CT 3 - The Patient With Psychotic Symptoms Flashcards
What is psychosis
Disorder of perception, thought form or content, derangement of personality and a loss of contact with external reality causing a deterioration of normal social functioning
May be present with or without organic damage
Maybe chronic or transient
What is a hallucination
Perception experienced in the absence of an external stimulus
What are the different types of hallucination
Auditory
Visual
Olfactory
Gustatory
Somatic
When assessing disorders of thought what should be looked at
Flow (the speed of thinking and deliverance of speech)
Form (loss of normal structure of thinking, appears muddled or illogical). includes flight of ideas which is when the content of speech moves quickly to another idea before the previous train of thought is completed)
(Commonly seen in schizophrenia are word salad, knight’s move and point thinking
Content ( what are beliefs and thoughts are. Includes delusions,obsessions, overvalued ideas and magical thinking
What are delusions
False beliefs that cannot be shaken. These beliefs are not true and accepted or recognised within the persons culture or religion
What is magical thinking
Belief that you can influence real world events with certain actions or rituals
Eg it is raining because I’m sad
What are the types of delusions
Persecutory (being followed or are going to be harmed)
Delusions of reference (belief that events occurring in the world are aimed at them)
Delusions of control (belief that thoughts,actions and beliefs are being controlled by an external force)
Delusions of thought insertion, withdrawal and broadcast
Grandiose delusions (inflated self esteem, powerful. Or have relationship with someone famous)
Delusions of jealousy / othello syndrome (belief that partner is being unfaithful)
Delusions of guilt (something happened because of them eg someone died..)
Nihilistic delusions (belief that they are dead or their body does not belong to them, world is ending, no money etc
Hypochondrial delusions (firm belief that they are ill and diseased)
What are signs and symptoms of psychosis
Psychosis is a mental health condition characterized by a disconnection from reality, where an individual may experience distorted thoughts, perceptions, and behaviors.
- hallucinations
- delusions
- disordered thinking
- abnormal behaviour ( agitation, Catatonia, violent or impulsive)
What is schizophrenia and what are the risk factors
characterized by a combination of symptoms that may include hallucinations, delusions, disorganized thinking, and impaired cognitive function.
Genetics:
Family History: Schizophrenia tends to run in families. People with a first-degree relative (parent, sibling) with schizophrenia have a higher risk of developing the disorder. However, most people with schizophrenia do not have a family history of the condition.
Genetic Variations: Certain genes related to brain development, neurotransmitter function, and the immune system may play a role in increasing the risk of schizophrenia.
- Brain Chemistry and Structure:
Neurotransmitter Imbalances: Dysregulation of neurotransmitters such as dopamine and glutamate is thought to play a role in schizophrenia. These chemicals are involved in brain signaling and thought processes.
Brain Abnormalities: Brain imaging studies have shown structural abnormalities in individuals with schizophrenia, such as enlarged ventricles, reduced gray matter, and abnormalities in certain brain regions involved in thinking, emotions, and memory.
- Prenatal and Early Life Factors:
Maternal Infection or Malnutrition: Exposure to certain infections (e.g., influenza or toxoplasmosis) or malnutrition during pregnancy may increase the risk of schizophrenia in offspring.
Complications During Birth: Problems such as oxygen deprivation during delivery or preterm birth can increase the likelihood of developing schizophrenia later in life.
- Environmental Factors:
Psychosocial Stress: Major life stressors, trauma, or early adverse experiences (e.g., abuse, neglect, or childhood adversity) can increase the risk of schizophrenia, especially in those who are genetically predisposed.
Drug Use: The use of psychoactive substances, especially cannabis, amphetamine, and cocaine, has been linked to an increased risk of schizophrenia, particularly in individuals who are genetically vulnerable. These drugs can trigger or worsen the onset of the disorder.
Urban Environment: Growing up in an urban environment or being exposed to high levels of social stress and isolation may also increase the risk of schizophrenia.
What are the positive symptoms of schizophrenia
Presence of problematic behaviours:
Hallucinations
Delusions
Disorganised thought and nonsensical speech
Bizarre behaviours
What are the negative symptoms of schizophrenia
-ve = absence of healthy behaviours
Flat affect
Reduced social interaction
Anhedonia
Avolition (less motivation, initiative+ focus)
Alogia (speaking less)
Catatonia (moving less)
What are the three major phases of schizophrenia
1) prodromal (non specific symptoms can be present for weeks or months preceding first acute psychotic event)
2) active phase (psychotic symptoms - mainly positive ones. May resolve spontaneously or can continue
3) residual phase (no longer having prominent psychotic symptoms but some negative symtoms may be present such as eccentric behaviour, blunted affect and social withdrawal)
Differential diagnoses for psychotic symptoms
1) rule out medical or organic causes
2) any substance misuse or withdrawal
3) schizophrenia
4) schizotypal PD
5) persistent delusional disorder
6) brief psychotic disorder
7) schizoaffective disorder
8) mood disorder with psychotic symptoms
What biological theories explain the basis for schizophrenia
- genetic predisposition
- elevated levels of dopamine
- differences in Brain structure (enlarged ventricles and reduced total brain volume)
- overactive HPA axis ( can also get steroid induced psychosis)
Dopaminergic pathways:
Disruption of Mesolimbic pathway (role in motivation, emotions and rewards) —> positive symptoms of psychosis (too much dopamine)
Mesocortical pathway (role in cognition, planning, focus, emotions and affect. Lowered function of this pathway leads to negative symptoms (low dopamine)
Nigrostriatal pathway - 80% of brains dopamine. Controls motor function +movement
Serotonin levels are thought to be lower in psychosis and may contribute to -ve symtoms
Glutamate hypothesis - excitatory NT - lower levels may predispose to schizophrenia
What does the mental health act 1983 allow for those with mental illness
Patients can be treated against their wishes and placed in hospital if they are a threat to themselves or anyone else. (Sectioned)
This assessment is carried out by an approved mental health professional and 2 doctors.
