HSD 11.2

Question 1

What is the difference between delusions and hallucinations?

Answer 1

Delusions: Fixed, false beliefs that don’t change even when shown clear evidence they’re wrong — they’re not shared or explained by normal experiences.

Hallucinations: False perceptions (seeing, hearing, or feeling things) that seem real and vivid but happen without any external stimulus and aren’t under voluntary control.

Question 2

List the types of delusions and examples to match them.

Answer 2

NIHILISTIC DELUSION (Cotard’s Syndrome)
person believes they are rotting or dead e.g “my intestines have rotted away”

DELUSIONAL JEALOUSY
person is afraid that their spouse is being unfaithful which if unfounded e.g “i have got a detective to investigative my man who im sure is cheating on me but idk why”

EROTOMANIA (De
Clerambault
syndrome)
person is convinced that a person (usually famous or superior) that they are fixated on is in love with them e.g “i am convinced the PM wants to marry me”

FOLIE A DEUX (induced delusional disorder)
shared psychosis between two people

Question 3

Which symptoms must one have to be diagnosed with Schizophrenia?

Answer 3

Question 4

Which symptoms must one have to be diagnosed with Drug-Induced psychosis?

Answer 4

Question 5

Which symptoms must one have to be diagnosed with Delusional Disorder?

Answer 5

Question 6

How can we divide the biological explanations of psychoses?

Answer 6

Question 7

What anatomical changes correlated in chronic schizophrenic brains?

Answer 7

Question 8

List 4 genes that could potentially contribute to the disorder of schizophrenia.

Answer 8

COMT gene - helps break down dopamine, issue is that is can mess with dopamine regulation especially in the prefrontal cortex

DRD2 gene - encodes dopamine D2 receptors which are the key targets for antipsychotic drugs

BDNF gene - supports brain growth and neuron survival so disruptions can affect brain development and function

AKT1 gene - impacts dopamine signalling and neuron survival

Question 9

What is the meaning of ‘aberrant salience’?

Answer 9

it is when the brain gives wrong importances to things that are actually irrelevant or harmless

Question 10

In schizophrenia, which brain regions ‘misfire’ when assigning importance or “meaning” to things in the environment?

What is this called? Give an example.

Answer 10

ventral striatum and insula

aberrant salience e.g a random person coughing might suddenly feel like a “secret message” or flickering light might seem “significant” or “meant for me”

Question 11

What does the Ventral Striatum do?

What do the Insula do?

Answer 11

VS: brain’s reward/motivation area - normally tells you what is important or rewarding however in schizophrenia, it starts flagging irrelevant stuff as “rewarding” or “important”

insula: helps you sense what is happening inside your body like emotions, hunger etc, when overactive or miswired, it can make normal sensations feel strange or significant

Question 12

What is “source error monitoring” and how is it linked to schizophrenia?

This explains why people with this condition may experience what?

Answer 12

source error monitoring: the brain’s ability to tell where a memory or thought came from - was it something you actually heard or something you just thought? this system goes HAYWIRE in schizophrenia

so person might think:
“ the voice i imagined actually came from outside my head”

this explain why they may experience AUDITORY HALLUCINATIONS

Question 13

Which brain regions are malfunctioning in source error monitoring in schizophrenia?

Answer 13

Question 14

List the 3 neurotransmitters which are involved in psychosis and mention which one is most correlated with schizophrenia.

Answer 14

Question 15

What prenatal factors may contribute to the explanation of psychoses?

Answer 15

Question 16

What perinatal factors may contribute to the explanation of why people develop psychoses?

Answer 16

Question 17

List 4 conditions associated with psychotic symptoms.

Answer 17

Question 18

List 4 classes of medications associated with psychotic symptoms.

Answer 18

Question 19

What was found to be present in 80% of patients with early psychosis?

Answer 19

exposure to childhood trauma

Question 20

Which 2 childhood traumas are most associated with psychosis at some point in people’s lives?

