Functional Psychosis Flashcards
Neurosis
Relatively mild mental illness that is not caused by organic disease but not a radical loss of touch with reality. Symptoms of stress (depression, anxiety, obsessive behaviour, preoccupation with physical illnesses)
Psychosis
Grossly impaired testing.
e.g., incorrectly evaluate the accuracy of their thoughts and perceptions, and make incorrect inferences about external reality, even in the presence of contrary evidence.
What is Psychosis associated with?
Severe impairment of social and personal functioning characterized by social withdrawal and inability to perform the usual social and household occupational roles. Lack of insight.
What should you use to understand patient’s symptoms?
Empathy- observation, questioning, rephrasing, and checking if you’ve got it right.
Psychotic symptoms
- Occurs on a continuum.
- One pole: grossly disorganised speech and behaviour.
- Other pole: symptoms are mild and difficult to distinguish from normal.
Key defining features
Delusions, hallucinations, disorganised thinking (speech), grossly disorganised or abnormal motor behaviour (including catatonia), and negative symptoms.
Examples of psychotic disorders
Schizophrenia psychosis, Schizophrenia, Schizoaffective disorder, Bipolar disorder, Brief psychotic disorder, Psychosis secondary to another medical condition, and Substance-induced psychosis.
Delusions
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. It is not an article of faith or religious belief.
Variety of delusion themes
Religious, grandiose, somatic, referential, nihilistic.
Bizarre Delusion
Clearly implausible and not understandable to same culture peers. Does not derive from ordinary life experiences.
Bizarre delusions include
Thought withdrawal, Thought insertion, Delusions of control, Thought broadcasting.
Non-bizarre delusion
Within realms of possibility but patently untrue.
Systematized Delusions
forms an association of ideas that fit into a coherent narrative, even though implausible.
Fragmentary delusions
Are bits of poorly, or non-associated ideas.
Causes of delusions
Schizophrenia, Bipolar disorder, Delusional disorder, Schizoaffective disorder, Dementia, Delirium, Neoplasms, Epilepsy, Traumatic brain injury, Vitamin deficiencies (Pellagra), Endocrinopathies (thyroid, etc).
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.
More on Hallucinations
Not under voluntary control
Auditory more common, sensorium must be clear.
Hypnagogic (falling asleep) and hypnopompic (waking up) normal.
May occur in religious context in certain cultures.
Auditory hallucination
One or more voices, familiar or unfamiliar. Commentate, command, echo thoughts.
Causes of auditory hallucinations
Schizophrenia, bipolar mood disorder, schizoaffective disorder, substance abuse/intoxication, dementia, tumours
Visual hallucinations
Bizarre, transient, usually terrifying, not cinematic.
Causes of visual hallucination
Delirium (e.g., DT’s), stroke, neoplasm.
Olfactory hallucination
Unexplained smell.
Causes of olfactory Hallucination
Epilepsy (Aura)
Gustatory hallucinations
Unexplained taste
Tactile hallucinations
Crawling sensation on skin
Causes of tactile hallucinations
Alcohol withdrawal (DT’s)
Somatic hallucinations
Sensations within the body- electric shocks, etc.
Causes of somatic hallucinations
Substance abuse/intoxication, schizophrenia, BPAD.
Types of Disorganised thinking
Formal thought disorder, Derailment/ loosening of associations, Tangentiality, and Incoherence/ word salad.
Formal thought disorder
Loss of the normal flow of thought, typically inferred from individual’s speech.
Derailment/ loosening of associations
Jumping from topic to topic
Tangentiality
Answer to a question may be obliquely related or completely unrelated.
Incoherence/ word salad
Speech that is severely disorganised as to be incomprehensible.
THOUGHT DISORDER
flight of ideas. A nearly continuous flow of
accelerated speech with abrupt changes from topic
to topic that are usually based on understandable
associations, distracting stimuli, or plays on words.
When severe, speech may be disorganized and
incoherent.
Characteristic of MANIA.
More on loosening of associations
Characteristic of schizophrenia.
Disturbance of thinking showed by speech in which ideas shift from one subject to another that is unrelated or minimally related to the first.
Statements that lack a meaningful relationship may be
juxtaposed, or speech may shift suddenly from one
frame of reference to another. The speaker gives no
indication of being aware of the disconnectedness,
contradictions, or illogicality of speech.
Circumstantiality
Pattern of speech that is indirect and delayed in reaching its goal because of excessive or irrelevant detail or parenthetical remarks. The speaker does not lose the point.
Catatonia
Decreased reactivity to the environment.
Decreased mobility to complete unawareness or …
Purposeless and unstimulated excessive motor activity (catatonic excitement).
Rigidity and maintenance of postures (‘waxy flexibility’).
Negativism: active resistance to instructions or attempts to move them.
Posturing: assuming bizarre postures.
Echolalia (meaningless repetition of words just spoken by another person) and echopraxia (involuntary repetition or imitation of another person’s actions).
Causes of catatonia
Schizophrenia, Depression, Neurological disorders (CVA, neoplasm, head trauma, encephalitis), Metabolic (hypercalcaemia, DKA, homocystinuria, hepatic encephalopathy), Dementia, Delirium.
Disorganized behavior
Poor self care.
Unkempt appearance.
Poor hygiene and inability to perform activities of daily living (e.g., shopping, cooking).
Inappropriate and bizarre behavior (e.g., public masturbation, exhibitionism, unusual dress).
Child like silliness to gross agitation.
Causes of disorganized behavior
This is a non-specific sign of psychosis.
Can be caused by any serious psychiatric or neuropsychiatric disorder.
Indication of severity of illness.
Schizophrenia
Aetiology unknown, likely a cluster of disorders.
Onset in males tends to be younger than in females; usually late teens/early twenties; often has a poorer prognosis.
Tends to run a relapsing and remitting course with gradual, progressive deterioration. However, 10-20% will have a single episode and are symptom free thereafter, although more vulnerable (e.g. unemployment, relationship conflicts, poverty, psychoactive drugs may serve as potential triggers).
Positive symptoms of Schizophrenia
Hallucination, delusions, disorders of thought form.
Negative symptoms of schizophrenia
Loss of volition, motivation, spontaneous behavior, social withdrawal, anhedonia (inability to experience joy or pleasure), affective flattening and poverty of thought, and alogia (speak less, say fewer words or only speak in response to others).
Mx of schizophrenia
Biological: first and second generation antipsychotics.
Non-biological: family intervention, education, supportive counselling, attending to basic needs such as accommodation).
Bipolar disorder type 1
Episodes of mania and depression (possibly less severe).
May also be mixed, with features of mania and depression simultaneously.
Bipolar disorder type 2
Episodes of hypomania and depression (possibly more severe).
