psychosis Flashcards
False beliefs not correctable by logic or reason, not based on simple ignorance, and not shared by a culture or subculture; persecution is most common
Delusions
sesnory perceptions not generated by external stimuli
Hallucinations
disorder characterized by disorganized thinking
Formal Thought Disorders
visceral sensations
cenesthetic
lack of informative content normally seen in speech (“It is red very red. Things are that way. I am.”)
Alogia
associating words by sound, not logical meaning (Í’mvery sure I’ve got a cure and I’m not pure…”’)
Echolalia
loss of logical meaning between words or thoughts (Patient begins to answer a question about her parents, then launches into a diatribe about world hunger.)
Loose Associations
inventing new words (A patient refers to a restaurant as an automatic automat)
Neologisms
repeating the same word or phrase over and over (I’m bad, I’m bad….that I’m bad.)
Perseverations
beginning a response in a logical fashion but then getting further and further from the point. (I’ll tell you about my thoughts, but let me tell you about other things in my head, like brains and blood.)
Tangentiality
misperception of real external stimuli (A woman interprets a dress in a dark closet as a person)
Illusions
- psychotic and residual symptoms lasting at least 6 months
- normal consciousness and memory function
- auditory hallucinations predominate
Schizophrenia
- psychotic and residual symptoms lasting 1-6 months
- obvious precipitating psychosocial factors
Schizophreniform
- psychotic and residual symptoms lasting more than 1 day but less than 1 month
- obvious precipitating psychosocial factors (eg job loss)
Brief psychotic disorder
-prominent hallucinations (often visual or tactile)
Or delusions directly related to use or withdrawal of a drug (esp stimulants and hallucinogens)
Substance induced psychosis
- hallucinations that are visible and changeable rather than auditory and recurrent
- occurs in the context of an acute medical illness
- symptoms not due to delirium or dimentia
Psychosis secondary to a general medical condition
- fixed, nonbizarre delusional system present for at least one month
- absence of other thought disorders
Delusional Disorder
- disturbance of consciousness
- fluctuates, fragmented and unsystematized psychotic symptoms
- treat underlying cause
Delirium
-development of a delusion in a person in a close relationship with someone who has a delusional disorder (the inducer)
Shared psychotic disorder (folie a deux)
Other behavioral disorders that may present with psychotic symptoms
Major depressive disorder
Bipolar disorder
Schizoaffective disorder
(screen for mood disorders)
Personality disorders that may mimic psychosis
Schizoid, Paranoid, Schizotypal, Borderline
peak age onset of psychosis in males
15-25
peak age onset of psychosis in females
25-35
- Systematized delusions of persecution
- Older age of onset and better functioning than other subtypes
- Highest level of functioning and best prognosis
Paranoid Schizophrenia
- At least one previous psychotic episode
- subsequent negative symptoms and mild positive symptoms
- No current frank psychotic symptoms
- we are seeing more patients w/schizophrenia live longer, esp. after age 50 their coping mechanisms often improve
Residual Schizophrenia
- incoherent speech
- mirror gazing
- facial grimacing
- poor grooming
- inappropriate emotional response (silliness)
- onset before 25 years of age
- worst prognosis; many of these people struggle to even complete a sentence
Disorganized (hebephrenic) Schizophrenia
- stupor or extreme agitation
- incoherent speech or muteness
- blank facial expression
- bizarre posturing (waxy flexibility)
- rare since introduction of antipsychotic agents
- they can become willfully unresponsive to their environment-may believe they can’t talk or the world will end, etc.
Catatonic Schizophrenia
How do you treat delirium?
Treat underlying condition! Do NOT use antipsychotics unless for the safety of the pt.
What conditions cause psychosis secondary to general medical condition?
AIDS, Alzheimer’s, Parkinsons.
Treat with antipsychotics
Displays characteristics of more than one subtype
Undifferentiated Schizophrenia
A 21 yr old disheveled patient hears voices in her head. She has no systematized delusions but believes that she can communicate with animals. Her affect is blunted but not flat, and she shows no catatonic features.
Undifferentiated Schizophrenia
A 34 yr old seems fearful when she tells you that the government has been listeningin on all her phone conversations for the past 2 years.
Paranoid Schizophrenia
A 30 yr old man who was hospitalized for 5 yrs previously with auditory hallucinations now shows flat affect, social withdrawal, and strange behavior but no delusions or hallucinations
Residual Schizophrenia
An 18 y/o male is unshaven and dirty.He stares into the mirror, posturing and grimacing, and giggles when he tells you that his stomach is “a monster machine ready to throw me on the train.”
Disorganized (hebephrenic) Schizophrenia
A 27 y/o patient does not speak and shows extreme psychomotor agitation to the point of physical exhaustion. At times, he holds unusual, uncomfortable looking body positions.
Catatonic Schizophrenia
