Psychosis Flashcards
To develop an understanding of the term “psychosis” To be able to identify the key features of psychosis To be able to define and discuss the different key concepts To understand the difference between functional and organic psychosis To understand the basic concepts that distinguish the different psychiatric diagnoses To develop a broad understanding of the differences between schizophrenia and bipolar disorders
what are the two broad categories of mental illness ?
- Psychosis
- Neurosis
what is neurosis ?
A relatively mild mental illness that is not caused by organic disease, involving symptoms of stress (depression, anxiety, obsessive behaviour, preoccupation with physical illnesses) but not a radical loss of touch with reality.
List the symptoms of stress that are experienced in neurosis
- stress
- depression
- anxiety
- obsessive behaviour
What is the main difference between neurosis and psychosis regarding the individual’s connection to reality?
- Neurosis: Individuals maintain a grip on reality, despite experiencing emotional and psychological distress.
- Psychosis: Individuals lose touch with reality.
Define psychosis
A severe mental disorder involving grossly impaired reality testing, i.e individuals incorrectly evaluate the accuracy of their thoughts and perceptions, making incorrect inferences about external reality even when evidence contradicts these beliefs.
How does psychosis affect social and personal functioning?
- It causes severe impairment of social and personal functioning.
What are the characteristics of severe impairment of social and personal functioning associated with psychosis ?
- social withdrawal
- inability to perform the usual social and household occupational roles.
What is a key feature of psychosis ?
Lack of insight
what communication tool can help with understanding the patient’s symptoms ?
empathy
what does emapthy involves when trying to understand the patient’s symptoms ?
- it involves observation, questioning, re-phrasing and checking if you’ve got it right (check understanding)
What are psychotic symptoms characteristic of?
Psychotic symptoms are characteristsics of many disorders.
Are psychotic symptoms specifically diagnostic for any disorder?
No.Even though they are characteristic of many disorders ,they are not specifically diagnostic for any.
example : most people with schizophrenia
experience hallucinations, but not everyone
who has hallucinations suffers from
schizophrenia
How can psychotic symptoms be described in terms of subtlety?
They can be very subtle (vague) and difficult to elicit
how can the experiences in psychosis be generally desccribed ?
They can be described as generally experiences that are beyond that of “normal experience.”
How do psychotic symptoms occur?
they occur in a continuum.
What characterizes one pole of the continuum of psychotic symptoms?
One pole: Grossly disorganized speech and behavior. Difficult or impossible to get a coherent account of the symptoms.
What characterizes the other pole of the continuum of psychotic symptoms?
The other pole: Symptoms are mild and difficult to distinguish from “normal.”
Which patients fall between the poles of the continuum of psychotic symptoms ?
Between the poles fall the patients whose symptoms are easier to spot.
Are any symptoms of psychosis definitive for a disorder?
None of the symptoms alone is definitive of any disorder.
Since the symptoms for sychosis are not specific for any disorder ,How can you reach a diagnosis ?
- Always provide a differential diagnosis for each symptom.
- Then settle on a diagnosis that fits the pattern best.
What are the key defining features of psychotic disorders ?
- Delusions
- Hallucinations
- Disorganised thinking (speech)
- Grossly disorganised or abnormal motor behaviour
(including catatonia) - Negative symptoms
give example of the negative symptoms of sychosis
- social withdrawal
- loss of volition
- loss of motivation
- Alogia (poverty of thought and speech)
- Anhedonia
list examples of pyschtic disorders
- Schizophreniform psychosis
- Schizophrenia
- Schizoaffective disorder
- Bipolar disorder
- Brief psychotic disorder
- Psychosis secondary to another medical condition
- Substance-induced psychosis
Define Delusions
fixed, firmly held, false
belief which is not amenable to change even in the face of contradictory evidence
What are some themes of delusions?
Variety of themes include:
*Persecutory
*Religious
*Grandiose
*Somatic
*Referential
*Nihilistic
what is a bizarre delusion
Delusion that is clearly implausible and not
understandable to same culture peers.
- And do not derive from ordinary life
experiences.
What are examples of bizarre delusions?
Bizarre delusions include:
*Thought withdrawal
*Thought insertion
*Delusions of control
*Thought broadcasting
What is a persecutory delusion?
A persecutory delusion involves the belief that one is being targeted, harassed, or conspired against by others, often leading to feelings of paranoia.
What is a religious delusion?
