Psychosis Flashcards
How does psychosis present?
hallucinations
psychomotor
thought disorder - eg. word salad, flight of ideas
delusions
negative symptoms
Psychosis differentials
schizophrenia
schizoaffective disorder
bipolar disorder
organic disorders (delirium, dementia, temporal lobe epilepsy, brain injury)
psychotic depression
post-partum psychosis
delusional disorder
substance-induced psychosis
What medical conditions should be ruled out in psychosis?
delirium
dementia
malignancy
epilepsy
head trauma
cerebrovascular accident
HIV/AIDS encephalitis
CJD
syphilis
metabolic (Ca, Na, glucose)
vitamin deficiencies (B1, B3, B12, folate)
medications
substances
What are the ICD-11 criteria for delusional disorder?
presence of a delusion or set of related delusions
persists for at least 3 months
absence of a depressive, manic or mixed episode
common forms of delusion = grandiose, somatic, persecutory, jealousy, erotomania
affect, speech and behaviour typically unaffected
symptoms not due to another disorder
Common delusions
persecutory
somatic
grandiose
jealousy
erotomania
What is capgras syndrome?
belief that a person closely related to the patient has been replaced by a double
What is Fregoli syndrome?
identifies familiar people in strangers
What is De Clerambault’s syndrome?
erotomania
often believe that someone of a higher social class is in love with them
commoner in women
they may pester the victim with letters/stalking behaviour
What is Othello syndrome?
also known as morbid jealousy
delusional belief that partner is having an affair without any evidence
occurs in alcoholism, organic states, affective psychosis
leads to domestic violence
What is Cotard’s syndrome?
nihilistic delusion
false belief that part of the body is dead, dying or doesn’t exist
typically seen in psychotic depression
What is Ekbom syndrome?
delusional parasitosis
describes the delusion of infestation
often associated with tactile hallucination (formication) in cocaine misuse, dementia and alcohol withdrawal
occurs in affective psychosis, delusional disorder, paranoid schizophrenia, organic brain syndromes
What is Foli-a-deux?
delusion disorder that occurs at the same time in 2 people that have a strong emotional or situational link
one person adopts the delusional belief of the other
delusions may remit in the less dominant person when the 2 individuals are separated
Causes of substance-induced psychosis
alcohol
cannabis
legal highs
amphetamines
cocaine
hallucinogens
inhalants/solvents
prescribed medications (anti-parkinsonian drugs, corticosteroids, anticholinergics)
Management of substance-induced psychosis
setting - do they need acute physical care? detention?
antipsychotics
abstinence from the substance
What is puerperal psychosis?
psychosis post-partum
Puerperal psychosis presentation
positive psychotic symptoms
depressive/manic symptoms also typically present
Puerperal psychosis risk factors
history of puerperal psychosis
pre-existing psychotic illness of severity requiring inpatient admission
family history of affective psychosis in 1st or 2nd degree relatives
Management of puerperal psychosis
as per psychosis in general
need to consider if mother is breastfeeding: olanzapine + quetiapine have lowest levels in breastmilk, mothers on clozapine should not breastfeed
Lewy body dementia pathology
alpha-synuclein cytoplasmic inclusions (Lewy bodies) in the substantia nigra, paralimbic and neocortical areas
Features of Lewy body dementia
progressive cognitive impairment
parkinsonism
visual hallucinations
fluctuating cognition
repeated falls, syncope
neuroleptic sensitivity
Lewy body dementia medical management
donepezil
rivastigmine
galantamine
antipsychotics - clozapine, quetiapine (typical antipsychotics will significantly worsen parkinsonism)
Behaviours and psychological symptoms of dementia
agitation, aggression, distress, psychosis
wandering + hoarding
depression + anxiety
sexual disinhibition
sleep problems
apathy + shouting
When should antipsychotics be given in dementia?
serious risk of harm to self or others
experiencing agitation, hallucination or delusions causing severe distress
What antipsychotics are preferred in dementia?
risperidone first choice (except in lewy body dementia)
haloperidol second choice
