Psychosis Flashcards
Psychosis is a diagnosis. True or false?
False. It is a description of symptoms
Definition
Separation of body and mind.
Inability to distinguish between subjective experience and reality.
Hallmark clinical features (7)
Hallucinations Ideas of reference Delusions Thought form disorder Thought interference Passivity phenomena Loss of insight
Hallucinations
A perception which occurs in the absence of external stimulus.
Experienced as originating in real space (not just thoughts)
Ideas of reference
Seeing significant meaning in things where there is no need for meaning
- eg believing that a radio station is broadcasting songs in such a way as to tell you something
Ideas of reference - self referential experiences
The belief that external events are related to you
Delusions
Fixed, falsely held belief held with unshakable conviction.
May be bizarre/impossible.
Delusions - types (7)
Self referential Paranoid Persecutory Grandiose Religious Misidentification Guilt Nihilistic
Which type of delusion is this: inflated self importance and optimism, “I am the second coming of Christ”
Grandiose
Which type of delusion is this: “the end of the world is coming”
Nihilistic
Which type of delusion is this: “I’m refusing to eat food that my parents have prepared as they are trying to poison me”
Paranoid
Which type of delusion is this: Lying in hospital -> family members come to visit but you think they’re strangers “Maybe my parents have been replaced”
Misidentification
Thought form disorder
Train of thought is hard to follow
- “my dad has a blue car. blue is the colour of the sea”
Neologisms
- a newly coined word or expression
Tangentiality
- start to answer a question then go off track and ramble about something else
Clanging and punning
Word salad
- i don’t care if its not in your dictionary, its in mine
Thought interference - types (4)
Thought insertion
Thought withdrawal
Thought broadcasting
Thought blocking
Thought interference - insertion
feel that your thoughts are being put into your head, they are not your own
Thought interference - withdrawal
feel that your thoughts are being taken out of your head
extracting information from you
Thought interference - broadcasting
“Everyone can know what I’m thinking”
Thought interference - blocking
Get halfway through thinking then the thoughts dry up
Passivity phenomena
Feeling of being controlled
Not having a sense of own control
Loss of insight
Patient does not realise they are unwell
Patient does not consider psychotic symptoms as being “illness”
Management
Anti-psychotics
- atypical are first line (since there are not as much side effects)
Examples of potential differential diagnoses
(note that diagnosis depends on nature of psychotic experience, associated psychiatric symptoms, natural history of symptoms)
Schizophrenia Schizoaffective disorder Bipolar disorder Unipolar depression Substance misuse Organic conditions - delirium, dementia, brain injury
Which type of delusion is this: the belief that external events are related to you
Self-referential
Depressive psychosis
Delusions of worthlessness, guilt, hypochondriasis, poverty
Hallucinations
- 2nd person (people talking directly to you)
- eg: “you are worthless”
Mania with psychosis
Hallucinations
- 2nd person (people talking directly to you)
- eg: cheery, the voice of God
Delusions
- grandiose
Flight of ideas
Delirium
Acute, transient disturbance
Impaired concentration/memory
Persecutory delusions
What is puerperal psychosis?
Psychosis which occurs in pregnancy.
Puerperal psychosis - clinical features
Acute onset of psychotic symptoms
Manic symptoms / disinhibition
Confusion
