Essentials of Psychosis Flashcards
Definition of neurosis
A relatively mild mental illness that is not caused by organic disease, involving symptoms of stress (depression, anxiety, obsessive behaviour, preoccupation with physical illnesses) but not a radical loss of touch with reality.
Define psychosis
Psychosis can be defined as grossly impaired reality testing .i.e. persons incorrectly evaluate the accuracy of their thoughts and perceptions and make incorrect inferences about external reality, even in the presence of contrary evidence.
Characteristics of psychosis
Psychosis is a broad term but is generally associated with severe impairment of social and personal functioning characterised by social withdrawal and inability to perform the usual social and household occupational roles
Lack of insight is a key feature
Empathy as a tool to understand a patient’s symptoms include:
this involves observation, questioning, re-phrasing and checking if you’ve got it right.
Explain the phrase “psychosis occurs on a continuum”
Occur on a continuum
One pole
Grossly disorganised speech and behaviour. Difficult or impossible to get a coherent account of the symptoms.
The other pole
Symptoms are mild and difficult to distinguish from “normal”
Can be very subtle and difficult to elicit
Between the poles fall the patients who’s symptoms are easier to spot.
List clinical features of psychosis
None of the symptoms alone is definitive of any disorder
Always entertain a differential diagnosis for each symptom, then settle on a diagnosis that fits the pattern best.
Delusions Hallucinations Disorganised thinking (speech) Grossly disorganised or abnormal motor behaviour (including catatonia) Negative symptoms
List examples of psychotic disorders
Schizophreniform psychosis Schizophrenia Schizoaffective disorder Bipolar disorder Brief psychotic disorder Psychosis secondary to another medical condition Substance-induced psychosis
Define delusion
fixed, firmly held, false belief which is not amenable to change even in the face of contradictory evidence
The belief is out of keeping with that of the individual’s cultural group
And is not an article of faith or a religious belief
Distinction between a strongly held belief (overvalued idea) and a delusion is sometimes difficult to make and depends on the degree of conviction with which the belief is held despite clear or reasonable contradictory evidence regarding its veracity.
Name some of the themes of delusions
persecutory religious grandiose somatic referential nihilistic
Explain non-bizarre delusions
Within realms of possibility but patently untrue
E.g. a belief that one is under surveillance by the police, despite a lack of any convincing evidence.
Explain bizarre delusions
If clearly implausible and not understandable to same culture peers and do not derive from ordinary life experiences
E.g. A belief that someone has implanted a chip in one’s brain and that this “other” is controlling one’s actions or behaviour.
Bizarre delusions include:
- Thought withdrawal
- Thought insertion
- Delusions of control
- Thought broadcasting
Delusions may be:
Systematized and fragmentary
Systematized forms an association of ideas that fit into a coherent narrative, even though implausible
Fragmentary are bits of poorly, or non- associated ideas
Name causes of delusions
Schizophrenia Bipolar Disorder Delusional disorder Schizoaffective disorder Dementia Delirium Neoplasms Epilepsy Traumatic brain injury Vitamin deficiencies (pellagra) Endocrinopathies (thyroid, etc.)
Define hallucinations
A sensory perception that has the compelling sense of reality of a true perception but that occurs without external stimulation of the relevant sensory organ.
Hallucinations should be distinguished from illusions, in which an actual external stimulus is misperceived or misinterpreted.
Describe features of hallucinations
Vivid and clear with full force and impact of normal perceptions
Not under voluntary control
May occur in any sensory modality
Auditory commonest
Sensorium must be clear
Hypnagogic (falling asleep) and hypnopompic (waking up) normal
May occur in religious context in certain cultures.
