psychosis Flashcards
what is psychosis and examples
difficulty perceiving and interpreting reality
umbrella for many diseases, ie- schizophrenia, bipolar I, delusional disorder, drug induced etc
types of psychosis symptoms domain
positive
negative
disorganised
example of positive symptoms
hallucination-perception in absence of stimulus
-all 5 senses
-commonly auditory
-1st= though echo, 2nd, 3rd person running commentary/command hallucinations
delusions-fixed, false belief not in keeping with social/cultural norms.
-passive experience- thought are controlled by external agent. ie. thought broadcasting, insertion, withdrawal.
what are some negative symptoms
alogia
anhedonia
asociality-
avolition
apathy
affective flattening
what is alogia
decreased speech
what is anhedonia
inability to feel pleasure
what is
asociality-
being more alone
what is avolition
lack of motivation
what is apathy and affective flattening
apathy -lack of enthusiasm
affective flattening-reduced facial expression/body language, poor eye contact
examples of disorganised symptoms
-bizzare behaviour=
-aggression, agitation, inappropriate social behaviour
-formal though disorder- lack of logical connection between thoughts
psychosis onset, course, morbidity, mortality?
onset- commonly early 20s, (peak later in women)
course- chronic+ episodic
morbidity- impact QoL (risk heart disease)//impact education, employment
mortality-high risk of suicide
what is in the Mental state examination (MSE)
A Sailor Makes Tea, Pours Calmly, and Ignores
Appearance and behaviour
Speech
Mood and Affect
Thoughts
Perceptions
Cognition
Insight
psych hx for psychosis: HPC/Psych hx, fam hx, environemnt?
HPC: 6-18 months before has prodromal symptoms similar to depression
Psych Hx: increased risk if they had mental issues in the past
fam hx- important as schizophrenia=highly heritable. High concordance in MZ twins. Highly polygenic
environmental-drugs, ACE, prenatal/birth complication
Examples of prodromal symptoms in psychosis that’s often misdiagnosed in depression
-increasing isolation
-poor self care
-social withdrawal
-declining academic performance
what to look out for in MSE for psychosis - appearance and behaviour
appearance:
Bizarre or inappropriate clothing
Self-neglect
Self-harm injuries
behaviour:
eye-contact
unreactive
agitation
Abnormal movements
what to look for in speech compartment of MSE
Comment on rate/rhythm/volume
description of thought disorder
circumstantial
tangential
flight of ideas
derailment
word salad
what is pseudohallucination (vs hallucination
pseudohallucination:
-insight preserved
-ie voices perceived originating from inside head rather than outside
what is tactile hallucination
involving sense of touch- ie ‘can feel chip inside his brain’
What difficulties might you have treating someone with poor insight into their psychosis?
-consenting to treatment
-FU attendance
-willing to admit to hospital
psychosis diagnosis?
can’t diagnose schizophrenia based from 1 psychotic episode.
-follow up for 3 years under Early Intervention of Psychosis Service
management of psychosis
antipsychotic
CBT
social support
antipsychotics in psychosis -2 types name of drug
dopamine antagonist-ie.risperidone
(but can also target NTs like serotonin, acetylcholine, histamine)
new partial agonist= aripiprazole
describe dopamine activity in psychosis
Increased dopamine activity in mesolimbic dopamine system cause positive symptoms of psychosis
side effect of dopamine agonist vs antagonist
agonist- used in parkinson’s disease can cause psychotic symptoms
antagonist: parkinsonism
what are extrapyramidal side effects (EPSEs)- explain and give examples
Dopamine blockade in the nigrostriatal (extrapyramidal) dopamine system (parts of the brain that enable us to maintain posture and tone)
Parkinsonism
Acute dystonic reactions
Tardive dyskinesia
Akathisia
other side effects of antipsychotics
weight gain, increased prolactin, long QTc
management of EPSE
counsel about risk,
use lowest therapeutic dose,
first line= atypical
typical vs atypical drugs in antipsychotics what are they
typical- older - first generation
atypical- newer- second generation
– associated with lower EPSE risk. Due to 5HT-2A antagonism
