Psych: Psychosis: Free MSRA Podcast

⚕️ FREE MSRA PODCAST – Psychosis
🎧 A clear, high-yield breakdown of this severe mental health condition affecting perception and reality – perfect for exam prep and real-life clinical scenarios.

🧠 Key Learning Points

📌 Definition
• Psychosis is a mental health condition characterised by a disconnection from reality, often involving hallucinations, delusions, and disorganised thinking. It significantly impairs a person’s ability to function.

📌 Causes & Risk Factors
• Primary psychiatric conditions (e.g. schizophrenia, bipolar disorder)
• Severe depression (psychotic depression)
• Substance misuse – particularly cannabis, LSD, cocaine
• Neurological conditions – e.g. Parkinson’s disease, brain tumours
• Family history of psychotic disorders
• Childhood trauma, social isolation
• Medical causes – neurosyphilis, HIV, space-occupying lesions
• Mnemonic: "S.C.A.R.E.D.":

• Substance misuse

• Conditions (neuro, infectious)

• Affective disorders (depression, bipolar)

• Risk factors (family history, trauma)

• Early onset

• Delusions/hallucinations

📌 Pathophysiology
• Dysregulation of dopamine and glutamate in brain circuits
• Structural and functional brain abnormalities (e.g. prefrontal cortex, limbic system)
• Abnormal signal processing leads to altered perception, delusions, hallucinations

📌 Symptoms
• Positive symptoms: hallucinations (esp. auditory), delusions, disorganised speech/behaviour
• Negative symptoms: social withdrawal, reduced motivation, blunted affect
• Cognitive symptoms: impaired memory, attention, executive function
• Associated: agitation, aggression, depression, self-harm thoughts
• Mnemonic: "HDD-NAC"

• Hallucinations

• Delusions

• Disorganised thinking

• Negative symptoms

• Aggression

• Cognitive deficits

📌 Differential Diagnosis
• Mood disorders with psychotic features (e.g. severe depression, mania)
• Substance-induced psychosis
• Delirium
• Dementia
• Medical conditions (e.g. infections, brain tumours, endocrine disorders)

📌 Diagnosis
• Clinical history + mental state exam
• Symptom-based diagnosis – no single confirmatory test
• Investigations to exclude organic causes:

• FBC, LFTs – check for alcohol misuse

• Serology – rule out syphilis

• HIV screening

• Urine drug screen – detect recreational drugs

• CT brain – if focal neurological signs present
  • Tip: CT is not routine, only used if structural lesion suspected

📌 Management
• Antipsychotics – risperidone, olanzapine (first-line)
• Mood stabilisers – lithium or carbamazepine (if bipolar-related)
• Psychological therapies – CBT, family therapy
• Hospital ad

Episode Transcript

(00:00):
Welcome back to the Deep Dive. If you're looking for a clear
high yield breakdown of a complex medical topic, well,
you're definitely in the right. Place.
Yeah, absolutely. Today we're diving into
psychosis. We've basically got a stack of
focused revision notes right here, and our mission really is
to unpack them. Pull out the essentials and give

(00:20):
you a solid, memorable overview.Exactly.
Think of it as your shortcut to getting a good grip on psychosis
straight from this source material we have.
Perfect. We're taking those detailed
notes and just distilling them down, highlighting the core
concepts and, you know, the connections you need, whether
you're revising or just want to understand it better.

(00:41):
Precisely. We'll guide you through.
OK, let's unpack this then. First things first, what is
psychosis? Fundamentally, our notes
describe it as a severe mental disorder, Yeah, where there's a
significant loss of contact withreality.
It's not just feeling a bit off,it's quite profound.
Right. It fundamentally alters how
someone perceives the world and that loss of reality, contact,

(01:02):
it affects, well, multiple areas.
Yeah, their thoughts, perceptions, emotions, even
their behaviours. And the classic symptoms we
often associate with it. What do the notes highlight?
Well, the notes point to the common ones, hallucinations, you
know, sensory experiences without any actual external
stimuli like hearing, voices. Then delusions, which are these

(01:24):
firmly held false beliefs, really not based in reality, and
also disorganised thinking wherespeech and thought processes can
become quite jumbled or illogical.
And crucially, this state impairs a person's ability to
function day-to-day, right? Exactly that impairment in daily
functioning is key. So is it always like a
standalone condition? Schizophrenia, for example.

