Pyschotic Disorders

Question 1

define schizophrenia

Answer 1

severe, long-term mental health disorder characterised by psychosis

Question 2

between what ages does schizophrenia most commonly present

Answer 2

15 and 30
- earlier in men than women

Question 3

how long must symptoms be present for before schizophrenia can be diagnosed

Answer 3

at least 1 month

Question 4

what is schizoaffective disorder

Answer 4

combines the symptoms of schizophrenia with bipolar disorder
- patients have psychosis and symptoms of depression and mania

Question 5

what is the difference between schizophrenia and schizophreniform disorder

Answer 5

schizophreniform disorder presents with the same features as schizophrenia but lasts less than six months

Question 6

how might you explain schizophrenia in simple terms

Answer 6

• condition that affects how the brain processes information
• normally the brain is good at understanding reality and organising thoughts in a structured way but with schizophrenia, sometimes it makes mistakes
• this can lead to strong beliefs that do not fit with reality, called delusions
• they may also experience voices that are not there, called hallucinations
• the disorganised thoughts can lead to unusual speech and behaviours, which is called thought disorder
• When these symptoms occur, it is called psychosis

Question 7

what are endocrine differentials of psychosis

Answer 7

• cushing’s syndrome (pt taking systemic steroids)
• hyperthyroidism

Question 8

what are other ddx of psychosis

Answer 8

• mania
• psychotic depression
• drugs e.g. hallucinogens and cannabis
• stroke
• brain tumours
• huntingtons

Question 9

what is the cause of schizophrenia

Answer 9

genetic + environmental
- specific genes increase risk
- affected family member is greater risk

Question 10

describe the overall presentation of schizophrenia

Answer 10

prodrome phase often precedes full symtpoms of pyschosis

Question 11

what may a pt experience during the prodrome phase of psychosis

Answer 11

• poor memory
• reduced concentration
• mood swings
• loss of appetite
• difficulty sleeping
• social withdrawal

Question 12

what is the central feature of schizophrenia

Answer 12

psychosis

Question 13

what are the positive symptoms of psychosis

Answer 13

• Delusions (beliefs that are strongly held and clearly untrue)
• Hallucinations (perceiving things that are not real)
• Thought disorder (disorganised thoughts causing abnormal speech and behaviour)

Question 14

what is lack of insight

Answer 14

lack awareness that the delusions and hallucinations are not based in reality

Question 15

what are key positive symptoms that are typical in schizophrenia

Answer 15

• Auditory hallucinations (hearing voices, particularly a voice narrating the patient’s actions)
• Somatic passivity (believing that an external entity is controlling their sensations and actions)
• Thought insertion or thought withdrawal (believing that an external entity is inserting or removing their thoughts)
• Thought broadcasting (believing that others are overhearing their thoughts)
• Persecutory delusions (a false belief that a person or group is going to harm them)
• Ideas of reference (a false belief that unconnected events or details in the world directly relate to them)
• Delusional perceptions

Question 16

what is a delusional perception

Answer 16

occurs when the patient experiences an ordinary and unremarkable perception (e.g., a cat crossing the road) that triggers a sudden, often self-related delusion (e.g., “and I knew I would be meeting the aliens on behalf of humanity”)

Question 17

what are the negative symptoms of schizophrenia

4 A’s

Answer 17

• Affective flattening (minimal emotional reaction to emotive subjects or events)
• Alogia (“poverty of speech” – reduced speech)
• Anhedonia (lack of interest in activities)
• Avolition (lack of motivation in working towards goals or completing tasks)

Question 18

give 3 patterns of schizophrenia presentation

Answer 18

• Continuous
• Episodic (relapsing and remitting)
• A single episode only

Question 19

how is schizophrenia diagnosed

Answer 19

at least one of the following for a period of one month or more:
- first rank symptoms (thought echo/insertion/withdrawal, delusions

at least 2 of the following
- hallucinations, thought disorder, catatonic behaviour or negative symptoms

Question 20

what are 4 aspects involved in managing patients with schizophrenia

Answer 20

• Early intervention in psychosis services are available for the first episodes of psychosis
• Crisis resolution and home treatment teams provide urgent support for patients in a crisis
• Acute hospital admission (under the Mental Health Act when required)
• Community mental health team for ongoing monitoring and management

Question 21

what are the 2 aspects of treating schizophrenia

Answer 21

• Antipsychotic medications
• Cognitive behavioural therapy

Question 22

what are 2 key associations with schizophrenia and antipsychotic drugs that need to be considered

Answer 22

1. metabolic syndrome
2. CVD

Physical health is monitored, including smoking status, alcohol consumption, illicit drug use, weight, activity levels, blood lipids and glucose, with interventions when indicated (e.g., smoking cessation and statins)

Question 23

what is the strongest risk factor for developing a psychotic disorder

Answer 23

family history

Having a parent with schizophrenia leads to a relative risk (RR) of 7.5

Question 24

what are 4 other selected risk factors for psychotic disorders

Answer 24

• Black Caribbean ethnicity - RR 5.4
• Migration - RR 2.9
• Urban environment- RR 2.4
• Cannabis use - RR 1.4

Question 25

what are schneider's first rank symptoms

Answer 25

1. auditory hallucinations of a specific type 2. thought disorders 3. passivity phenomena 4. delusional perceptions

