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Psychiatry - Crash Course > Psychosis > Flashcards

Psychosis Flashcards

1
Q

Psychosis

A

A grossly distorted sense of reality, resulting in delusions, hallucinations and thought disorder

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2
Q

Perception

A

Process of making sense of the physical information we receive from the 5 senses

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3
Q

Hallucination

A

A perception occurring in the absence of an external physical stimulus

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4
Q

Illusion

A

A misperception of real external stimuli - can occur in healthy people, associated with inattention or strong emotion

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5
Q

Pseudohallucination

A

Perceptual experience that the patient recognises as having coming from within their own mind, yet beyond conscious control

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6
Q

Elementary auditory hallucinations

A

Simple, unstructured sounds e.g. whirring, buzzing, whistling or single words

Commonly occur in acute organic states

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7
Q

Complex auditory hallucinations

A

Spoken phrases, sentences or dialogue in 1st, 2nd or 3rd person

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8
Q

Audible thoughts

A

1st person auditory hallucination

Person hears their thoughts spoken aloud as they think them

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9
Q

Thought echo

A

1st person auditory hallucination

Person hears their own thoughts as an echoed by a voice after they have thought them

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10
Q

Second person auditory hallucinations

A

Patients hear a voice/voices speaking directly to them

Often persecutory, critical, complimentary or issue commands (command hallucinations)

Often associated with mood disorders with psychotic features, where they are mood congruent

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11
Q

Third person auditory hallucinations

A

Patients hear voices speaking about them or referring to them

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12
Q

Autoscopic hallucination

A

The experience of seeing an image of oneself in an external space

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13
Q

Charles Bonnet syndrome

A

Complex visual hallucinations associated with no other psychiatric symptoms or impairment in consciousness - usually in older adults, associated with a loss of vision

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14
Q

Lilliputian hallucinations

A

Seeing miniature people or animals

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15
Q

Somatic hallucinatons

A

Hallucinations of bodily sensations

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16
Q

Tactile (haptic) hallucinations

A

Experience of the skin being touched, pricked or pinched

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17
Q

Formication

A

Unpleasant sensation of insects crawling on or just below the skin
Associated with long-term cocaine use and alcohol withdrawal

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18
Q

Hygric hallucinations

A

False perception of fluid e.g. ‘I can feel water sloshing in my brain’

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19
Q

Visceral hallucinations

A

False perceptions of internal organs - include deep sensations of organs throbbing, stretching, distending or vibrating

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20
Q

Kinaesthetic hallucinations

A

False perception of joint or muscle sense

Includes feeling sensation of free-falling as you are about to fall asleep

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21
Q

Olfactory hallucinations

A

Often occur with gustatory hallucinations, as the two senses are closely related

Important to rule out epilepsy (especially temporal lobe) and other organic brain diseases

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22
Q

Hypnagogic hallucinations

A

False perceptions in any modality (often auditory or visual) that occur as a person goes to sleep
Not indicative of psychopathology

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23
Q

Hypnopompic hallucinations

A

False perceptions in any modality (often auditory or visual) that occur as a person wakes up
Not indicative of psychopathology

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24
Q

Extracampine hallucinations

A

False perceptions that occur outside of the limits of a person’s normal sensory field e.g. hearing voices from 100 miles away

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25
Q

Functional hallucination

A

When a normal sensory stimulus is required to precipitate a hallucination in the same sensory modality e.g. voices that are only heard when the doorbell rings

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26
Q

Reflex hallucination

A

When a normal sensory stimulates in one modality precipitates a hallucination in another e.g. voices that are only heard when the lights are on

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27
Q

Delusion

A

An unshakeable false belief, not in keeping with the patient’s social and cultural background

A delusion is to ideation what a hallucination is to perception

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28
Q

Delusional atmosphere

A

Where the world seems subtly altered, uncanny, portentous or sinister. This resolves into a delusion, usually in a revelatory fashion, which seems to explain the unusual feeling of anticipation

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29
Q

Delusional intuition

A

Where delusions arrive ‘out of the blue’, without external cause

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30
Q

Delusional perception

A

Where a normal percept is interpreted with delusional meaning. For example, a person sees a red car and knows that this means their food is being poisoned by the police

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31
Q

Secondary delusions

A

Secondary delusions (sometimes called delusion-like ideas) are considered to be, at least in principle, understandable in the context of a person’s life history, personality, mood state or presence of other psychopathology. For example, a person becomes depressed, suffers very low mood and self-esteem, and subsequently believes they are responsible for some terrible crime which they did not commit.

