Differential Diagnosis of Psychosis Flashcards
What is psychosis? (4 features)
-what are psychotic experiences? (6)
Qualitatively different from normal experience
Involves inability to distinguish between subjective experience and reality
Characterised by lack of insight
Harmful to the individual’s functioning and interpersonal relationships
-hallucinations delusions passivity Formal thought disorder emotional disturbance Physical symptoms
What are Schneider’s first rank symptoms?
In schizophrenia:
auditory hallucinations
delusions of thought interference
Delusions of control
What is flight of ideas?
Words are associated together inappropriately because of their meaning or rhyme so that speech loses its aim and the patient wanders from the original theme. The patient jumps from topic to topic but with recognizable links such as rhyming, punning or environmental distractions.
formal thought disorders, what are the following:
- Knights move thinking/loosening of associations?
- tangential thinking?
- Circumstantiality?
- nonsesnical
- Wandering from the topic and never returning to it or providing the information requested
- An inability to answer a question without giving excessive, unnecessary detail. This differs from tangential thinking, in that the person does eventually return to the original point.
What are the Ddx of psychotic symptoms? (10)
Schizophrenia Psychoactive substance use Mania Depression Schizoaffective disorder Delirium Dementia persistent delusional disorder delusional disorder Other organic cause
What language should be used in a consultation with a suspected psychotic patient?
Do not disagree but do not agree either:
It is important to recognise the importance of the experience & not give the impression that it is “all in your head”. Make the effort to understand as best you can what the patient is explaining in their own words:
“I just want to check that I am understanding this correctly, I don’t want to misunderstand you, I think what you are saying is that ……
But still need to challenge to check insight
Think of creative ways to challenge:
“What would you say if someone said to you that [these beliefs] are not true?”
“Can you just explain to me how this is possible?”
It is possible to “agree to disagree”
eventually…
There does come a time to say “I think that this is evidence that you are actually unwell and I think you need to be in hospital & receive treatment – although I recognise that you disagree with this”
Schizophrenia
-what are the distinguishing features? (5)
-prodromal symptoms & gradual functional decline
first rank symptoms typical but not necessary
Negative symptoms may be prominent
depressive/manic symptoms are absent/minmimal
self referential experiences
Drug induced psychosis
-what are the distinguishing features? (3)
-tend to be short lasting if access to NPS removed
beware COMORBIDITY in context of substance abuse and schizophrenia & bipolar disorder
e.g. cocaine, amphetamines, LSD etc.
Depressive psychosis
-what are the distinguishing features? (2)
-typified by mood congruent content of psychotic symptoms
i.e. delusions of worthlessness, guilt, poverty, hypochondriasis
hallucinations of accusation/insulting/threatening voices
Mania with psychosis
-what are the distinguishing features? (4)
mood congruent content of psychotic symptoms
delusions of grandeur, special ability, persecution, religiosity
Hallucinations auditory
Flight of ideas
Schizoaffective disorder
-what are the distinguishing features? (2)
-presencee of BOTH symptoms typical of schizophrenia and affective disorder
any episode can be schizo-manic or schizo-depressed
Delirium
- what are the distinguishing features? (2)
- what happens to cognition? (2)
- symptoms? (5)
acute confusion
-transient global disturbance
common and related to an underlying condition
e.g. alcohol withdrawal, infection, septicaemia, organ failure
-clouding of consciousness (disorientated, fluctuating course, worse at night)
impaired concentration/memory
-visual hallucinations/illusions +/- auditory hallucinations persecutory delusions Psychomotor disturbance irritability insomnia