(01:45):
No, and this is a really important point from the notes.
Psychosis can be a primary condition, yes, but it can also
show up as a symptom of other conditions.
Things like mood disorders, severe depression or bipolar
disorder, certain neurological conditions too, or even
substance misuse. The core feature, though, is
always that altered perception of reality.

(02:06):
That's the thread. Got it.
So a state of altered reality, potentially with different root
causes. OK, moving from what it is to
why it might happen. The aetiology.
The notes say the exact cause isn't fully understood.
That's right. Which honestly is common for
many complex brain conditions, but they do point towards a
combination of factors. Check a mix.

(02:27):
Yeah, it's seen as an interplay between sort of genetic
vulnerability, neurobiological factors, things happening in the
brain, and environmental influences.
And specifically about the brain, what neurobiological
factors are mentioned? The notes implicate disruptions
in brain chemistry. They specifically mention
excessive dopamine activity as akey factor.

(02:48):
Dopamine. OK.
And they also mentioned structural and functional
abnormalities in the brain itself playing a role.
So it's a complex interaction, your genes, your brain chemistry
and structure and life experiences, which leads us
nicely to risk factors. This is where it gets really
interesting, doesn't it? What makes someone more
susceptible? Yeah, the notes list several key
factors that increase the likelihood.

(03:09):
A big one is family history of psychotic disorders.
Makes sense linking back to the genetic side.
Absolutely. Substance abuse is another
significant risk factor mentioned.
We'll see that pop up again, right?
And early childhood prama or neglect also feature quite
prominently in the notes. What about other biological
factors beyond just genetics? Well, the notes include things

(03:30):
like prenatal exposure to infections or toxins, certain
medical conditions like brain tumours for instance, and even
just high levels of stress are listed as contributing risk
factors. These are all points the notes
flag as increasing vulnerability.
Wow. It really gives you a sense of
the different pathways that could potentially lead to this
state. So we've covered the why.

(03:52):
Now for the how the pathophysiology, What's the
actual mechanism behind the symptoms?
OK, so the notes explained it involves dysregulation of
neurotransmitters. They specifically pointed
dopamine again and also glutamate within various brain
circuits. So, like, the brain's chemical
messengers aren't quite working right?
Exactly. Think of it like the signals

(04:13):
aren't being transmitted correctly.
It's not just on, off, it's about the balance and flow,
right. And the notes add that this
dysregulation is linked to thosestructural and functional
abnormalities we mentioned in key brain regions involved in
processing perception, thinking,emotion.
And these physical changes contribute directly to the
symptoms people experience. That's the idea, yeah.

(04:35):
The changes contribute to the hallucinations, the delusions,
the disorganised thinking. OK.
Now, if someone presents with these symptoms, clinicians
obviously need to think about what else it could be right the
differential diagnosis. Absolute crucial step.
The notes really emphasise this.You've got to rule out other
conditions that might look similar on the surface.