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32
Q

Primary delusions

A

Do not occur in response to any previous psychopathological state - their genesis is un-understandable

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33
Q

Partial delusion

A

Beliefs that were previously held with delusional intensity, but then become held with less conviction.
Occurs when patients start recovering after receiving treatment

34
Q

Overvalued idea

A

A plausible belief that a patient becomes preoccupied with to an unreasonable extent . The pursuit of the idea causes considerable distress to the patient or those living around them

35
Q

Persecutory delusion

A

False belief that one is being harmed, threatened, cheated, harassed or is a victim of a conspiracy

36
Q

Grandiose delusion

A

False belief that one is exceptionally powerful (including having ‘mystical powers’), talented or important

37
Q

Delusions of reference

A

False belief that certain objects, people or events have intense personal significance and refer specifically to oneself, e.g. believing that a television
newsreader is talking directly about one

38
Q

Religious delusions

A

False belief pertaining to a religious theme, often grandiose in nature, e.g. believing that one is a special messenger from God

39
Q

Delusions of love (erotomania)

A

False belief that another person is in love with one (commoner in women).

40
Q

de Clerambault syndrome

A 
A woman (usually) believes
that a man, frequently older and of higher status, is in love with her
41
Q

Delusions of infidelity (morbid jealousy, Othello syndrome)

A

False belief that one’s lover has been unfaithful. Note that morbid jealousy may also take the form of an overvalued idea, that is, non-psychotic jealousy

42
Q

Capgras syndrome

A

Belief that a familiar person has been replaced by an exact double – an impostor

43
Q

Fregoli syndrome

A

Belief that a complete stranger is actually a familiar person already known to one

44
Q

Nihilistic delusions

A

False belief that oneself, others or the world is non-existent or about to end. In severe cases, negation is carried to the extreme with patients claiming that
nothing, including themselves, exists

45
Q

Somatic delusions

A

False belief concerning one’s body and its functioning, e.g. that one’s bowels are rotting. Also called hypochondriacal delusions (to be distinguished
from the overvalued ideas seen in hypochondriacal disorder)

46
Q

Ekbom’s syndrome

A

False belief that one is infested with small but visible organisms. May also occur secondary to tactile hallucinations, e.g. formication

47
Q

Delusions of control (passivity or ‘made’ experiences)

A

False belief that one’s thoughts, feelings, actions or impulses are controlled or ‘made’ by an external agency, e.g. believing that one was made to break a window by demons

48
Q

Thought insertion

A

Belief that thoughts or ideas are being implanted in one’s head by an external agency

49
Q

Thought withdrawal

A

Belief that one’s thoughts or ideas are being extracted from one’s head by an external agency

50
Q

Thought broadcasting

A

Belief that one’s thoughts are being diffused or broadcast to others such that they know what one is thinking

51
Q

Loosening of association (derailment/knight’s move thinking)

A

When the patient’s train of thought shifts sud- denly from one very loosely or unrelated idea to the next

Characteristic of schizophrenia

52
Q

Word salad

A

Most extreme form of loosening of association. Speech becomes a mixture of incoherent words and phrases

53
Q

Thought blocking

A

A sudden cessation to the flow of thought, often in mid-sentence. Patients have no recall of what they were saying or thinking

54
Q

Neologisms

A

New words created by the patient

55
Q

Perseveration

A

When an initially correct response is inappropriately repeated

Highly suggestive of organic brain disease

56
Q

Echolalia

A

When patients senselessly repeat words or phrases spoken around them by others

57
Q

Negative symptoms

A

Indicate a clinical deficit
Include marked apathy, poverty of thought and speech, blunting of affect, social isolation, poor self-care and cognitive deficits

58
Q

Catatonic rigidity

A

Maintaining a fixed position and rigidly resisting all attempts to be moved

59
Q

Catatonic posturing

A

Adopting an unusual or bizarre position that is then maintained for some time

60
Q

Catatonic negativism

A

A seemingly motiveless resistance to all instructions or attempts to be moved; patients may do the opposite of what is asked

61
Q

Catatonic waxy flexibility (flexibilitas cerea)

A

Patients can be ‘moulded’ like wax into a position that is then maintained

62
Q

Catatonic excitement

A

Agitated, excited and seemingly purposeless motor activity, not influenced by external stimuli

63
Q

Catatonic stupor

A

A presentation of akinesis (lack of voluntary movement), mutism and extreme unresponsiveness in an otherwise alert patient (there may be slight clouding of
consciousness)

64
Q

Echopraxia

A

Patients senselessly repeat or imitate the actions of those around them. Associated with echolalia – also occurs in patients with frontal lobe damage

