Psychosis Flashcards
Define psychosis
Severe mental disorders in which thoughts and emotions are so impaired that contact is lost with external reality
Define acute psychosis
Sudden onset psychosis (significant alterations to a person’s perception, thoughts, mood and behaviour), tend to LACK insight, resolving in <3 months
What is the epidemiology of acute psychosis
80% between 16-30 years
Higher prevalence in BME individuals
What are the causes of psychosis
Affective psychosis- depression, BPAD
Transient psychotic disorder- usually substance misuse
Schizophrenia-like non-affective disorders- brief psychotic disorder, delusional disorder, schizophreniform disorder
Puerperal psychosis
Schizophrenia
Organic
Delirium, steroids, dementia, porphyria, tumours, stroke, systemic infection, thyroid dysfunction
Drug-induced: cannabis, ketamine
What are the symptoms of psychosis
Positive:
- Hallucinations
- Delusions
- Thought disturbance
- Passivity (sensations controlled by an external influence, actions/impulses/feelings imposed on the individual by others)
Negative:
- Apathy / blunting of affect
- Anhedonia
- Alogia
- Avolition
- Self-neglect
- Social withdrawal
Impaired insight, neologisms
What is Charles-Bonnet syndrome
persistent/ recurrent hallucinations with a clear consciousness (insight preserved); usually on BG of visual impairment
What investigations should be done for psychosis
Collateral history
Brief psychiatric rating scale (BPRS)
Bedside: urine toxicology
Bloods: LFTs, FBC, syphilis/HIV serology
Imaging: MRI, EEG
What is the management for acute psychosis
Risk assess
High risk → crisis resolution team and home treatment team
If <35 and first episode → refer to early intervention in psychosis services
Bio:
- Short term antipsychotics/BDZ e.g. high dose olanzapine
- Antidepressant/mood stabilisers after e.g. low dose aripiprazole
Psycho
- Reality-oriented/adaptive/supportive psychotherapy
Education and support
