psychosis Flashcards
4 things seen in psychosis?
hallucinations, delusions, passivity, formal thought disorder
what is passivity?
(passive movements) feeling as if the mind or body is under the control of some external agency or force
formal thought disorder?
umbrella term for disorders such as neologism, thought blocking, poverty of speech, tangenitally, circumstantiality, flight of ideas
what is flight of ideas?
words are associated inappropriately, but there is a logical link i.e. rhyming/connection
how is a formal thought disorder evidenced?
disorganised thinking causes disorganised speech
“He went to the ballpark and bought Frank’s beer belly home in a bag of grass seed.”
What kind of thought disorder?
knights move thinking/loosening of associations
4 areas in brain associated with fear?
SHHAT - sensory cortex, hippocampus, hypothalamus, amygdala, thalamus
differential diagnosis od psychosis?
Schizophrenia Psychoactive Substance Use Mania Depression Schizoaffective Disorder Delirium Dementia Other organic cause
what is schizo—-affective disorder?
pyschotic symptoms and mood symptoms
typical auditory hallucination in severe depression?
2nd person derogatory - you are shit
depressive psychosis typified by what psychotic symptoms?
mood congruent…worthlesness, guilt, hypochondriasis, guilt
why do you have to be careful in drug induced psychosis? what could be underlying?
underlying schizophrenia/biplolar disorder. they are more likely to use illicit drugs
psychosis is a marker of severity in depression. typified by ______ congruent content of psychotic symptoms
mood
what kind of delusions do you get in depressive psychosis?
guilt/worthlesness/poverty (nihilistic delusions)
mania with psychosis. typically what kind of delusions?
delusions of grandeur, religious and paranoid/suspicious
man bought new porsche. new girlfriends. big stakes business transactions. hears gods voice. thinks he is madonnas son and is going to inherit large sums of money?
mania with psychosis
septicaemia, organ failure (cardiac, renal, hepatic), hypoglycaemia, post-op hypoxia, post-ictal, encephalitis, space occupying lesion, drug intoxication (e.g. steroids, digoxin, diuretics, anticholinergics), drug withdrawal (e.g. benzodiazepines.
what kind of psychosis?
delirium
man having hallucinations (worse at night) in hospital after surgery for MI. seeing people running around and hearing 2nd person auditory threatening hallucinations?
delirium
when is delirium worst?
at night
orientation in delirium?
loss of orientation in time, place and person
what is the course of delirium like?
fluctuating with lucid intervals
auditory hallucinations in delirium are often?
threatening
delusions are ?
persecutory (jesus cross)
uncle d, delirious patients are irritable and insomnic
yes
3rd person auditory hallucinations suggests?
schizophrenia
79 year old man retired bank manager admitted for elective fem-pop bypass graft (28/10/10)
PMH: aortic stenosis, LVH. No PPH
? post-op MI (31/10/10)
referred to psychiatrist on-call 2:00am 2/11/10
increasingly difficult to manage,
? hallucinated, disorientated in time & place,
trying to leave the ward
WORSE AT NIGHT
DELIRIUM POST MI (hypoxic)
55 year old farmer brought by his wife to GP
He believes he has brought financial ruin to his whole family and deserves to die
He admits to very poor sleep, has no energy or appetite and has lost 1st weight in the past 2 months
His thoughts are generally pessimistic and negative towards himself & the future
DEPRESSIVE EPISODE WITH PSYCHOTIC FEATURES
i.e. delusions of guilt / poverty
farm difficulties a possible precipitating factor
23 year old unemployed graduate presents to his GP
he has been involved in a number of new business ventures over recent weeks involving a proposed sum of £150 000. He has also tried to buy a Porsche on credit.
He has been involved with a number of new girlfriends and was caught speeding on the A90 at 110mph
He admits to poor sleep over the last 3 weeks but does not feel tired.
He feels full of energy and new ideas and can’t see that he has done anything wrong.
He says he just found out that he is Madonna’s secret son and stands to inherit
£5 000 000 next month.
He knows this because she has broadcast messages to him over the radio & TV
manic
what is psychosis characterised by?
hallucinations, delusions, thought disorder and lack of insight
olfactory and gustatory hallucinations suggest?
seizure
what diagnosis is made when psychosis and mood symptoms are present in equal measure?
schizoaffective disorder