Question 26

what are the specific types of auditory hallucinations in schizophrenia

Answer 26

* two or more voices discussing the patient in the third person * thought echo * voices commenting on the patient's behaviour

Question 27

what are factors associated with poor prognosis in schizophrenia

Answer 27

* strong family history * gradual onset * low IQ * prodromal phase of social withdrawal * lack of obvious precipitant

Question 28

what are persecutory delusions

Answer 28

based on the belief that someone or some group is plotting against them, harassing or intending to harm them

Question 29

what are grandiose delusions

Answer 29

exaggerated sense of self-worth, importance, talent, or knowledge

Question 30

what are erotomaniac delusions

Answer 30

false belief that another person, often of higher status, is in love with them ## Footnote also referred to as **De Clerambault’s** Syndrome

Question 31

what are jealous delusions

Answer 31

the conviction that a sexual partner or spouse is being unfaithful without evidence ## Footnote sometimes called morbid jealousy or pathological jealousy - more common in men

Question 32

what are somatic delusions

Answer 32

the belief in having a disease or an imagined medical condition - bugs or insects crawling on skin ## Footnote monosymptomatic hypochondriacal psychosis and forms part of somatic delusional disorder

Question 33

what are delusions of reference

Answer 33

involve interpreting insignificant events or comments in one's environment as having a special, personal meaning

Question 34

what are 2nd person auditory hallucinations

Answer 34

when a person hears a voice or voices **addressing them directly**, as if speaking to them in the second person ("You are going to die") or giving them commands ("Kill him")

Question 35

what are 3rd person auditory hallucinations

Answer 35

a symptom where a person hears voices talking about them in the third person, like "He is an evil person," or two or more voices discussing them - highly suggestive of schizophrenia but can also occur in affective disorders - can take the form of a running commentary on the person's actions or thoughts, or the voices may argue or converse among themselves about the individual

Question 36

what is the drug of choice for treatment resistant schizophrenia

Answer 36

clozapine

Question 37

what are passivity phenomena

Answer 37

delusional beliefs where an individual feels their thoughts, actions, or body sensations are controlled by an external force, rather than by themselves

Question 38

what are 2 important indications for ECT in schizophrenia

Answer 38

1. severe depressive symptoms accompanying schizophrenia 2. rare cases of catatonic stupor

Question 39

what is induced delusional disorder/ folie a deux

Answer 39

delusional disorder shared by 2 or more people with close emotional links - usually persectutory in nature - one person (dominant personality) has a psychotic disorder and is the originator which is then induced on the second. person - more common in women

Question 40

what is tangentiality

Answer 40

speech that deviates from the original topic and never returns to it

Question 41

What is circumstantiality

Answer 41

inability to answer a question without giving excessive, unnecessary detail

Question 42

What is echolalia

Answer 42

Repetition of someone else’s speech, including the question that was asked

Question 43

how can OCD be differentiated from psychosis

Answer 43

perspective on the rationality of concerns - if the patient has insight and is able to recognise her thoughts are irrational despite being unable to resist compulsion is characteristic of OCD

Question 44

how can hypomania be differentiated from mania

Answer 44

- time frame: less than 7 days - absence of psychotic symptoms e.g. hallucinations ## Footnote does not interefere with daily living acitivites

Question 45

what is a pseudohallucination

Answer 45

false sensory perception in the absence of external stimuli when the affected is aware that they are hallucinating ## Footnote commonly occur in people who are grieving - need REASSURANCE & SAFETY NET

Question 46

give an example of a hypnagogic hallucination

Answer 46

occurs when transitioning from wakefulness to sleep - these are experienced vivid auditory or visual hallucinations which are fleeting in duration

Question 47

what are capgras delusions

Answer 47

a person is convinced that someone close to them, like a family member or friend, has been replaced by an identical imposter

Question 48

what are potential causes of capgras delusions

Answer 48

1. schizophrenia 2. organic: brain injury, alzheimer's/parkinsons, metabolic/nutritional deficiencies 3. substance abuse

Question 49

what are the types of delusional misidentification disorder

Answer 49

- capgras syndrome - fregoli syndrome - intermetamorphosis - syndrome of subjective doubles

Question 50

what is fregoli syndrome

Answer 50

opposite of capgras - person perceives different people in their environment as being the same familiar individual, just with different appearances

Question 51

what is intermetamorphosis

Answer 51

- a person believes that a familiar individual and a stranger have physically and psychologically exchanged places, essentially transforming into one another - both phsyically and a shift in personality which distinguishes it from capgras

Question 52

what is paraphrenia

Answer 52

a chronic psychotic disorder, sometimes seen in late life, characterized by well-organized paranoid delusions and hallucinations but with preserved personality and intellect - common in elderly

Question 53

what is an encapsulated delusion

Answer 53

a fixed, false belief in a specific area of a person's life that is isolated from other aspects of their functioning, allowing them to maintain a generally normal life despite the unshakable belief - unlike other psychotic conditions, it doesn't affect their overall behavior or cognition

Question 54

what is the difference between knight's move and flight of ideas

Answer 54

* knight's move: illogical leaps from one idea to another * flight of ideas: discernible links