This type of delusion involves beliefs that are centered around religious themes.Individuals may believe that they possess divine powers, or are on a mission from God.
What is a grandiose delusion?
A grandiose delusion is characterized by an inflated sense of self-importance, power, or identity, where individuals believe they have exceptional abilities or fame
What is a somatic delusion?
A somatic delusion involves the belief that one has a physical illness or defect, despite medical evidence to the contrary.
What is a referential delusion?
A referential delusion involves the belief that common elements of the environment are directly related to oneself, such as thinking that media contains hidden messages about them.
What is a nihilistic delusion?
A nihilistic delusion is characterized by the belief that oneself, others, or the world does not exist or has been destroyed, often leading to feelings of despair.
a belief that one is under
surveillance by the police, despite a lack
of any convincing evidence
* Is this a non-bazarre or bazarre delusion ?
non-bazarre
A belief that someone has
implanted a chip in one’s brain and that this “other” is controlling one’s actions or behaviour.
Is this a non-bazarre or bazarre delusion ?
Bazarre
Individuals may feel that they are dead or that the world is coming to an end, leading to feelings of despair and hopelessness.
What type of delusion is this ?
Nihilistic Delusion
An individual thinks that television shows, songs, or news articles are specifically about them or contain hidden messages directed at them. What type of delusion is this ?
Referential Delusion
Someone thinking they are a famous celebrity or a historical figure. what type of delusion is this ?
Grandiose Delusion
How can delusions be categorized?
SYSTEMATIZED or FRAGMENTARY
explain what is a systematized delusion ?
A systematized delusion is a type of delusion where the individual forms an association of ideas that fit into a coherent narrative, even though the narrative is implausible. The beliefs are organized and interconnected.
explain what is a fragmentary delusion ?
A fragmentary delusion is characterized by bits of poorly or non-associated ideas. These delusions lack coherence and do not form a unified narrative, making them more disorganized and disconnected.
What is the distinction between a strongly held belief and a delusion?
The distinction between a strongly held belief and a delusion primarily lies in the degree of conviction and the response to contradictory evidence.
How does the response to contradictory evidence differ between a strongly held belief and a delusion?
A strongly held belief may be reconsidered or discussed when presented with clear contradictory evidence, while a delusion remains unchanged and resistant to any evidence that contradicts it.
List the causes of delusions
- Schizophrenia
- Bipolar Disorder
- Delusional disorder
- Schizoaffective disorder
- Dementia
- Delirium
- Neoplasms
- Epilepsy
- Traumatic brain injury
- Vitamin deficiencies (pellagra)
- Endocrinopathies (thyroid, etc.)
What is one major cause of delusions related to severe mental illness?
Schizophrenia
Which mood disorder can lead to delusions?
Bipolar Disorder
What is a specific disorder characterized by persistent delusions?
Delusional Disorder
Which disorder combines symptoms of schizophrenia and mood disorders?
Schizoaffective Disorder
What cognitive decline condition can cause delusions?
Dementia
What acute confusional state can lead to delusions?
Delirium
What type of growth can be a cause of delusions?
Neoplasms
Which neurological condition can result in delusions?
Epilepsy
What type of injury can lead to delusions?
Traumatic Brain Injury
What vitamin deficiency is associated with delusions?
Vitamin deficiencies (e.g., Pellagra-> vit B3)
What type of hormonal disorder can cause delusions?
Endocrinopathies (e.g., thyroid disorders)
What is a hallucination?
A sensory perception that has the compelling sense of reality of a true perception but that occurs without external stimulation of the relevant sensory organ.
How do hallucinations differ from illusions?
Hallucinations occur without external stimuli, while illusions involve misperception or misinterpretation of actual external stimuli.
What are the characteristics of hallucinations?
They are vivid, clear, and have the full force of normal perceptions, but are not under voluntary control.
In which sensory modalities can hallucinations occur?
Hallucinations can occur in any sensory modality, with auditory hallucinations being the most common.
What must be true about the sensorium when experiencing hallucinations?
The sensorium must be clear; hallucinations are not typically associated with confusion or altered consciousness.
What are hypnagogic and hypnopompic hallucinations?
Hypnagogic hallucinations occur while falling asleep, and hypnopompic hallucinations occur while waking up; both are considered normal .
In what context may hallucinations occur in certain cultures?
Hallucinations may occur in a religious context in certain cultures.
What are the different types of hallucinations ?
*Auditory
*Visual
*Gustatory
*Olfactory
*Tactile
*Somatic
What type of hallucination involves hearing voices?