Answer 20

bullying

intention to harm or maltreatment by an adult

Question 21

Which substance has the strongest predisposition as a risk factor to psychoses?

Especially in young adults with which gene?

List 4 other associated substances.

Answer 21

cannabis

COMT gene

alcohol
cocaine
LSD
amphetamine

Question 22

What does the term spiritual emergence refer to?

Answer 22

Question 23

What is the difference between Spiritual Emergence and Spiritual Emergency?

Answer 23

spiritual emergence is a positive, transformative process, like a spiritual “upgrade” - key idea is that you are expanding your consciousness and connecting deeply with meaning, purpose and inner peace - EMOTIONALLY ENRICHING AND MANAGEABLE

spiritual EMERGENCY is when that same process for off the rails - awakening becomes overwhelming - too intense and disorienting or traumatic = DISTRESS, CONFUSION, PSYCHOSIS-LIKE SYMPTOMS

Question 24

What are the four main dopamine pathways in the brain?

Answer 24

MESOLIMBIC pathway = positive symptoms
- controls reward, pleasure, motivation
- TOO HIGH IN SCHIZOPHRENIA -> causes positive symptoms i.e hallucinations, delusions and paranoia

MESOCORTICAL pathway = negative symptoms
- cognition and emotion
- in S, dopamine is too low -> causes negative symptoms i.e flat affect, lack of motivation, poor speech

NIGROSTRIATAL pathway = movement side effects
- co-ordinates movement
- if blocked by antipsychotics = causes extrapyramidal side effects like tremors

TUBEROINFUNDIBULAR pathway = hormone problem
- usually regulates prolactin release
- if blocked by antipsychotics = low dopamine -> high prolactin -> HYPERPROLACTINEMIA (galactorrhea, amenorrhea, sexual dysfunction)

Question 25

What is the mechanism of action of 1st gen anti-psychotics? Give an example and list 3 side effects.

Answer 25

Question 26

What is the mechanism of action of 2nd gen anti-psychotics? Give an example and list 3 side effects.

Answer 26

Question 27

What is a 2nd generation antipsychotic medication for the treatment of resistant psychosis? Explain its mechanism of action.

Answer 27

CLOZAPINE - lower affinity for D2 receptor antagonism, higher affinity for D1 and D4 receptor antagonism - antagonism of 5-HT2 muscarinic and a-adrenergic receptors side effects: - agranulocytosis, regular FBC for monitoring neutrophils

Question 28

What 3 things make up the psychological treatment of psychosis?

Answer 28

CBT family interventions ART therapy

Question 29

How does CBT help with the treatment of psychosis? What are they key techniques?

Answer 29

aims to reduce distress and/or social/occupational disturbances by working with: - delusion - hallucinations - negative symptoms key techniques - distraction using headphones - desensitisation: describing and recording and recognising connection between stressors and hallucinations

Question 30

What areas does family therapy cover in the treatment of psychosis? What does it focus on?

Answer 30

Question 31

How does Art Therapy help in the treatment of psychoses?

Answer 31

Question 32

What is the NICE guidelines for treating schizophrenia?

Answer 32

step 1 - REFERRAL if high risk: - early intervention in psychosis service if available or same day specialist mental health assessment if not high risk - specialist MH assessment step 2 - MEDICATION and PSYCHOLOGICAL therapies - trial of antipsychotics and any/all of the following: CBT ART therapy FAMILY INT THERAPY step 3 - TX RESISTANCE - clozapine - monitor FBC weekly for 18 weeks then fortnightly for a year then monthly thereafter

Question 33

How often should FBCs be done for someone on clozapine?

Answer 33

Question 34

What is the guideline for treating Delusional Disorder?

Answer 34

Question 35

What are the 5 P's in Case Formulation?

Answer 35

Question 36

What is agranulocytosis and which medication can cause it?

Answer 36

dangerous loss of neutrophils -> high infection risk CLOZAPINE

Question 37

What type of antipsychotic is haloperidol?

