Psych - Psychosis Flashcards
What is psychosis
Difficulty perceiving and interpreting reality
What are the causes of psychosis
Schizoaffective disorder Bipolar I Schizophrenia Depression with psychotic features Delusional disorder Other medical conditions Substance related
What are the 3 types of psychosis symptoms?
Postive
Negative
Disorganisation
What are the main 2 positive symptoms?
Hallucinations
Delusions
What are hallucinations
Perception in the absence of a stimulus
What kind of hallucinations can we have
Auditory Voices talking about you or to each other Visual Somatic/tactile Olfactory (rare)
What are delusions
Fixed false beliefs out of keeping with social/cultural backgrounds
What kind of delusions can we have
Persecutory Control Reference Mind reading Grandiosity Religious Guilt/sin Somatic Thought broadcasting, thought insertion or thought withdrawal
What are the 4 main negative symptoms of psychosis
Alogia
Avolition/apathy
Anhedonia/asociality
Affective flattening
What is alogia
Poverty of speech - slow to respond and little content
What is avolition
Poor self care, lack of motivation or lack of persistence in work
What is affective flattening examples
Unchanging facial expressions Few expressive gestures Poor eye contact Lack of vocal intonations Inappropriate affect
What is anhedonia/ asociality
Few close friends, or social activities
What are the 2 main disorganisation symptoms
Bizarre behaviour
Thought disorder
What is bizarre behaviour
Bizarre social behaviour, clothing.
Aggression/agitation
Repetitive stereotype behaviours
What is thought disorder
Derailment Circumstantial speech Pressured speech Distractibility Incoherent/illogical speech
What is the onset of psychosis
Occurs at any age but most commonly in the late adolescence and early 20s. It is a later onset for females
What is the morbidity of psychosis
There is a risk not only from the behaviours associated with psychosis but also increased risk of other medical problems such as heart disease. There is a significant impact on work education and functioning
What is the course of psychosis
Often chronic and episodic however is very variable
What is the mortality of psychosis
Substantial - knocks off 15 years from life expectancy and there is a high risk of suicide especially with schizophrenia
What are the main aspects of the psychiatric history
HPC Past psych history Background history (family, personal, social) PMHx and DHx Corroborative history
Why are medical problems relevant to a psychiatric history
Medical problems can be a cause or consequence of mental disorder or psychiatric treatment
What is a corroborative history
This is when we talk to informants such as relatives, friends and the authorities to see if the patient is correct in their tellings - however we need consent to do this
What do we examine in the mental state examination
Appearance and behaviour Speech Mood Thoughts Perceptions Cognition Insight
What aspects of appearance and behaviour do we look at
General appearance Facial expression Posture Movements Social behaviour
What aspects of speech do we look at
Quantity
Rate
Spontaneity
Volume
What aspects of mood do we look at?
Subjective Objective: - Predominant mood - Constancy - Congruity
What is incongruity
When their mood does not match up with the current situations. E.g. if they are cheerful when describing sad events
What do we look at in terms of thoughts
Stream Form Content: - Preoccupation - Morbid thoughts, suicidality - Delusions. overvalued ideas - Obsessional symptoms
What is folie a deux
memory shared delusions between 2 individuals
What perceptions do we look for
Illusions
Hallucinations
Distortions
What are illusions
Misperception of a real external stimulus
What is a pseudohallucination
Hallucinations experienced by the patient however they still maintain insight and are aware that there is no true stimulus
What is Charles Bonnet syndrome
Visual hallucinations in someone whose vision is starting to deteriorate
What aspects of cognition do we look at
Consciousness Orientation Attention and concentration Memory Language functioning Visuospatial functioning
What do we look at in terms of insight
Awareness of oneself as presenting phenomena that are considered abnormal
Recognition that the phenomena are abnormal
Acceptance that they are caused by mental illness
Knowing you need treatment and accepting this
What are the 3 main types of treatment offered for psychosis
Pharmacological
Psychological
Social support
What antipsychotics can we give
Dopamine antagonists such as olanzapine
What are the side effects of antipsychotics
EPSEs
Sedation
GI e.g. constipation
Haematological - agranulocytosis and neutropenia
Metabolic e.g. weight gain, increased appetite, diabetes
Pituitary e.g. increased prolactin
Cardiac e.g. dysrhythmia, long QTc
