Psychosis Flashcards
Symptoms of psychosis
Hallucination:visual, auditory Delusion Agitation /pacing Mood change Disjointed thoughts Self-care decline (negative symptoms)
Psychosis
General term which refers to a cluster of symptoms that involve major distortions in how people perceive and interpret
-delusion and hallucination =major disturbance in thinking, feeling, and behaviour
Delusion
Belief
- usually false,very pre-occupying, subjectively important
- held for reason that are difficult to make sense of
- usually directly relevant to the person experiencing it
Not -understandable in the context of the person’s religion, culture
-amenable to challenge or counter-argument
Hallucination
Vivid perception without an external stimulus when no actual stimulus
Often auditory, or visual-can also be touch, smell,taste
Normal in some situations (bereavement,when falling asleep)
Not- easily distinguished from “real” perception in internal space
Psychotic disorder that are not related to mood disorder or organic factor
Schizophrenia
Delusional disorder
Acute and transient psychotic disorder
– isolated episode of psychosis might be due to stress
Psychotic disorder related to mood
Mania or depression with psychotic symptoms (bipolar)
Psychotic disorder relayed to organic factor
Street drug, medicine (steroid), confusional states, dementia, neurological/endocrine illness
Schizophrenia
Before onset
- emotionally and socially detached, solitary
- mild cognitive, emotional, motor problems in childhood
Prodrome (before develop acute symptom) -前兆
- median 2-3 years
- insidious loss of motivation, social withdrawal,decline in performance
- attenuated psychotic symptoms; misperceptions, illusions, unusual ideas
These features do not occur in everybody
Acute/Positive Symptoms of schizophrenia
- hallucination; any sense (esp,auditory)
- delusion; any content
- passivity experience; boundary b/w self and outside world breaks down
- –ie, your thoughts are taken away by some external agent, broadcast your thoughts out
- thought disorder; incoherence of thought and speech with drifting b/w topics that doesn’t make sense of
- disorganized behaviour, deterioration in social functioning and self-care,distress
Negative symptoms of schizophrenia
- loss of drive and determination
- loss of interest in other people and capacity for forming relationship
- loss of emotional reactivity
- paucity of speech and loss of interest
- often the most disabling aspects of illness, even though much less dramatic than positive symptoms
- have an environmental component-ie,unstimulating environment
- accompanied by minor deficits in cognitive functioning, fall in IQ already present by onset of illness
Symptom pictures that esp suggest schizophrenia
- positive symptoms for at least a month (6month in us)
- passivity experience or voice talking in 3rd person
- affect doesn’t fit with content of speech-incongruous or flat affect
- > ie, laughing when talking about their pets death
- psychotic symptoms are not obviously mood-related
- content of delusions is bizzar or impossible
- hallucinations are very persistent
Bipolar affective disorder /manic depressive illness
- Episodes of both depression and of elevated mood
- most people who have manic episodes also have depressive ones
- bipolar spectrum including milder undiagnosed presentation. (Bipolar ||)
Onset: median age of early 20s
Impact of schizophrenia
1% of population, one of the top ten cause of disability
High rate of suicide (10-15%)
Drug and alcohol abuse
Cardiovascular disease
12-15years reduction in life expectancy
Prognosis of schizophrenia
10-20% one episode only
1/3 -deteriorating court with poor recovery between episodes including negative symptoms
2/3- recurrent episode but good recovery in between
Better prognosis of schizophrenia with
Acute onset (without prodrome), esp response to stress
Family history of affective disorder, not schizophrenia
Good premorbid functioning
Later onset , female
No substance misuse
Not in high expressed emotion environment
Developing country
Neuro chemistry evidence of schizophrenia
Dopamine theory
Overactive of dopamine
Drug reducing dopamine reduce psychosis
Imaging shows the evidence of over activity in mesolimbic dopamine (D2) pathway; reward motivation area
Structural evidence of schizophrenia
Reduction in brain volume overall, including progressive thinning of cortex
Abnormal connection in white matter may pre-date illness many years
Epidemiological finding of risk of schizophrenia
Men- affected earlier and more severe
Risk factor
- cannabis use esp early adolescence
- social deprivation
- urban environment
- migrant background, esp black Caribbean
- trauma
Course of bipolar affective disorder
- Euthymia (normal mood)
- Hypomania
- Mania
- Mania + psychotic symptom (2/3 people with mania)
Hypomania
Persistent elevated mood
Increased energy, activity, sociability, feeling of wellbeing
Disinhibition, increased libido
Decreased sleep, concentration
Talkative & speech pressured
Perception more vivid, mild overspending
Depression +hypomania = bipolar II
Mania
Speech-uninterruptible Flight of idea-Jump topics rapidly Very disrupted sleep Restless +agitation Loss of inhibition and impulse control Disregard of risk Irritability and aggression, occasionally violence
1 week of duration: complete disruption of work + social life
Frequency of psychosis
New case of psychosis( incidence)
-20-30 new case per year (5-15 schizophrenia)
Lifetime risk of psychosis
-1.5-3 % (0.5-1.5-% schizophrenia )
Contributory psychosocial factors for bipolar
- strong negative and positive beliefs about the self, world, others
- extreme positive and negative interpretation of change to mood
- unstable self esteem
- poor coping style
- over sensitive to disruption to routine and sleep patterns
- over sensitivity to reward and achieving goal
- poor social support
- positive and negative life events, such as childhood trauma
Epidemiology of bipolar
1% prevalence diagnosed
“Bipolar spectrum” including milder undiagnosed presentation (bipolar II) -up to 5-6%
Onset -median 20s
Most people recover but 10-20% remain significantly unwell
Prognosis of bipolar
Much more time in depression than manic episode (20% vs 5%)
Suicide risk in depression
Increase depression than mania as get older
Worse prognosis with
- early onset
- comorbid substance abuse, anxiety, personality disorder
Service for management of psychosis
First onset & acute relapse
Acute inpatient wards
Crisis & home treatment team
Early intervention service
Continuing care -first 3 years
Supporter housing, day and vocational service, welfare service
Continuing care- after first 3 years Assertive outreach teams Rehabilitation service Community mental health team Primary care
Antipsychotic medication
In acute relapse of schizophrenia
-75% recover with antipsychotic vs 25% without
- most improvement in first 6 weeks
- 55% relapse without antipsychotic vs 14-24% with it
No/limited effect in negative symptoms
Side effect of antipsychotic
Weight gain Metabolic syndrome Motor side effect -repetitive movement Sedation Raised prolactin Cardiac arrhythmias Neuroleptic malignant syndrome
Common comorbid disorder in psychosis
Depression
Anxiety
Substance abuse
PTSD
High expressed emotion
Critical comments and emotional over-involvement
Risk factor for bipolar
Genetic
-67% risk for twins
15-20% for children of a parent with bipolar disorder
Life event-triggers for individual episode
Can begin after child birth
Organic mania- especially if late onset (hormone, drugs)
Some psychological risk factor
-black/white thinking