Answer 37

typical first gen potent D2 receptor antagonist - mainly in the mesolimbic pathway - reduces positive symptoms e.g hallucinations and delusions

Question 38

What type of antipsychotic is quetiapine?

Answer 38

atypic second gen antipsychotic D2 and 5HT2A receptor antagonist - improves both positive and negative symptoms

Question 39

List 3 antipsychotics, including one for resistance, their mechanism and side effects.

Answer 39

Question 40

This dopamine pathway is overactive in schizophrenia, leading to positive symptoms such as hallucinations and delusions. What pathway is this?

Answer 40

mesolimbic

Question 41

This dopamine pathway is underactive, causing negative symptoms like lack of motivation, flat affect, and social withdrawal. What pathway is this?

Answer 41

mesocortical

Question 42

Blocking dopamine in this pathway causes extrapyramidal side effects (tremors, rigidity, dystonia) and tardive dyskinesia. What pathway is this?

Answer 42

nigrostriatal ( tardive dyskinesia: late-onset, often irreversible movement disorder caused by long-term use of dopamine-blocking drugs (mainly antipsychotics, especially the typical ones like haloperidol)

Question 43

Blocking dopamine in this pathway increases prolactin release, leading to hyperprolactinemia (galactorrhea, amenorrhea, sexual dysfunction). What pathway is this?

Answer 43

tuberoinfundibular pathway

Question 44

Which pathway is responsible for reward and motivation, and becomes overactive in schizophrenia?

Answer 44

mesolimbic

Question 45

Which dopamine pathway connects to the prefrontal cortex and is linked with cognitive and emotional regulation?

Answer 45

mesocortical

Question 46

Which pathway runs from the substantia nigra to the striatum and controls movement coordination?

Answer 46

nigrostriatal

Question 47

Which dopamine pathway runs from the hypothalamus to the pituitary gland, regulating hormone secretion?

Answer 47

tuberoinfundibular pathway

Question 48

A patient insists they are dead and that their internal organs have decayed. What type of delusion is this?

Answer 48

Nihilistic delusion (Cotard’s syndrome)

Question 49

A man believes his partner is cheating, even though there’s no evidence and she denies it. He hires a private investigator to prove it. What type of delusion is this?

Answer 49

Delusional jealousy

Question 50

A woman claims a famous actor is in love with her and sends her secret signals through movie scenes. What type of delusion is this?

Answer 50

Erotomania (De Clérambault’s syndrome)

Question 51

Two family members share the exact same false belief that their neighbour is trying to harm them, despite no proof. What type of delusion is this?

Answer 51

Folie à deux (induced delusional disorder)

Question 52

Which group of people has the highest suicide rate?

Answer 52

males aged 45-49

Question 53

List 5 risk factors for suicide.

Answer 53

Question 54

List 5 protective factors against suicide.

Answer 54

Question 55

List 4 ways in which you could help someone who is feeling suicidal.

Answer 55

Question 56

List 5 suicide red flags.

Answer 56

Question 57

What is the definition of Self-harm? Who is it more common in?

Answer 57

Question 58

What is the relationship between self-harm and suicide? List 5 things.

Answer 58

Question 59

What is the Mental Health First Aid Action Plan?

Answer 59

ALGEE

Question 60

How can you acutely and long-term manage a patient who is a suicide risk?

Answer 60

Question 61

Under which act can you detain someone voluntarily or against their will for urgent treatment for a mental disorder that puts themselves or others at risk?

Answer 61

MHA 1983

Question 62

What are the different types of Sections for?

Answer 62

Question 63

Which section is for assessment and possible treatment for up to 28 days?

Answer 63

section 2

Question 64

Which section includes police having to obtain a warrant to enter a private building?

Answer 64

section 135

Question 65

Which section is for doctors and nurses to briefly detain a patient until a 'detention section' takes place?

Answer 65

section 5 - 5.2 and 5.4