Psychosis Flashcards
Negative Symptoms of Psychosis
- asociality (few friends, poor relationships with friends, lack of motivation for relationships, reduced social interaction)
- anhedonia (difficulty or inability to anticipate future pleasure, few leisure activities, lack of interest in sexual activity)
- avolition (emotional withdrawal, apathy, poor grooming and hygiene, decreased involvement with work/school)
- anergia (no energy)
- alogia ( short or monosyllable answers to questions, avoids communication, uses few words)
- blunted effect (diminished facial and vocal expressions, poor eye contact, mimal use of gestures)(REMEMBER A WORDS)
Positive Symptoms of Psychosis
- Delusions
- Hallucinations
- Disorganized Speech
- Disorganized behavior
- Agitation
Definition of Psychosis
DSM-5 defines psychosis as abnormailities in 5 symptomatic domains:
- Delusions: extreme paranoia (i.e. someone is going to hurt them); persecution (i.e. someone is out to get them) or grandeur (they are the queen, they’re amazing, can fly)
- Hallucinations: auditory is the most common; command hallucinations are the most scary as they are being told to do something and could actually do it; visual hallucinations can be caused by psychological things such as alcohol withdrawal or dehydration - can be danger to themselves or others, acute withdrawal symptoms
- Disorganized thought
- Disorganized or abnormal motor behavior
- Negative symptoms
Scope of Psychosis
- Absence of psychosis
- Subclinical symptoms
- Mild
- Moderate
- Severe
Mild-Severe = clinically significant psychosis
Subclinical threshold: able to hold a job, go to school, but may not need treatment; if it is not a problem then it is not a problem
Acute vs Chronic Psychosis
Acute: delirium can occur
Chronic: schizophrenia; cannot resolve; is a long term illness
Primary Psychosis
Psychiatric illnesses can manifest psychotic symptoms of episodes
- Bipolar I Disorder: acute mania, auditory hallucinations, delusions of grandeur
- Major Depressive Disorder: acute episodes, at their worst, can have psychotic symptoms, not everyone will have these psychotic symptoms
Personality disorders and psychosis symptoms relationships
Symptoms from comorbidities rather than personality disorder
- 13.4% comorbidity with major depressive disorder
- 8.1% with bipolar spectrum disorder
- 10.9% with alcohol use disorder
- 5.6% with substance use disorder
Define Secondary Psychosis
Secondary Psychosis: when the psychosis begins following the onset of the medical condition, varies in severity with the severity of the medical condition, and resolves when the medical condition improves
- Toxic Psychosis: related to an underlying and untreated medical issue (i.e. delirium)
- Dementia: neurocognitive disorders( i.e. Alzheimer’s disease, vascular disorders, HIV, traumatic brain injuries, etc. )
- Medical Illness: central nervous system disorders, infections, etc.
- Toxins, Drugs, and Medications
- Substance/Medication induced Psychosis: carbon monoxide, mercury, bath salts, methamphetamines, psychomimetic drugs (LSD), sedative-hypnotic agents, amphetamines, mefloquine, anticholinergic agents
Physiologic Consequences of Psychosis and Treatment
- Extrapyramidal effects (EPS)
- Hyperglycemia
- Dyslipidemia
- Hypertension
- Hepatotoxicity
- Immune compromise
- Lens opacities (cataracts) - more common in 1st gen antipsychotics
SMOKING CAN INCREASE EFFECTS
Behavioral Physiologic Consequences of Psychosis and Treatment
- Activity intolerance
- Obesity - significant weight gain (i.e. 40 lbs in a year)
- Substance Use
- Violence - related risk
- Infectious disease exposure - at risk due to bone marrow suppression as well as living in a group setting cause them to be exposed to more illnesses; many schizophrenic patients are homeless which can lead to them being exposed to violence and unsafe areas
- Vitamin deficiency
Individual Risk Factors for Psychosis
- Environmental: early life (i.e. trauma, abuse, socioeconomic status), childhood (neglect, poor structure, poor parenting, abuse, early institutionalization), later life
- Genetic: family hx of psychosis (1st degree relative)
- Physiologic: pre-existing psychiatric illness (Bipolar 1 would increase risk), past psychotic episodes
- Behavioral Risk Factors: substance abuse, bath salts
- Stress intolerance: no coping skills makes it difficult to prevent psychosis
- Ineffective coping skills
Assessment for Psychosis
- Include hx, physical assessment, mental status exam, and diagnostic testing
- Many subclinical sx appear before a pt. displays overt psychotic sx: increased withdrawal, increased adonia, may last a while before they have a break, early adulthood is typical emergence of schizophrenic sx
History Assessment
- Risk factors: ask about life as a kid or life at home
- Personal medical hx: physiological concern (difference in brain anatomy), Parkinson’s, open-ended questions, make a list of things and ask if they enjoy them
- Mental health hx
- Substance use
- Perinatal trauma: involuntary c section, breeched delivery, toxic relationship during gestational period
- Developmental hx
- Family hx: who raised them
- Trauma exposure
- Culture and beliefs: ask about comfort zone, ask directly, “At any point if you become uncomfortable, please let me know so we can pause”, “Do you have any beliefs that may inhibit your care?”
Physical Assessment
- Vital Signs
- Cranial Nerve Assessment: injured or nonfunctional parts of the brain; differentiate psychotic vs physiological symptom
Mental Status Examination: - Appearance: disheveled, attention to hygiene, attention to ADLs
- Attitude: may not want to talk, unfriendly, may not feel safe, internally preoccupied making it difficult to talk
- Behavior
- Mood and Affect: negative sx –> flat affect
- Speech: clang, echolia, word salad, dysphasia, neologism
- Thought process
- Thought content
- Perceptions: audio or visual hallucinations
- Cognition: ability to solve problems
- Insight: I understand what I am seeing or hearing isn’t happening
- Judgement: poor, good, or limited
Diagnostic Tests for Assessment
- THERE ARE NO DIAGNOSTIC TESTS TO DEFINITIVELY RULE IN OR RULE OUT PSYCHOSIS
- Schizophrenia is a dx by exclusion
- CT or MRI
- EEG
- PET
Common Labs: - CBC: bone marrow suppression
- CMP: BUN, creatinine, blood glucose
- thyroid: hypothyroid –> sx of depression; hyperthyroid –> sx of mania
- HIV
- heavy metals: led toxicity
- toxicology
- urine drug screen
- culture and sensitivity
