause and why?

Answer 51

metabolic syndrome; interactions at serotonin receptors my modulate aspects of hte immune response and inflammation

Question 52

What problems does histamine blockade cause?

Answer 52

sedation and increased appetite

Question 53

What is clozapine used for?

Answer 53

treatment resistant SZ

Question 54

What are the problems associated with clozapine?

Answer 54

agranulocytosis; myocarditis

Question 55

How often should FBCs be done with clozapine?

Answer 55

weekly for first 6 months; fortnightly for next 6 months; every 4 weeks thereafter

Question 56

What diseases is formal thought disorder seen with?

Answer 56

SZ and mania

Question 57

What is formal thought disorder?

Answer 57

group of first rank symptoms of delusions of thought interference-thought withdrawal; thought insertion and thought broadcasting

Question 58

What diseases is passivity phenomenon seen with?

Answer 58

SZ and substance misuse

Question 59

What diseases are visual hallucinations seen with?

Answer 59

substance misuse and delirium/dementia