Auditory Hallucinations
What are the characteristics of auditory hallucinations?
They can involve one or more voices, which may be familiar or unfamiliar, and can commentate, command, or echo thoughts.
What type of hallucination involves seeing things?
Visual Hallucinations
How are visual hallucinations typically described?
They are often bizarre, transient, usually terrifying, and not cinematic.
They are often strange or unsual typically presenting bizarre and frightening images.They are often brief and may come and go quickly, rather than being persistent or long-lasting.They lack a coherent narrative, appearing disjointed rather than cinematic, which can lead to significant distress for the individual experiencing them.
What type of hallucination involves taste?
Gustatory Hallucinations
What is a characteristic of gustatory hallucinations?
They involve unexplained tastes.
What type of hallucination involves smell?
Olfactory Hallucinations
What is a characteristic of olfactory hallucinations?
They involve unexplained smells.
What type of hallucination involves sensations on the skin?
Tactile Hallucinations
How are tactile hallucinations often described?
They may feel like a ‘crawling sensation’ on the skin.
What type of hallucination involves sensations within the body?
Somatic Hallucinations
What is a characteristic of somatic hallucinations?
They can include sensations such as electric shocks within the body.
What are some common causes of auditory hallucinations?
Schizophrenia, bipolar mood disorder, schizoaffective disorder, substance abuse/intoxication, dementia, and tumors.
What conditions can lead to visual hallucinations?
Delirium (e.g., DTs), stroke, and neoplasms.
What is a common cause of olfactory hallucinations?
Epilepsy (specifically during an aura).
What is a common cause of gustatory hallucinations?
Epilepsy (specifically during an aura)
What can cause tactile hallucinations?
Alcohol withdrawal (e.g., DTs).
What are some causes of somatic hallucinations?
Substance abuse/intoxication, schizophrenia, and bipolar affective disorder (BPAD).
What is a “formal thought disorder”?
A loss of the normal flow of thought, typically inferred from the individual’s speech.
What does “derailment” or “loosening of associations” refer to?
It refers to jumping from topic to topic in speech, where the connections between ideas are weak or absent.
What is “tangentiality” in disorganized thinking?
It is when the answer to a question may be obliquely related or completely unrelated to the question asked.
What is “incoherence” or “word salad”?
Speech that is so severely disorganized that it becomes incomprehensible, lacking any logical structure or meaning.
What is “flight of ideas” in thought disorders?
A nearly continuous flow of accelerated speech with abrupt changes from topic to topic, often based on understandable associations, distracting stimuli, or plays on words. It is characteristic of mania.
What characterizes “loosening of associations”?
A disturbance in thinking where ideas shift from one subject to another that is unrelated or minimally related. The speaker is often unaware of the disconnectedness or illogicality of their speech. This is characteristic of schizophrenia.
What is “circumstantiality” in thought disorders?
A pattern of speech that is indirect and delayed in reaching its goal due to excessive or irrelevant detail. The speaker does not lose the main point.
“Thanks for keeping me under your wing for verily the angels shall sing, remember me for who I am the speed of a car lies in its cam.” This is an example of ….
disorganised thinking
what is catatonia ?
Catatonia is a psychomotor syndrome characterized by a range of motor and behavioral abnormalities, including:
* decreased reactivity to the environment,
* significant reductions in movement,
* excessive motor activity (catatonic excitement),
* rigidity (waxy flexibility),
* negativism (resistance to movement or instructions), posturing (assuming unusual positions),
* and may include echolalia (repeating speech) and echopraxia (imitating actions).
What is a key feature of catatonia related to environmental interaction?
Decreased reactivity to the environment.
What does “decreased mobility” in catatonia refer to?
It can range from complete unawareness to a significant reduction in movement.
What is “catatonic excitement”?
Purposeless and unstimulated excessive motor activity observed in some individuals with catatonia.
What does “waxy flexibility” mean in the context of catatonia?
It refers to rigidity and the maintenance of postures, where the individual can be positioned in unusual ways and maintain those positions.
What is “negativism” in catatonia?
Negativism refers to a tendency to resist or oppose instructions, requests, or attempts to be moved, often without a clear reason.
What does “posturing” refer to in catatonia?
Assuming bizarre postures that may appear unusual or uncomfortable.
What are “echolalia” and “echopraxia”?
Echolalia is the repetition of another person’s speech, while echopraxia is the imitation of another person’s actions.
which conditions can cause catatonia ?
