Psychosis Flashcards
Definition
Difficulty perceiving and interpreting reality
Positive symptoms
Hallucinations - perception in absence of stimulus - auditory, visual, olfactory
Delusions - fixed, false belief, out of keeping with social/cultural background - persecutors, control, mind read, guilt, thought broadcasting, withdrawal, insertion
Negative symptoms
Alogia - poverty of speech
Avolition/apathy - poor self care, lack of motivation
Anhedonia/asociality - few close friends, impair social function
Affective flattening - unchanging facial expression, poor eye contact
Disorganisation symptoms
Bizarre behaviour - social, clothing, aggression
Thought disorder - derailment, pressured speech
Psychiatric history
HPC Past psychiatric history Background - family, personal, social Past medial history Corroborative history
Mental state examination
Appearance and behaviour Speech Mood Thoughts Perception Cognition Insights
Management
Pharmacological - antipsychotic medication
Psychological - CBT
Social support - supportive environment
Neurotransmitter system affected by antipsychotics
Dopamine - but also serotonin, acetylcholine, histamine
How do antipsychotics affect dopamine
Antagonist
Increased dopamine is implicated in causing reality distortion in psychosis
Aripiprazolr is a partial agonist
Dopamine agonist like those used for Parkinson’s can cause psychotic symptoms
Antipsychotics side effects
Extrapyramidal side effects
Parkinsonism
Acute dystonia
Tardive dyskinesia
Akathisia
Parkinsonism
Rigidity, slow and shuffling gait, lack of arm swing, pill rolling tremor
Acute dystonia
Increased motor tone - sustained abnormal posture
Tardive dyskinesia
Repeated oral, facial, buccal, lingual movements
Akathisia
Inner restlessness
Compelled to move, but does little to alleviate
Legs most commonly affected
Typical and atypical antipsychotic
Typical cause Extrapyramidal side effects
Atypical less likely
