Psychosis Flashcards
What is psychosis?
A collection of symptoms in which a patient experiences a significant alteration in perceptions, thoughts, mood and behaviour, involving an inability to distinguish between subjective experience and objective reality and characterised by a lack of insight
What are the main symptoms psychosis?
Hallucinations Delusions Thought disorder Loss of insight Self-referential experiences Ideas of reference
What is a hallucination?
A perception which occurs in the absence of an external stimulus
A misrepresentation of inner experience as having external origin
What is a delusion?
A fixed, falsely held belief held with unshakeable conviction
What is the difference between primary and secondary delusions?
Primary - arrive fully formed without need for explanation
Secondary - attempts to explain anomalous experiences
Which is more common - primary or secondary delusions?
Secondary
What are thought disorders?
Any disturbance in cognition that adversely affects language and thought content, and thereby communication
What are examples of thought disorder?
Passivity phenomenon Thought interference Loosening of associations Knight's move thinking Neologisms Circumstantiality Tengentiality Verbigeration
What is passivity phenomenon?
The feeling that the patient’s actions, feelings, urges aren’t their own
What is thought interference?
The feeling that the patient’s thoughts not their own, being withdrawn, broadcast, blocked
What is loosening of associations?
Speech is muddled, illogical, difficult to follow and cannot be clarified
What is Knight’s move thinking?
Jumps from topic to topic with no logical connection between them
What are neologisms?
An abnormality of speech in which the patient makes up a new word or phrase or uses existing words or phrases in bizarre ways which have no generally accepted meaning but which have idiosyncratic meaning to the patient
What is circumstantiality?
When the patient talks around the point but gets there eventually
What is tangentiality?
When the patient talks around the point and never actually gets to it
What is verbigeration?
Individual words don’t connect and sentences make no sense whatsoever
What are self-referential experiences (paranoia)?
The belief that external events are related to oneself
How are persecutory thoughts different to paranoia?
Paranoia is when you think unrelated things are related to you
Persecutory is only when you think someone is out to get you/others
What are ideas of reference?
Innocuous or coincidental events are ascribed significant meaning
What are psychiatric causes of psychosis?
Schizophrenia
Scizoaffective disorder
Mania
Depression
What are organic causes of psychosis?
Dementia Delirium Huntington's SLE Syphilis Hyperthyroidism Hypoglycaemia Parkinson's HIV/AIDS Syphilis
What cause of psychosis do auditory hallucinations make more likely?
Schizophrenia
What cause of psychosis do visual hallucinations make more likely?
Drugs
What cause of psychosis do tactile hallucinations make more likely?
Delirium
Alcohol withdrawal
What drugs can cause psychosis?
Cannabis Amphetamine Levodopa Steroids Antimalarials Anticonvulsants Antipsychotics Antidepressants
The withdrawal of which substances can cause psychosis?
Alcohol
Benzodiazepines
What is the treatment for drug-induced psychosis?
Cessation of use of the causative drug - usually takes about 4 weeks
When are psychosis symptoms mood congruent?
In mood disorders
What are features of psychosis in depression?
Delusions of worthlessness, guilt, nihilism
Auditory hallucinations that are derogatory, insulting or threatening
Cottard’s syndrome - belief that the body has already died
Typically second person
Affirming their perception of themself
What are features of psychosis in mania?
Delusion of grandeur, special ability, persecution, religiosity
Hallucination tend to be second person and auditory
Flight of ideas
What is schizoaffective disorder?
The diagnosis that bridges the gap between bipolar and schizophrenia
When psychosis and mood symptoms are present in equal measure
Who is schizophrenia most common in?
Men
Lower socioeconomic class
Onset in young adulthood
What is the aetiology of schizophrenia?
Multi-factorial neurodevelopment disorder
Genetics (80% inherited)
Environmental factors (obstetric complications, childhood CNS infection, early cannabis use)
Psychological factors (stress, adverse life events, psychoactive drug use)
What biological changes happen in schizophrenia?
Changes in dopamine signalling pathways in the brain
Lack of gliosis (reactive change of glial cells in response to damage to the central nervous system)
Ventricular enlargement and alteration fo CSF flow
Decrease in white matter volume
What are the ‘first rank’ symptoms of schizophrenia?
3rd person auditory hallucinations
Thought insertion, broadcast or removal
Passivity phenomenon
Delusions
Describe the hallucinations of schizophrenia?
3rd person auditory hallucinations that give a running commentary or discussion of the patient
Describe the delusions of schizophrenia?
Persistent
Culturally inappropriate or completely impossible