Psychosis Flashcards
psychosis
difficulty in perceiving and interpreting reality
- symptom not a condition
what are organic psychosis causes?
a variety of conditions including strokes, brain injury, encephalitis, Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, temporal lobe epilepsy or brain tumours.
Functional psychoses include schizophrenia and mood disorders such as manic-depression.
types of symptoms in psychosis
- positive symptoms (experiencing things that aren’t there- adds to reality)
- negative symptoms (opposite)
- disorgnaisation symptoms
types of positive symptoms
- Hallucinations:
- Auditory
- Voices commenting on you or talking to each other
- Visual
- Tactile hallucination (feel like sometimes tapping you)
- olfactory hallucinations
- delusions
what are delusions?
Give some examples
beliefs with lie outside of normal social or cultural beliefs
- Mind reading
- Grandiosity
- Religious
- Guilt/sin
types of negative symptoms
- alogia (poverty of speech- pausing and slow to respond)
- avolition/apathy (poor self care, lack of persistence at work/school, lack of motivation)
- affective flattening (unchanged facial expressions, few expressive gestures, lack of eye contact)
- anhedonia (few close friends, few hobbies)
disorganisation symptoms
- thought disorder
- bizarre behaviour
peak age of incidence of schiz
adolescence/early 20s -> peak later in women
course of schiz
- chronic and episodic
- -> very variable
how many years of life is lost in schiz?
15 years
- also 28% of excess mortality due to suicide
the psych history
- history of presenting concern
- past psychiatrics history
- background history
- past medical history and medicines
- corroborative history
what type of psychological symptoms should you check for in psychosis?
prodromal symptoms
management of psychotic disorders
- pharmacological
- psychological
- social support
which NT system is most implicated in the mechanism of antipyschotics
- Dopamine
antipsychotics act on many NTS including serotonin, ACh, histamine. - drug actions are never agonistic when giving dopamine for minimising psychotic issues
Extrapyramidal side effects of dopamine blockers?
What can we also call these side effects?
Parkinson’s syndrome side effects:
acute dystonia
tardive dyskinesia
akathisia
what is dystonia
motor tone is increased; abnormal postures. If affects larynx it can be fatal.
tardive dyskinesia
- repeated oral/facial/buccal/lingual movements - more common in women.
akathisia
- inner restlessness
- feel compelled to move but it doesn’t make them feel better.
- most commonly affects the legs
typical antipsychotics cause what?
- extrapyramidal side effects at therapeutic doses
- definition isn’t based on pharmacological drug target
other examples of side effects of antipsychotics (typical and atypical)?
- EPSE
- GI constipation
- Haematological issues (agranulocytosis, neutropenia)
- metabolic - eat more, gain weight
- cardiac dysrhythmia
- Pituitary causes increased prolactin (release suppressed by dopamine)
Describe what bizarre behavior might include
• Bizarre social behaviour • Bizarre clothing/appearance • Aggression/agitation • Repetitive/sterotyped behaviours
Describe what though disorder may include
Derailment Circumstantial speech • Pressured speech • Distractibility • Incoherent/illogical speech
What is the impact of psychosis on morbidity?
Substantial from the disorder itself and increased risk of common health problems e.g. heart disease
Impact on education, employment and functioning
What is the impact of psychosis on mortality?
2.5 times all cause mortality
15 years expected life loss
Highest risk of suicide in schiz (28%)
What are 2 fundamental parts of diagnosing psychosis?
The psychiatric history
Mental state examination
What do we call it when an individual is immobile and mute?
Stupor
What are the 4 things we observe when looking at speech?
Quantity
Rate
Spontaneity
Volume
What are the 2 types of delusions?
Primary- occurs suddenly (out of the blue)
Secondary (arises from previous abnormal idea/ experience)
Whata re the 2 types of hallucinations related to when you’re asleep on awake?
Hypnagogic- occur between wakefulness and REM sleep
Hypnopompic- Occur after having woken up
Give an example of a disease related to visual hallucinations
Charles Bonnet Syndrome
What is a pseudohallucination?
Either a true perception (illusion) or is coming outside of the head (person is aware it’s abnormal)
What is insight?
Aware of oneself as presenting phenomena that other people consider as abnormal
Acceptance that abnormal phenomena are caused my mental illness and that treatment in required
