Psychosis Flashcards
What is psychosis
The presence of hallucinations or delusions Describes symptoms, not a diagnosis in itself
What are hallucinations
Perception without a stimulus
Can be in any sensory modality
Visual hallucinations are usually organic (caused by problem with brain or eyes)
What are delusions
Delusion – abnormal belief, outside of cultural norms, unshakeable
What is organic psychosis
Organic psychosis •Delirium caused by infection •Delirium tremens •Acute drug/alcohol intoxication •Post-ictal psychosis •Hyperthyroidism •Encephalitis (including anti-NMDA receptor) •Hypercalcaemia •Cerebral lupus(and many more!)
Don’t forget iatrogenic causes
•Steroids
•L-dopa
What are first rank symptoms
Schneiderian first-rank symptoms (FRS) of schizophrenia encompass a small range of hallucinations and delusions: • Auditory hallucinations • Passivity experiences • Thought withdrawal, broadcast or insertion • Delusional perceptions • Somatic hallucinations
What are examples of auditory hallucinations
Thought echo – hearing thoughts aloud
Running commentary –
‘He’s brushing his teeth, he’s sitting down’
Voices referring to patient in third person and conversing with each other about the patient
What are passivity experiences
Patient believes an action or feeling is caused by an external force, ‘MI5 have been moving my leg’
What is thought withdrawal, broadcast or insertion
Thought withdrawal – thoughts are being taken out of the mind
Thought broadcast - thoughts are being made known to others e.g. via radio
Thought insertion – thoughts implanted by others
What is delusional perception
Delusional perception
‘attribution of new meaning,
usually in the sense of self-reference, to a normally perceived object’
New meaning cannot be understood as arising from patient’s affective state or previous attitudes
‘The traffic lights went red and I knew this was a sign that aliens were going to land soon’
What are somatic hallucinations
Somatic hallucinations
Mimics feeling from inside the body
What are positive and negative symptoms of schizophrenia
Positive symptoms:
Delusions, hallucinations, thought disorder, lack of insight
ie Added symptoms
Negative symptoms:
Underactivity, low motivation, social withdrawal, emotional flattening,
Self neglect
Symptoms that take away from the patient
What are he icd10 criteria for scizophrenia
- At least one of the following
a) Thought echo, insertion, withdrawal, broadcast
b) Delusions of control, influence or passivity, clearly referred to body/limb movements or specific thoughts actions or sensations, delusional perception
c) Hallucinatory voices giving a running commentary on the patient’s behaviour, or discussing them between themselves, or other types of hallucinatory voices coming from some part of the body
d) