Psych - Psychosis Flashcards
What is psychosis?
difficulty perceiving and interpreting reality
What disorders can cause psychosis?
→ schizoaffective disorder → bipolar I → depression with psychotic features → due to other medical condition → substance-related → schizophrenia (1%) → delusional disorder
What are the symptom domains fo psychosis?
→ positive symptoms
→ negative symptoms
→ disorganisation
What are some positive symptoms of psychosis?
→ hallucinations
→ delusions
What are the features of psychotic hallucinations?
percepts in absence of a stimulus • Auditory • Voices commenting on you • Voices talking to each other • Visual • Somatic/tactile • Olfactory (rare)
What are the features of psychotics delusions
Fixed, false beliefs, out of keeping with social/cultural background • Persecutory • Control • Reference • Mind reading • Grandiosity • Religious • Guilt/sin • Somatic • Thought broadcasting • Thought insertion • Thought withdrawal
What are the negative symptoms of psychosis
→ alogia → anhedonia → abolition / apathy → affective flattening → associality
What is alogia?
→ poverty of speech
→ paucity of speech, little content
→ slow to respond
What is avolition or apathy?
→ poor self-care
→ lack of persistence at work / education
→ lack of motivation
What is anhedonia or asociality?
→ few close friends
→ few hobbies or interests
→ impaired social functioning
What is affective flattening?
→ unchanging facial expression → few expressive gestures → poor eye contact → lack of vocal intonations → inappropriate affect
What are disorganisation symptoms in psychosis?
→ bizarre behaviour
→ thought disorder
What are features of bizarre behaviour?
• Bizarre social behaviour • Bizarre clothing/appearance • Aggression/agitation • Repetitive/stereotyped behaviours
What are features of thought disorder?
- Derailment
- Circumstantial speech
- Pressured speech
- Distractibility
- Incoherent/illogical speech
What is the average onset of psychosis?
→ can occur at any age
→ peak incidence in adolescence or early 20s
→ peak later in women
What is the course of psychosis like?
→ often chronic + episodic
→ very variable
What is the morbidity of psychosis like?
→ Substantial, both from disorder itself and increased risk of common health problems e.g. heart disease
→ Significant impact on education, employment and functioning
What are the rates of mortality in psychosis?
→ substantial
→ all-cause mortality = 2.5x higher
→ 15 years of life expectancy lost
→ high risk of suicide in schizophrenia with 28% excess mortality
When taking a psychiatric history for psychosis, what do you look for?
- History of Presenting Concern
- Past Psychiatric History
- Background History (Family, Personal, Social)
- Past Medical History and Medicines
- Corroborative History
What do you look for in History of Presenting Concern?
- patient’s description of the presenting problem – nature, severity, onset, course, worsening factors, treatment received
- Circumstances leading to arrival to hospital
- WHY NOW?
What do you look for in Past Psychiatric History?
- Any known diagnosis?
- Any treatment?
- Known to a community team?
- Any previous admissions to hospital?
What do you look for in Background + Family History?
- Age of parents, siblings, relationship with them
- Atmosphere at home
- Mental disorder in the family, abuse, alcohol/drugs misuse, suicide
What do you look for in Personal History?
- Mother’s pregnancy and birth
- Early development, separation, childhood illness
- Educational and occupational history
- Intimate relationships
What do you look for in Social History?
- Living arrangements
- Financial issues
- Alcohol and illicit drug use
- Forensic History
What do you look for in Past Medical History + Medicines?
- Regular medications?
- Compliance?
- Over the counter medications?
- Interactions?
What do you look for in Corroborative History?
after gaining consent:
• Informants: relatives, friends, authority
• Confidentiality
