Schizophrenia and Psychotic Disorders

Question 1

what is psychosis?

Answer 1

Psychosis is a severe form of mental illness that patients lack insight into. It represents an inability to
distinguish between symptoms of delusion, hallucination and disordered thinking from reality.

Question 2

clinical presentation of psychosis

Answer 2

hallucinations

delusions

Question 3

describe hallucinations in psychosis

Answer 3

Hallucinations have the full force and clarity of true perception. They are located in external space
with no external stimulus. They cannot be willed or controlled. They can affect all 5 senses – auditory
most common in psychosis. Visual hallucinations are more likely to be caused by other disease such
as delirium. Tactile, olfactory and gustatory.

Question 4

visual hallucinations are mostly associated with what kind of illness

Answer 4

organic

Question 5

what is a delusion?

Answer 5

A delusion is an unshakable idea or belief which is out of keeping with the person’s social and cultural
background; it is held with extraordinary conviction

Question 6

give examples of types of delusions

Answer 6

grandioses
paranoid (persecutory)
hypochondriacal
self-referential

Question 7

what illnesses may produce psychotic symptoms?

Answer 7

schizophrenia
delirium
severe affective disorder
depression with psychosis
mania with psychosis

Question 8

what are the 1st rank symptoms of schizophrenia?

Answer 8

A = auditory hallucinations
B = broadcasting
C = controlled thought
D = delusional perception

Question 9

what domains does schizophrenia affect?

Answer 9

thinking
emotion
behaviour

Question 10

what is the most common cause of psychosis?

Answer 10

schizophrenia

Question 11

what % of the population suffer from schizophrenia?

Answer 11

1%

Question 12

are females or males more affected by schizophrenia?

Answer 12

equally

Question 13

what is the mean age of onset of schizophrenia?

Answer 13

15-35

Question 14

list positive symptoms of schizophrenia

Answer 14

hallucinations
delusions
disordered thinking

Question 15

list negative symptoms of schizophrenia

Answer 15

apathy
lack of interest
lack of emotions - different to inability to feel
amotivation
paucity of thought

Question 16

for a diagnosis of schizophrenia list the criteria for which only one needs to be present for > 1 month

Answer 16

alienation of thought
delusions of control
hallucinatory voices
persistent delusions

Question 17

for a diagnosis of schizophrenia list the criteria for which 2 or more needs to be present for > 1 month

Answer 17

persistent hallucinations in any modality
neologisms
catatonic behaviour
negative symptoms

Question 18

what does alienation of thought include?

Answer 18

thought echo
thought insertion or withdrawal
thought broadcasting

Question 19

describe hallucinatory voices

Answer 19

running commentary on the patient’s behaviour or discussing him between themselves. or other types of hallucinatory voices coming from some part of the body

Question 20

describe neologisms

Answer 20

breaks or interpolations in the train of thought resulting in incoherence or irrelevant speech

Question 21

what term is used for a schizophrenic patient that puts random words together that make no sense?

Answer 21

schizophasia

Question 22

what is catatonic behaviour?

Answer 22

excitement
posturing or waxy flexibility
negativism
mutism 
stupor

Question 23

what biological factors may contribute to schizophrenia?

Answer 23

o Genetics
§ Acknowledged heritability from twin/family studies
§ Neuregulin
§ Dysbindin
§ Di George Syndrome
§ Multiple genes with a small effect on development of schizophrenia
§ DSC genes
o Neurochemistry
§ Dopamine hypothesis
§ Glutamate
§ GABA
§ Serotoninergic transmission
o Obstetric complications
o Maternal influenza
o Malnutrition and famine
o Winter birth
o Substance misuse – cannabis if someone is at risk of psychotic disorder anyway

Question 24

4 Ps of mental health

Answer 24

predisposing
precipitating
perpetuating
protective

Question 25

describe the Jung's Concept of Collective unconscious

Answer 25

“a storehouse of latent memory traces from man’s ancestral past. These typical symbols of myth, fable, and fairy stories are not accessible other than through altered consciousness, dreams or perhaps psychosis.”

Question 26

Conrad (1958) used the concepts of Gestalt Psychology to Identify Stages in the Development of Delusions describe

Answer 26

1. A state of fear 2. The delusional idea appears 3. An effort to make sense of the experience by altering one’s view of the world 4. Final breakdown, as thought disorder and behavioural symptoms emerge

Question 27

Phenomenology Science and the Anthropology of the Self: A New Model for the Aetiology of Psychosis describe

Answer 27

This theory recognises gross excess of schizophrenia in migrant population. All individuals construct a sense of self within a framework of time, morality and cultural symptoms. When individuals migrate, it is probably that change will occur at all these levels. This massive alteration in how one perceives oneself will have neuronal correlates with consequent vulnerability to severe mental illness

Question 28

what social factors may contribute to schizophrenia?

Answer 28

* Occupation and social class but be aware of the drift hypothesis * Migration * Social isolation * Life events as precipitants * Cultural factors are not implicated

Question 29

what are the psychotic illnesses?

Answer 29

delirium or acute organic brain syndrome | affective psychoses

Question 30

describe delirium

Answer 30

o Consequent upon brain or systemic disease o Prominent visual experience, hallucinations and illusions (misperception of real stimulus) o Affect of terror o Delusions are persecutory and evanescent o Fluctuating, worse at night

Question 31

describe depression with psychosis

Answer 31

§ Delusions of guilt, worthlessness, and persecution | § Derogatory auditory hallucinations

Question 32

describe mania with psychosis

Answer 32

§ Delusions of grandeur, special powers or messianic roles | § Gross overactivity, irritability and behavioural disturbance: Manic excitement

Question 33

how does the Scottish Recovery Network define recovery from schizophrenia?

Answer 33

"being able to live a meaningful and satisfying life, as defined by each person, in the presence or absence of symptoms".

Question 34

how many recover after their first episode of psychosis?

Answer 34

80%

Question 35

good prognostic factors for recovery of psychosis

Answer 35

* Absence of family history * Good premorbid function – stable personality, stable relationships * Clear precipitant * Acute onset * Mood disturbance * Prompt treatment * Maintenance of initiative, motivation

Question 36

poor prognostic factors for recovery of psychosis

Answer 36

* Slow, insidious onset and prominent negative symptoms * Mortality is 1.6x higher than the general population * Shorter life expectancy is linked to CV disease, resp disease and cancer * Suicide risk is 9 x higher * Death from violent incidents is twice as high * 36% of patients have substance misuse problems * Childhood onset

Question 37

discuss cognition and schizophrenia

Answer 37

Chronic schizophrenic patients show poorer cognition than first onset patients. There is no decline in cognition in follow up studies of first onset psychosis. The finding in chronic patients are an artefact of selective loss of patients – those who recover are not studied.