Psychosis Flashcards
Psychosis
loss of touch with reality
difficult perceiving and interpreting reality
What are negative symptoms of psychosis?
Loss of function
Alogia (slow speech),
Anhedonia (not experiencing pleasure),
Avolition/apathy (low will/self care),
Affective flattening (emotionally flat, poor eye contact)
What are positive symptoms of psychosis?
Gain of function
Hallucinations (usually auditory, but any modality), Delusions (consider thought broadcasting, insertion and withdrawal)
What is the definition of delusion?
Fixed, false belief that is not understandable considering the person’s sociocultural upbringing
What are disorganisation symptoms of psychosis?
Bizzare behaviour (social, clothing, aggression),
Formal Thought Disorder (lack of thought form - loose association)
What is the typical onset of psychosis?
Any age, but peak incidence in adolescence/early 20s
What usually precedes psychosis?
Prodromal symptoms - changes to personality, social behaviour, thought process, usually misdiagnosed as depression
How can cannabis use act as a risk factor for psychosis?
Brings the onset of psychosis forward
What are some other environmental risk factors for psychosis?
Birth complications, socioeconomic deprivation, childhood trauma
What things would you look out for in appearance and behaviour in psychosis?
Bizzare clothing,
psychomotor agitation/retardation, (may be due to induced parkinsonism from anti-psychotics)
self-neglect,
self-injury,
echophenomena (mimic movements),
eye contact
What things would you look out for in speech in psychosis?
Rate, Volume, intonations (monotonous)
Why is it important to assess for mood in psychosis?
High risk of another mental disorder such as depression, there is a suicide risk
What is affect?
emotional range
may become flattened/ blunted
causes them to react inappropriately (may laugh in sad situations)
What things would you look out for in thought content in psychosis?
Thought insertion, thoughts that weren’t his
withdrawal
broadcasting
What things would you look out for in perceptions in psychosis?
Hallucinations, potentially command hallucinations (risk), assess if they are pseudohallucinations (they are aware they are hallucinations) or not
Types of auditory hallucinations
1st person, echo
2nd person, talking to you
3rd person, talking about you
What things would you look out for in cognition in psychosis?
Check for orientation and confusion (time,place,person)
affects cognition in long term
What things would you look out for in insight in psychosis?
Are they aware of hallucinations, usually lacks insight
What is a consequence in patients lacking insight in psychosis?
Poor compliance with treatment, consent for treatment may not be achieved as they do not believe that they are sick
Diagnosis
Send to early diagnosis psychosis team, watch over a longer period of time before coming up with a final diagnosis
What are 3 categories of management for psychosis?
Antipsychotic medication,
CBT, for more chronic, stable patients
Social support
What is the typical action of antipsychotics in psychosis?
Dopamine antagonists
meso-limbic system in the brain
partial agonist will still reduce dopamine as it is competing with the native agonist
What are EPSEs and why do they occur?
Extrapyramidal Side Effects, from dopamine blockage of nigrostriatal system (basal ganglia relevant for posture and tone)
outside the pyramid of the medulla
What are some examples of EPSEs?
Parkinsonism (bradykinesia, hunched over gait),
Acute dystonic reactions (involuntary contractions),
Tardive dyskinesia (irregular movements), orofacial dyskinesia
Akathisia (cannot stay still), internal restlessness
What types of antipsychotics cause less EPSEs?
Atypical antipsychotics have less EPSEs, unlike typical EPSEs
What are some other effects of antipsychotics?
Sedation/Weight Gain, due to blockage of histamine receptor
Agranulocytosis,
Dysrhythmia,
Constipation