(04:55):
Like what sort of things would be on that list?
Well, the source lists mood disorders that can have
psychotic features, so severe depression or mania.
Substance induced psychosis is avery common one to consider.
They also mentioned delirium, that acute state of confusion,
often from a medical illness. Right, different from psychosis
itself. Exactly, and other General

(05:15):
Medical conditions that can sometimes mimic psychotic
symptoms. It's all about figuring out the
primary issue. Makes total sense.
Need to treat the right thing. OK, let's switch gears slightly
to epidemiology. How common is psychosis?
What are the numbers? Right.
The notes give us the UK figuresprevalence is about .5% to 1%,
so that's the percentage of the population affected at any given

(05:37):
time and incidents. So new cases is around 26.6 per
100,000 people per year. And when does it typically first
show up? Is there a usual age?
Yes, it usually emerges in late adolescence or early adulthood.
The notes specifically highlight15 to 30 years as the peak age
range for onset. That's a key detail to remember
for revision. 15 to 30 got it. Any differences noted in who

(06:00):
gets it? Demographics.
Yeah, the notes mentioned a potentially high risk in men and
possibly in some racial or ethnic groups.
But they also say there's variation depending on location
and specific population characteristics.
OK, so 1530 is definitely the number to lock in for onset age.
Let's try and visualise what it actually looks like in a person.
The clinical presentation, we touched on the core symptoms

(06:21):
earlier. Right, the notes give a bit more
detail. Hallucinations, as we said,
sensory experiences without external stimuli, Seeing things,
feeling things. But most commonly it's auditory
hallucinations. Hearing voices is very typical.
Right. Hearing voices is often the one
people think of first, isn't it?It really is.
Then there are delusions. These are those strongly held

(06:44):
false beliefs, Not just odd ideas, but fixed, unshakable
beliefs, often paranoid, like believing you're being
persecuted or grandiose, believing you have special
powers or importance. And they aren't easily corrected
by evidence. And the disorganised speech or
behaviour, what does that look like?
This replaced difficulty with thought processes.
Speech might become incoherent, jump between unrelated topics or

(07:07):
just not make sense. Behaviour can seem erratic,
unpredictable, maybe inappropriate for the situation.
And the notes mentioned other symptoms too beyond those main
3. Yes, they include what are
sometimes called negative symptoms.
Things like social withdrawal, reduced motivation, almost like
a flattening of emotion. Emotional instability can be
there too, and impaired cognition.

(07:28):
So problems with memory, attention, general thinking
ability. Are there other associated
features? Yeah, the notes mention
agitation or aggression can occur.
Further neurocognitive impairment.
Depression is common, sometimes severe enough to be psychotic.
Depression and importantly, thoughts of self harm.
Right. And as we mentioned earlier,
these symptoms can peer across different underlying conditions.

(07:50):
Exactly the notes list where psychosis occurs.
Schizophrenia is the classic one, but also severe depression
and bipolar disorder. Queer purple psychosis which
happens postpartum, brief psychotic disorder which is
short lived, certain neurological conditions like
Parkinson's disease and of course drug use, both prescribed
meds and illicit substances. That's a pretty broad list.

(08:12):
So how do clinicians actually figure this out?
The investigations? It starts with talking to the
person I assume. Absolutely, the notes stress
diagnosis begins with a comprehensive psychiatric
evaluation. That means taking a detailed
history, background, symptom timeline, any potential
triggers, then a mental status examination to assess their
current state, mood, thought process, perceptions right now

(08:35):
and a specific symptom assessment to really pin down
the nature of the hallucinations, delusions,
disorganisation. OK.
And what about the medical testslisted in the notes?
Why are those specific ones likeLFTS and FBC?
Right, the notes are clear on the reasons, which is high yield
info. Liver function tests, LFTS and a
full blood count FBC are done partly to screen for alcohol

(08:57):
misuse. Alcohol can cause abnormal liver
markers or macrocytosis, those enlarged red blood cells.
Got it. Specifically looking for alcohol
as a possible factor. What about the others
serological tests? Serological tests are included
to check for syphilis because neurosyphilis can actually cause
psychiatric symptoms. Aid screening is mentioned
because of the increased risk ofCo occurring infections in some

(09:18):
populations which can affect brain function.
And the urine drug screen seems fairly obvious.
Yeah, that's specifically to detect recreational drug use
like cannabis, which the notes explicitly list as a potential
cause or trigger. Right.
And the CT brain scan, when is that used?
That's done if there are focal neurological signs, you know,