65
Q

Mannerisms

A

Apparently goal-directed movements (e.g. waving, saluting) that are performed repeatedly or at socially inappropriate times

66
Q

Stereotypies

A

A complex movement that does not appear to be goal-directed (e.g. rocking to and fro, gyrating)

67
Q

Tics

A

Sudden, involuntary, rapid, recurrent, non-rhythmic motor movements or vocalizations

68
Q

Differential diagnosis for the psychotic patient

A

Psychotic disorders
• Schizophrenia
• Schizophrenia-like psychotic disorders
• Schizoaffective disorder
• Delusional disorder
Mood disorders
• Manic episode with psychotic features
• Depressive episode, severe, with psychotic features
Secondary to a general medical condition
Secondary to psychoactive substance use Dementia/delirium
Personality disorder (schizotypal, borderline, schizoid, paranoid)
Neurodevelopmental disorder (autistic spectrum)

69
Q

ICD-10 diagnostic guidelines for schizophrenia (4,5)

A

One or more of the following symptoms:
a. Thought echo, insertion, withdrawal or broadcast
b. Delusions of control or passivity; delusional
perception
c. Hallucinatory voices giving a running commentary;
discussing the patient among themselves or ‘originating’ from some part of the body
d. Bizarre delusions

OR

Two or more of the following symptoms:
e. Other hallucinations that either occur every
day for weeks or that are associated with fleeting delusions or sustained overvalued ideas
f. Thought disorganization (loosening of association, incoherence, neologisms)
g. Catatonic symptoms
h. Negative symptoms
i. Change in personal behaviour (loss of interest,
aimlessness, social withdrawal)

70
Q

How long do symptoms need to be present to diagnose schizophrenia?

A

Symptoms should be present for most of the time during at least 1 month

71
Q

Schneider’s first rank symptoms of schizophrenia (3+3+3+2)

A
  1. Made phenomena
    - Made affect (emotion)
    - Made impulse (drive)
    - Made volition (acts)
  2. Disruptions of thought
    - Thought insertion
    - Thought withdrawal
    - Thought broadcast
  3. Types of auditory hallucinations
    - Voices giving a running commentary on the patient
    - Hearing thoughts spoken out loud
    - Voices in the third person criticising or discussing the person
  4. Somatic passivity

5 . Delusional perception

72
Q

Paranoid schizophrenia

A

Dominated by the presence of delusions and hallucinations (positive symptoms). Negative and catatonic symptoms as well as thought disorganization are not prominent. The prognosis is usually better and the onset of illness later than the other subtypes.

73
Q

Hebephrenic (disorganised) schizophrenia

A

Characterized by thought disorganization, disturbed behaviour and inappropriate or flat affect. Delusions and hallucination are fleeting or not prominent. Onset of illness is earlier (15 to 25 years of age) and the prognosis poorer than paranoid schizophrenia

74
Q

Catatonic schizophrenia

A

A rare form characterized by one or more catatonic (psychomotor) symptoms

75
Q

Residual schizophrenia

A

1 year of predominantly

chronic negative symptoms which must have been preceded by at least one clear cut psychotic episode in the past

76
Q

Delusional disorder

A

The development of a single or set of delusions for the period of at least 3 months is the most prominent or only symptom

77
Q

Folie a deux

A

When a non-psychotic patient with close emotional ties to another person suffering from delusions (usually a dominant figure) begins to share those delusional ideas themselves. The delusions in the non-psychotic patient tend to resolve when the two are separated

78
Q

Medical conditions that can cause psychotic symptoms

A

-Cerebral: neoplasm, infarct, trauma, infection, inflammation
-Endocrinological: thyroid, parathyroid, adrenal
-Epilepsy (especially temporal lobe)
-Huntington’s disease
-SLE
-Vitamin B12, niacin (pellagra) and thiamine deficiency (Wernicke’s encephalopathy)
Acute intermittent porphyria

79
Q

Substance-related causes of psychotic symptoms

A
  • Alcohol
  • Cannabis
  • ‘Legal highs’
  • Amphetamines
  • Cocaine
  • Hallucinogens
  • Inhalants/solvents

Prescribed:

  • Antiparkinsonian drugs
  • Corticosteroids
  • Anticholinergics
80
Q

Schizophrenia-like psychotic disorder

A

ICD-10: acute and transient psychotic disorder
DSM-IV: schizophreniform disorder or brief psychotic disorder

If symptoms have been going on for

Psychiatry - Crash Course (11 decks)

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