Psychiatry - Psychosis & Addiction Flashcards
Define psychosis.
- a set of symptoms rather than a diagnosis in its own right
- thoughts, affective responses, ability to recognise reality, and the ability to communicate/relate to others is significantly impaired;
- loss of ability to distinguish between subjective experience and objective reality
Name and describe the key features of psychosis.
- hallucination (described in Mood Disorders)
- ideas of reference: innocuous / coincidental events ascribed significant meaning (‘message about me’)
- paranoia, persecutory delusion: external events related to oneself in some way
- delusion (see Mood Disorder)
- passivity phenomena (made actions/ feelings/ thought; ‘they made me feel this way;)
Describe the risk factors for schizophrenia and psychosis, and the structural changes that occur in the brain.
- risks for schizophrenia: 2nd trimester viral illness, PET, foetal hypoxia, emergency C/S, childhood viral illness
- risks for psychosis: amphetamines, cocaine, cannabis, ‘legal highs’
- decreased function of frontal lobe, frontotemporal volume, increased lateral ventricles
Describe the dopamine hypothesis.
- drugs which release dopamine (and D2 agonists) in the brain produce psychosis, and their antagonists are used to treat it
- D1 (and 5) activate cAMP
- D2 (3, 4) inhibits AC and VGCC
Describe the differential diagnosis of schizophrenia.
- dementia and delirium: formal thought disorder, poverty of thought, delusion, passivity phenomena, hallucination, fluctuant, and impaired LOC
- substance misuse: delusions, passivity phenomena, hallucination, fluctuant, LOC can be impaired
- schizophrenia: formal thought disorder, poverty of thought, delusions, passivity phenomena, hallucination
- mania: formal thought disorder, delusion, auditory hallucination
- depression: poverty of thought, persecutory delusion, auditory hallucinations can occur
Give the diagnostic classification of schizophrenia.
1 of:
- thought echo, insertion, withdrawalm broadcasting
- delusions of control, influence, passivity
- hallucinatory voices
- persistent delusions of other kinds that are culturally inappropriate or impossible
or 2 of:
- persistent hallucination in any modality every day for 1 month
- neologisms, breaks in train of thought, incoherent speech
- catatonic behaviour / excitement
- negative symptoms: marked apathy, paucity, blunting of responses
Name the psychiatric conditions more likely to affect young people.
- bipolar disorder
- disruptive behaviour disorders
- ASD
- ADHD
- separation anxiety
- trauma and attachment
Name the risk factors for developing delirium (and dementia).
I WATCH DEATH
- infection
- withdrawal
- acute
- toxins
- CNS pathology
- hypoxia
- deficiencies
- endocrine
- acute vascular shock
- trauma
- heavy metals
Name and describe the four core models concerning addiction and its treatment.
- moral: those who take substances do so purely by choice, with no regards for the consequences of their behaviour on themselves or others
- medical: those who take substances are ill, with physiological and psychological changes that override the degree of choice they were once able to use
- dispositional disease: ‘disease’ of addiction is irreversible - no cure, but can be arrested by total abstinence (benevolent models, such as AA and NA use this model)
- personality: personality traits, such as inability to cope with stress, contribute to addiction, and resolution requires restructuring of personality.
Define ‘conditioning’ in relation to addiction.
an individual comes to associate a desired behaviour with a previously unrelated stimulus; thus, substance misuse is ‘learned behaviour’, requiring relearning.
Describe Pavlov conditioning and the conditioned compensatory response theory.
- classical conditioning / associative learning
- ringing of a bell with dog food causes the dog to salivate, conditioning the dog to salivate at sound of the bell
- conditioned compensatory response: one is more likely to survive an overdose if taken in the same environment where previously received.
Describe Skinner conditioning.
- operant / instrumental
- positive: adds a stimulus
- negative: removes a stimulus
- positive reinforcement: relaxed after using drug
- positive punishment: being yelled at after using
- negative reinforcement: removes withdrawal symptoms
- negative punishment: loss of home, family, work etc.
Describe and exemplify the five main types of thinking error that may lead to addiction.
- permission giving: ‘just a treat’
- minimisation: ‘it’s only one’
- denial: ‘i can stay in control’
- blaming: ‘she made me angry, so i had to use’
- rationalisation: i haven’t used in a week, so why not?
Define and describe formulation.
- a provisional exploration / hypothesis for how an individual comes to present with a certain disorder at a particular time / circumstance [1996]
- summarises the core problems, how difficulties may relate to one another, and aims to explore the development / maintenance of difficulties, while indicating a plan of intervention rooted in psychological principles; open to constant revision [2014]
Describe the social, psychological, and biological factors contributing to a psychological formulation.
- social: self-concept, self-esteem, values, relationships, social, cultural, network, environment
- psychological: perception, executive, social function, action, memory function
- biological: metabolism, endocrine, immune, nervous, cardiovascular factors.