- Schizophrenia
- Depression
- Neurological disorders: CVA, neoplasms, head trauma, encephalitis,
- Metabolic: hypercalcaemia, diabetic ketoacidosis, homocystinuria,
hepatic encephalopathy - Dementia
- Delirium
what are the metabolic causes of catatonia ?
- Hypercalaemia
- diabetic ketoacidosis
- Homocystinuria
- Hepatic encephalopathy
What are the characteristics of disorganized behavior?
- poor self-care
- unkempt appearance
- poor self-hygiene
- inability to perform daily living activities (e.g., shopping, cooking)
- inappropriate and bizarre behavior
- child-like silliness to gross agitation
- unpredictable outbursts of swearing or shouting.
Give examples of inappropriate and bizarre behavior in disorganised behaviour
- public masturbation
- exhibitionism
- unsual dress
What types of disorders can cause disorganized behavior?
Disorganized behavior can be caused by any serious psychiatric or neuropsychiatric disorder.
How does the presence of disorganized behavior relate to the severity of illness?
The presence of disorganized behavior indicates a higher severity of illness
What is the significance of disorganized behaviour in relation to psychosis?
Disorganized behavior is considered the most non-specific sign of psychosis, indicating the presence of a serious underlying issue.
What is schizophrenia?
Schizophrenia is a major functional psychotic disorder that affects approximately 1 per 100 people across all cultures, characterized by symptoms such as hallucinations, delusions, and disorganized thinking.
How does schizoaffective disorder differ from schizophrenia?
Schizoaffective disorder includes significant mood disorder symptoms alongside psychotic symptoms, whereas schizophrenia primarily focuses on psychotic symptoms without the mood component being as prominent.
what is the cause of Schizophrenia ?
The aetiology is unknown and likely represents a cluster of disorders.
Are there specific diagnostic tests for schizophrenia?
No specific diagnostic tests are available; diagnosis is made clinically based on symptoms and signs and after excluding primary organic disorders.
How does the onset of schizophrenia differ between genders?
Onset in males tends to be younger than in females, usually in late teens/early twenties, often with a poorer prognosis.
What is the typical course of schizophrenia?
It tends to run a relapsing and remitting course with gradual, progressive deterioration.
What percentage of individuals with schizophrenia may have a single episode and remain symptom-free?
Approximately 10-20% will have a single episode and are symptom-free thereafter
What factors may trigger vulnerability in individuals with schizophrenia?
Unemployment, relationship conflicts, poverty, and psychoactive drugs may serve as potential triggers.
How are the symptoms of schizophrenia categorized?
Symptoms are divided into positive and negative symptoms .
list positive symptoms o Schizophrenia
- hallucinations
- delusions
- disorders of thought form
List the negative symptoms of Schizophrenia
- loss of volition and motivation
- spontaneous behavior
- social withdrawal
- anhedonia
- alogia (affective flattening and poverty of thought and speech)
What is the commonest cause of premature death in individuals with schizophrenia?
Suicide is the commonest cause of premature death, particularly in the first year post diagnosis, with approximately 10% at risk.
What does the management plan for schizophrenia include?
- The management plan is based on pharmacological (first and second generation antipsychotics)
- and non-pharmacological (family interventions, education, supportive counseling, attending to basic needs such as accommodation) treatment approaches.
What evidence supports the importance of early intervention in schizophrenia?
Evidence shows that early intervention during the prodrome or first episode improves long-term prognosis.
Eample : EISH program at Valkenberg
Hospital (EISH= Early interention ,support and health )
How is bipolar disorder classified?
- Bipolar disorder is classified as a mood disorder, with disturbances of mood being a necessary major diagnostic criterion.
- There is type 1 and type 2
What characterizes Bipolar Disorder Type 1?
Bipolar Disorder Type 1 is characterized by episodes of mania and possibly less severe depression, and may include “mixed episodes” with features of both mania and depression simultaneously.
What characterizes Bipolar Disorder Type 2?
Bipolar Disorder Type 2 is characterized by episodes of hypomania and possibly more severe depression.
What does the presence of psychotic features during elevated mood indicate in Bipolar Disorder ?
If psychotic features are present while mood is elevated, it indicates mania (Type 1), even if the individual is not particularly energetic or disruptive.
Can psychosis occur in depressive episodes of bipolar disorder?
Yes, psychosis can occur with depressive episodes and indicates severity.