(09:39):
signs pointing to a specific area of the brain being
affected, like weakness on one side, numbness.
So not routine for everyone. No, it's to rule out structural
issues like a brain tumour, a space occupying lesion, or
cerebral atrophy which is shrinking of brain tissue only
if indicated. OK.
So targeted investigations basedon the clinical picture makes

(10:00):
sense. Once a diagnosis is made or
strongly suspected, how is psychosis managed?
The notes describe a combinationapproach.
It's usually pharmacotherapy, somedication plus psychosocial
interventions, which means various therapies.
And the medication is primarily antipsychotics.
Correct antipsychotic meds are really the cornerstone for
reducing the positive symptoms like hallucinations and

(10:21):
delusions. And the therapies?
The notes and that psychologicaltherapies are crucial.
They specifically list CBT, cognitive behavioural therapy
and family therapy. These are important for
supporting recovery and, really importantly, for preventing
relapse. What are the main goals of
treatment according to the notes?
The aims listed are minimise thetime between symptoms starting

(10:43):
and getting treatment, getting help quickly is key, accelerate
remission, getting symptoms under control and then prevent
future relapses using both meds and therapy and ultimately
maximise the person's ability toreturn to their usual life as
much as possible. And getting that prompt
assessment, sometimes that involves hospital admission.
Yes, the notes state. Admission to a psychiatric unit

(11:06):
might be necessary, especially if it's severe or acute, or if
there's a risk to the person themselves or to others.
And in situations where treatment is really needed but
the person can't consent, perhaps due to the psychosis
itself, compulsory hospitalisation and treatment
might be required under the Mental Health Act.
That's the legal framework in the UK, but the initial step is
always getting that presumptive diagnosis and a specialist

(11:29):
assessment and secondary care. Do the notes mention specific
medication preferences dependingon what's causing the psychosis?
They offer some guidance, yeah. For psychosis and schizophrenia,
the newer atypical antipsychotics like risperidone
or olanzapine are often preferred first line for mania
or hypomania. With psychosis, again atypical

(11:51):
antipsychotics are used, maybe with benzodiazepines short term
for agitation or sleep issues and mood stabilisers like
lithium or carbamazepine, but those need special supervision.
And if it's part of depression? The notes suggest that's often
linked to the bipolar spectrum and stress that treating the
psychosis itself is central. It really sounds like acting

(12:12):
fast, that early intervention isvital.
Hugely. The notes explicitly state that
early recognition and correct management of a first episode
are crucial for improving long term outcomes.
And addressing those external factors.
Yes, like substance misuse, tackling that is highlighted as
vital for reducing relapse ratesand involving the family through

(12:34):
intervention programmes is also mentioned as helpful.
And throughout all this, the importance of respectful
treatment. Absolutely.
That's reiterated alongside the potential need for compulsory
treatment under the Mental Health Act when it's truly
necessary for safety. OK, so early intervention, meds,
therapy, tackling substance use,family support, those seem to be
the recurring themes. What about the long term

(12:56):
picture, the prognosis? What can someone expect?
Well, the notes describe the prognosis as highly variable.
It really depends on a lot of factors such as the underlying
cause, how well someone respondsto treatment, how early they got
that intervention, whether they stick with medication, the
strength of their support system, their overall physical
health. Lots of things.
Is there any data on that variability?

