Psychosis Flashcards
What is psychosis?
The presence of hallucinations or delusions
A SYMPTOM, NOT A DIAGNOSIS
What are hallucinations?
Perception without a stimulus, can be in any sensory modality
What are visual hallucinations usually caused by?
A problem with the brain or eyes (organic)
What are considered ‘normal’ hallucinations?
Hypnogogic or hypnopompic hallucinations
Going to sleep/waking up
What is a delusion?
An abnormal and unshakeable belief, outside of cultural norms
How do schizophrenic auditory hallucinations normally present?
Either as a thought echo (speaking thoughts aloud) or as a running commentary.
Refer to the patient in third person, converse about the patient.
What are passivity experiences?
Patient believing an external force is causing an action/feeling
What beliefs may be held about thoughts?
That they are being taken out of the mind (withdrawal), made known to others (broadcast), or implanted by others (insertion)
What is delusional perception?
Attribution of a new (usually self-referential) meaning to a normally perceived object
What are somatic hallucinations?
Mimicking feelings from within the body
Eg: there’s something in my stomach
What are the positive symptoms of schizophrenia?
Delusions, hallucinations, thought disorders, lack of insight
What are the negative symptoms of schizophrenia?
Underactivity, low motivation, social withdrawal, emotional flattening, self neglect
What is required for a diagnosis of schizophrenia?
One or more of:
Thought echo/insertion/withdrawal/broadcast
Delusions of control/influence/passivity relating to body movements, thoughts, actions, or sensations. Delusional perception.
Hallucinatory voices giving running commentary/discussing the patient/coming from some part of the body
Persistent delusions
OR 2+ of persistent hallucinations accompanied by delusions, breaks/interpolations in train of thought leading to incoherence/irrelevant speech, catatonic behaviour, negative symptoms (apathy, paucity of speech, blunt/incongruous emotional response)
What is paranoid schizophrenia?
Delusions/hallucinations are prominent
What is hebephrenic schizophrenia?
Sustained flattening/shallowness or incongruity/inappropriateness of affect, aimless and disjointed behaviour, thought disorder affecting speech.
Hallucinations/delusions do NOT dominate
What is simple schizophrenia?
Loss of drive and interest
Aimlessness, idleness
Self absorbed attitude and social withdrawal
Marked decline in social/academic/work performance
No hallucinations/delusions
What is undifferentiated schizophrenia?
Insufficient symptoms/too many symptoms to meet/fit one criteria
What is the pathology of schizophrenia?
Large ventricles (possible atrophy), brain changes including limbic system (reduced hippocampal formation, parahippocampal gyrus, amygdala, prefrontal cortex) Mesolimbic pathway (ventral tegmental area to limbic structures and nucleus accumbens) Mesocortical pathway (ventral tegmental area to frontal cortex and cingulate cortex)
How is schizophrenia treated?
Typical antipsychotics:
block D2 receptors in CNS dopaminergic pathways, main action on mesolimbic and mesocortical pathways
Atypical:
Low affinity for D2 receptors, minor side effects as quickly dissociate away
Where are D2 receptors?
The striatum, pituitary gland, and substantia nigra
What are good prognostic factors for psychosis?
Absence of family history Good premorbid function Acute onset Mood disturbance Prompt treatment Maintenance of initiative and emotion
