Psychosis Flashcards
What is psychosis
difficulty perceiving and interpreting reality
Common cause
Schizophrenia
What are three symptoms domains
positive, negative, disorganised
Examples of positive symptoms
- hallucinationsperception in absence of stimulusany sensory modality1st (thought echo) 2nd 3rd person possible
Running commentary
Common hallucinations
Visual
Somatic/tactile/firnication
Olfactory
Gustatory - delusions
Fixed false beliefs not in line with social or cultural norms. Usually are persecutary paranoid reference grandiosity religious pathological jealous nihilistic/guilt somatic and erotimanic
Passivity experience -1st rank symptoms thought broadcasting thought insertion thought withdrawal
Examples of negative symptoms
- alogiapaucity or poverty of speech
- anhedonia/asocialityfew close friends, interests, impaired social functioning
- avolition/apathypoor self-care, lack of motivation
- affective flatteningunchanging facial expressions, poor eye contact, lack of vocal and emotional range
Examples of disorganization symptoms
bizarre behaviour eg inappropriate social behavior,bizarre appearance ,aggression,repetitive behavior
formal thought disorder-lack of logical connection between thoughts eg
Circumstantial thought (get to point after a long time),tangential thought (never get to point) flight of ideas (fast thoughts),derailment of association,word salad
types of the latter in worsening order?
circumstantial thought, tangential thought, flight of ideas, derailment/loosening of association, word salad
Typical onset and course of psychosis as well as morbidity and mortality
peak incidence early 20s, any age possible
often chronic and episodic
Morbidity increase risk of health problem and impact on education /work
Mortality they lose 15-20 years and high risk of suicide in schizophrenia
what is psychosis often preceded by?
prodromal symptoms e.g. increasing isolation and poor self-care,declining academic performance,isolation,6-18 months before florid psychotic symptoms emerge
What is this misdiagnosed as
Depression
psychosis risk factors → non-modifiable?
previous diagnosis with a mental illness, family history (high heritability with polygenic influence)
Schizophrenia is highly heritable
Highly polygenic so lots of genes involved
psychosis environmental risk factors?
drug use esp cannabis
prenatal complications, maternal infections
migrant, socioeconomic deprivation, childhood trauma
what is echopraxia and echolalia
involuntarily mimicking someone else’s movements
Echolalia is meaning,Ed’s repition of someone else’s words
What might you look for in Simone with psychosis (apppearance and behavior)
Bizarre or inappropriate clothing
Psychomotor retardation/agitation
Abnormal movements (medication related)
Self neglect
Self harm
Exhophenomena (echopraxia and echolalia)
Stupor and mutism (catatonia
examples of 1st rank delusion symptoms?
thought broadcasting, thought insertion, thought withdrawal
- insight preserved in pseudo, true indistinguishable from real perception
what distinguishes true hallucinations from pseudohallucinosis?
insight preserved in pseudo, true indistinguishable from real perception
Voices must be perceived as originating from the outside for true hallucinations
what is one measure of cognition? What do we see in schizophrenia
addenbrooke’s cognitive examination III
Schizophrenia described as dementia (praecox which is dementia of the young
Commonly affects working memory and executive function
Poor educational attainment
Cognitive impairment is stable over time but difficult to treat
what are the three main treatment approaches to psychosis
pharmacological, psychological, social support
what do antipsychotic drugs target?
Dopamine system
what kind of action do these take?
antagonist or partial agonist eg arpiprazole is a partial agonist
Agonists can cause psychotic symptoms too as increase dopamine activity in mesolimbic dopamine system implicated in causing postive symptoms of psychosis
what are extrapyramidal side effects?
side effects outside pyramidal movement pathway
What are extrapyramidal side effects caused by
dopamine blockade in nigrostriatal dopamine system (parts of brain that enable us to maintain posture and tone)
What does the nigrostriatal system usually do
enable us to maintain posture and tone
side effect symptoms?
- parkinsonismbradykinesia, postural instability, rigidity, slow gait, tremor (slow thumb across other fingers),festinisation (chasing centre of gravity)
- acute dystonic reactionsloss of muscle tone
- tardive dyskinesiarepetitive involuntary movements e.g. eye blinking, grimacing
- akathisiainability to remain still
antipsychotic drug divisions?
older → typical, first generation
newer → atypical, second generation
which is more likely to cause extrapyramidal side effects?
typical as atypical involves 5HT-2A antagonism
other antipsychotic side effects?
CNS → EPSEs, sedation
haematological → agranulocytosis, neutropenia
metabolic → increased appetite, weight gain, diabetes
GI → constipation
pituitary → prolactin up
cardiac → dysrhythmia, long QTc
Cognitive impairment in schizophrenia
Affects working memory and executive function
Poorer educational attainment
Cognitive imoairement difficukt to treat and cause comorbidity
Prognosis and long term management
Some may recover after an episode of psychosis but majority relapse with periods of wellness
LTM
Community follow up,manage antipsychotic side effects,reduce risk factors,