(13:18):
Any stats in the notes? Yes, they provide some
statistics, while around 80% of people do respond positively to
treatment within the first year,which is quite high.
That sounds promising initially.It does, but the picture changes
longer term. Only about 20% remain completely
episode free for five years, Thecommon course described as an

(13:39):
initial improvement but then often recurrent episodes.
So relapse is common. It seems to be, yeah, Yeah.
And they also mentioned that roughly 15% might experience
persistent symptoms that don't fully respond to treatment even
after two years. OK, so treatment helps most
people initially, but it's oftena condition with a risk of
return. What factors might suggest a

(13:59):
tougher road ahead? The poor prognosis factors.
The notes list several indicators that might predict a
more challenging recovery, a longer period of untreated
psychosis before starting treatment.
That highlights the early intervention point again, right?
An early age of onset or an insidious sort of gradual onset?
Particularly for schizophrenia, being male is noted as a risk

(14:20):
factor for poor prognosis. Interesting.
The presence of significant negative symptoms like that,
lack of motivation, a family history of the disorder, lower
IQ, lower socioeconomic status or social isolation, a history
of previous significant psychiatric illness, and
crucially, continued substance misuse that comes up.

(14:41):
Again, that list really feels connected to everything else.
Risk factors, treatment challenges, delays, ongoing
substance use, lack of support. They all make sense as hurdles.
Yeah. OK, finally, what if psychosis
isn't treated? What are the potential
consequences? The complications.
Yeah, the notes details some pretty serious potential
outcomes of psychosis is left untreated.

(15:02):
Severe social and occupational impairment making it hard to
keep relationships or a job. A significantly increased risk
of self harm or suicide. Worsening substance abuse which
can become a vicious cycle. Increased medical comorbidities.
Other physical health problems popping up.
Homelessness is mentioned as a sad but real complication and
just a drastically decreased quality of life overall.

(15:24):
Those are very stark potential outcomes.
They really underscore the absolute necessity of early
detection, intervention and ongoing support.
The notes emphasise these are vital to minimise these severe
complications and promote the best possible recovery.
It just reinforces everything we've discussed about getting
help quickly and comprehensively.

(15:44):
So, wrapping things up slightly,what does this all mean?
Let's do a quick memory refresh.Hit some high yield points
straight from these notes. For anyone revising, let's test
recall a bit. Can you remember the two main
neurotransmitters mentioned as being dysregulated?
Dopamine and glutamate. The notes focused on those two.
Spot on. And what was that key age range
for typical onset the notes wanted us to remember?

(16:06):
That was 15 to 30 years. Yes, definitely lock that one
in. OK, Besides hallucinations and
delusions, what was the other core symptom area we covered?
Disorganised thinking or disorganised speech and
behaviour? Right.
And thinking about the investigations, what was one
specific reason ACT scan might be done according to the notes?
If there were focal neurologicalsigns to rule out things like

(16:28):
tumours, structural problems. Excellent, perfect.
And if we look across managementprognosis, complications, what
two major factors kept coming upas crucial for improving
outcomes and preventing relapse?Early intervention was
definitely 1, and addressing substance misuse was the other
big one that kept reappearing. Absolutely.
Those threads run right through it all, don't they?

(16:50):
From risk to recovery. Hopefully framing these points
helps them stick. Yeah, understanding how all
these pieces fit together, from the biochemistry to the social
impact, is really key to grasping the full picture these
notes provide. So to wrap up this deep dive,
we've really navigated the essential points from the notes
on psychosis, defining it, causes, symptoms, diagnosis,

(17:10):
treatment, prognosis, complications, the works.
Considering how variable that prognosis can be and how
critical early intervention clearly is, here's a final
thought. How my understanding those risk
factors we discussed actually influence community initiatives
or public health efforts, you know, to try and identify people
who need help sooner. That's a really valuable

(17:30):
question to ponder as you process all this information,
thinking about prevention and early detection strategies.
Definitely something to think about now if you're revising for
exams like the MSRA and found this kind of note breakdown
helpful, you should absolutely check out Pass them sra.com,
they've got loads of resources like this.
Yeah, great resources there. And you can find some free

(17:51):
materials to get you started over at freemsra.com as well.
That's pass them sra.com and freemsra.com.
Thank you so much for joining usfor this deep dive into the
notes on psychosis. Hope.
It was helpful for your learningand revision.