psychosis Flashcards
What is psychosis?
Difficulty perceiving and interpreting reality (break from reality) can be caused by many disorders eg. schizophrenia
What are positive and negative symptoms?
Positive symptoms are changes in thoughts & feelings that are added on to a persons experience (eg hallucinations) but negative symptoms are things that are taken away or reduced
What are positive symptoms of psychosis + their definitions?
- hallucinations (percepts in absence of stimulus - perceiving something that isnt there) eg. Auditory, visual, somatic/tactile, rarely olfactory
- delusions (fixed false beliefs out of keeping with social/cultural background) eg. Persecutory, control, mind-reading, gradiose, religious, guilt/sin, thought broadcasting, insertion, withdrawal
What are negative symptoms of psychosis + their definitions?
- alogia (poverty of speech) eg. Paucity of speech, slow, little content
- anhedonia/associality (few friends, few hobbies/interests, impaired social functioning)
- avolition/apathy (poor self-care, lack of motivation, lack of persistence of work/education
- affective flattening (unchanging facial expressions, few expressive gestures, poor eye contact, lack of vocal intonations, inappropriate affect)
What are disorganisation symptoms of psychosis + their definitions?
- bizarre behaviour (bizarre social behaviour, clothing/appearance, aggression, repetitive/stereotyped behaviours )
- thought disorder (impaired ability to sustain conversation eg. Derailment, circumstantial speech, pressured speech, distractability, incoherent/illogical speech)
What is the epidemiology of psychosis? Its onset and course?
Onset can occur at any age but peak incidence in adolescence/early 20s and women.
Course often chronic & episodic (rarely one episode - if yes stress induced).
Why is treatment of psychosis important?
To prevent relapse because every relapse is worse & more treatment resistant
Why is morbidity and morality substantial in psychosis?
- Morbidity substantial from disorder itself and increased risk of health problems (CV disease, not healthy lifestyle) + impact on education, employment, functioning.
- Mortality substantial high risk suicide in schizophrenia (15 years life expectancy lost)
What is important to include in a psychiatric history on top of the usual?
- history of presenting complain (usual)
- past psychiatric history (diagnoses, treatments, previous hospital admissions)
- family history (atmosphere at home, metal disorder in family, abuse, drugs, suicide)
- personal history (mothers pregnancy, early development, childhood, occupational history, intimate relationships)
- social history (living arrangement, finances, alcohol/drug misuse, crime history)
- past drug history (medications, compliance, OTC, cannabis & skunk increase psychosis risk, steroids affect mental health)
- collateral history (content) - from family, friends, authority, confidentiality important
During a mental state examination what is important to include in appearance/behaviour?
General appearance (neglect), weight loss (depression, anorexia, circumstances), facial expression (depressive, wooden - parkinsonian), posture (hunched, depressive, anxious), movements (overactive, restless, inactive, slow, immobile, tics, termors, dystonia, choreic movements, mannerisms), social behaviour (disinhibited, withdraw, signs of violence)
What do you look at when looking at their speech?
Quantity, rate, spontaneity, volume
What do you look at when looking for their mood?
Subjective (what they tell you) and objective (what you see) - predominant mood, constancy (emotional lability, reduced reactivity, irritability), congruity (cheerful when describing sad events)
What do you include in examination of their thoughts?
Stream (pressure, poverty, blocking), form (flight of ideas, preservation), content (preoccupations, morbid thoughts, suicide), delusions (primary, secondary), folie a deux (same delusion present in 2 closely associated people), overvalued ideas, obsessional symptoms, compulsions)
What do we include in examination of perceptions?
Illusions (misperception of real stimulus), distortion (size of things relative to each other), hallucinations - auditory (2nd person, 3rd), visual, olfactory, gustatory, tactile
What do you assess in cognition? When should you not assess cognition?
- Consciousness, orientation, attention & concentration, memory, language functioning, visuospatial functioning.
- Don’t assess cognition when floridly psychotic
