Psychosis Flashcards
What is madness/ people who are”mad”?
People who hear voices/ disorganised behaviour/ thought disorder considered differently to other mental illnesses, and are seen as less relatable and put in a separate box.
Do you understand this diagram about madness?
What is linked to psychosis?
Hallucinations, delusions, and/ or thought disorder
Reality failure (group of pathologies which disrupt the process of perceiving and interpreting reality)
Clear consciousness and intellectual capacity usually preserved
Delusions
Hallucinations
Inappropriate/ blunted affect
Thought disorganisation
What is psychosis usually defined as?
Hallucinations and delusions
Psychosis represents a large group of different disease processes which are grouped together purely because they all share an end result which looks broadly similar.
Conceptualise psychosis as reality failure (just like heart and kidney failure)
What is consciousness?
Probably modular, not unitary
- Parallel processing= battery of unconscious processing
Content of conscious awareness is selected by attention
- Both active/ voluntary, and passive (salience and automatic screening of irrelevant stimuli)
What are auditory verbal hallucinations?
Thoughts/ internal monologue experienced as external/ other
Experienced by roughly 5% of the population
What are delusions?
Fixed, false, unshakeable belief (out of context with cultural background)
Result of efforts to make sense of perplexity?
What are positive symptoms of schizophrenia?
Hallucinations
delusions
Persecutory/ grandiose
Delusional perceptions
Delusions of control
Thought delusions or interference
(these experiences are v real for the patient)
What are negative symptoms of schizophrenia?
Anhedonia
Apathy
Social Withdrawal
blunted mood
What are disorganized symptoms of schizophrenia?
Thought disorder
Disorganised speech/ behaviour
Inappropriate affect
What are examples of disturbances in fundamental components of experience/ self-awareness?
May include:
Perplexity
- Disruption of language/ meaning
- Aberrantly salient experiences
- Overwhelmed by formless sense of something fishy going on
disruption of the sense of self
- your thought/ experiences lose their “mine-ness”
- your internal world spills into external world
- the other intrudes into your internal world
Is schizophrenia genetic?
It has a significant genetic component
Prevalence is roughly 1% with an 80% heritability
What are the figures for heritability of schizophrenia?
from single parent is roughly 10%
From both parents is roughly 50%
in monozygotic twins it is 40%
What is the gene component of schizophrenia?
more than 200 genes multifactorial (epi)genetic causes most common; very few single gene causes
Genes for D2, neurodevelopment and inflammation
What is there an excess of in schizophrenia?
Striatal dopamine
especially in response to stress
What is the organisation of the default mode network in schizophrenia?
Abnormal; stimulus-independent thought and self-reflection
What is the role of dopamine in schizophrenia?
Anticipated reward–> directed attention
Reward prediction error signalling
Salience (sense of importance attached to perception)
What is working memory in regards to schizophrenia?
Preconscious working memory stores large amount of data
Allows you to contextualise the present moment
Deficits in working memory–> thought and perception loses context, flow, order?
What are the causes of psychosis?
Genetic component
Developmental adversity/ abuse
Neurodevelopmental
Life stressors
relationship with recreational drugs
Explain the genetic component of the causes psychosis?
Genes predisposing to SCZ must also confer significant advantage (a more flexible grasp of reality)
Explain the developmental adversity/ abuse component of the causes psychosis?
Biased cognitive schemas
Sensitised striatal dopaminergic system
High expressed emotion, “double-bind” family dynamic
Explain the neurodevelopmental component of the causes psychosis?
Prematurity, hypoxia, infection, winter/ spring births
Explain the life stressors component of the causes psychosis?
Stress vulnerability model
Explain the relationship with recreational drugs component of the causes psychosis?
roughly 25% of psychosis patients
Strong correlation with earlier age of cannabis use and strength of cannabis with onset of psychotic illness
What are treatments for psychosis?
Antipsychotics
Psychological therapies
Social support
Expand on antipsychotics treatments for psychosis?
Antidopaminergic (also serotonergic, anticholinergic, antihistaminergic…)
Typical and atypical
Expand on psychological therapies treatments for psychosis?
CBT for psychosis
Avatar therapy (just real enough to be immersive)
Sense of agency over voices
Expand on social support treatments for psychosis?
Supportive environments, structures and routines
Housing, benefits
Support with budgeting/ employment
Medication for psychosis…
Dopamine theory for psychosis (dopamine blockade)
Neuroanatomy of dopamine pathways; cerebrum (cortical and limbic), striatum, pituitary.
What are side effects of medication for psychosis?
Neurological (EPSE, tardive dyskinesia, parkinsonism, dystonia, sedation)
Prolactin (amenorrhoea, erectile dysfunction, gynaecomastia)
Metabolic (diabetes, weight gain)
GI (increased appetite, constipation)
Muscarinic (hypersalivation)
Haematological (neutropenia, agranulocytosis - especially clozapine)
Cardiac (arrhythmias, tachycardia, prolonged QTc)
Sedation
Are psychosis patients more likely to be victims of violence?
Yes
What groups are rates of violence high in?
SCZ (untreated and comorbid substance use) increase violence 2-4x
Alc increases violence x10-20
Why might someone be violent?
Do they feel threatened
Is psychosis a unitary disease?
no, iit is a complex syndrome
What does psychosis represent?
A large group of different disease processes
What is the overview definition of psychosis?
Psychosis is a complex syndrome represents a large group of different disease processes.
Psychosis and Schizophrenia have a wide variety of biological causes and social determinants.
Their experiences are real for them. Much more likely to be victims of violence.
