Assessment of Psychosis Flashcards
how does psychosis present
hallucinations
psychomotor
thought disorder
delusions
negative symptoms
Assessment of Psychosis
history
MSE
risk assessment
Physical exam
organic causes of psychosis
(there’s a lot)
Delirium, dementia, malignancy, epilepsy, head trauma, CVA, HIV/AIDS encephalitis, CJD, syphilis, metabolic (thyroid, Ca, Na, glucose), vitamin deficiencies (B1, B3, B12, folate), medications, substances
what classification is a delusional disorder
ICD-11
what is included in the ICD-11
- Presence of a delusion or set of related delusions
- Persists for at least 3 months
- Absence of a depressive, manic, or mixed episode
- Content varies across individuals, but stable within individuals - can evolve in time
- Common forms of delusion: persecutory, somatic, grandiose, jealousy, erotomania
- Absence of hallucinations, FTD, experiences of influence/passivity/control, or negative symptoms suggestive or schizophrenia. In some cases, there may be specific hallucinations related to the delusionary content
- Apart from actions/attitudes directly related to the delusional system, affect, speech and behaviour typically unaffected
- Symptoms not due to another medical condition, substances, medications, withdrawal. Not better explained by another mental disorder
what is capgras syndrome
Belief that a person closely related to the patient has been replaced by a double
what is fregoli syndrome
Identifies familiar people in strangers
what conditions does capgras or fregoli syndrome occur
schizophrenia, traumatic brain injury, affective psychosis, Alzheimer’s disease
what is erotomania
Believe that somebody of a higher social class is in love with them
who is more at risk of erotomania
F>M
what is othello syndrome
morbid jealousy
Delusional belief that partner is having an affair without any evidence
when is Othello syndrome more common
alcoholism, organic states, affective psychosis
what is cotard’s syndrome
False belief that part of the body is dead, dying, or doesn’t exist
when is cotards syndrome typically seen
psychotic depression
what is ekbom syndrome
Delusional parasitosis, describes the delusion of infestation
what is ekbom syndrome associated with
tactile hallucination (formication) in cocaine misuse, dementia, and alcohol withdrawal
in what conditions does ekbom syndrome occur
affective psychosis, delusional disorder, paranoid schizophrenia, organic brain syndromes
what is Foli-à-deux
madness of 2
Delusion disorder that occurs at the same time in two people who have a strong emotional or situational link
What’s the diagnosis?
A patient believed that an electronic device was jamming his mind. He claimed that this started 5 years ago when he picked up his telephone and heard an unusual clicking noise.
delusional perception
What’s the diagnosis?
A patient on the ward believes that he has special powers and hears the voice of God telling him how to help others
grandiose delusion
What’s the diagnosis?
A patient believes that her neighbour could change his appearance and even sex at will to spy on her.
fregoli syndrome
What’s the diagnosis?
A patient suffering from severe depression believes that she is very wicked and about to be imprisoned for life.
delusion of guilt
Whats the diagnsois
A woman believes that her husband has been replaced by an exact double
capras syndrome
what’s the diagnosis
A man believes he is being tormented, followed, tricked, spied on ridiculed
persecutory delusion
whats the diagnosis
A woman believes that the Prime Minister is in love with her. She has never met him and writes him regularly
erotomania
(De Clerambaults syndrome)
whats the diagnosis
A man normally mildly jealous suffering from alcohol dependence becomes convinced that wife is having an affair
Othello syndrome
whats the diagnosis
A patient believes that certain comments, newspapers and song lyrics are specifically directed at her
delusions of reference
what substances can cause psychosis
Alcohol
cannabis, “legal highs
amphetamine
cocaine
hallucinogens,
inhalants/solvents
prescribed medications (antiparkinsonian drugs, corticosteroids, anticholinergics)
what is puerperal psychosis
Considered a type of BPAD in DSM-V. Positive psychotic symptoms, depressive/manic symptoms also typically present.
what cause lewy body dementia
alpha-synuclein cytoplasmic inclusions (Lewy bodies) in the substantia nigra, paralimbic, and neocortical areas
what are the key features of lewy body dementia
Progressive cognitive impairment
Parkinsonism
Visual hallucinations
Fluctuating cognition
Repeated falls, syncope
Neuroleptic sensitivity – parkinsonism
what are the 2 main drugs given for lewy body dementia
Donepezil or rivastigmine
whats the difference between delirium and dementia
delirium is abrupt, lasts hours to weeks, sleep impaired, hallucinates, delusional
dementia is slow, sleep normal, no hallucinations
what are non-pharmaceutical management of delirium
Calm environment, consistent caregivers
visit from friends/family
good eyesight - glasses
good hearing - hearing aids
what pharmacological management can be done for delirium
haloperidol - 1st choice
quetiapine
what must you avoid in delirium
Benzos!!
What’s the psychopathology?
A 45 year old man believes his wife is having an affair as she has been frequently coming home late from work and he thinks he saw her kissing another man. He is upset and has been trying to get evidence to confront her. He has quit his job in order to follow her and taken out a loan to buy cameras to place in her car, workplace, and handbag.
obsession
What is the most likely diagnosis?
An 18 year old man is brought to A&E by his flatmates because for the last fortnight he has been complaining the neighbours are talking about him and tonight stated “enough was enough” and picked up his cricket bat to go and confront them. His friends cannot hear the neighbours. The man has smoked cannabis every day for the last 6 months and has recently been experimenting with “legal highs”.
Psychosis secondary to psychoactive substance use
What is the most likely diagnosis?
An 80 year old lady with macular degeneration is brought to her GP by her daughter who is concerned that her mother has been asking her to move non-existent dogs and cats off her couch. Her mother is otherwise alert, orientated, and in good health.
Charles Bonnet syndrome
what is Charles bonnet syndrome
people who have lost some or all of their sight to see things that aren’t there. (hallucinations)
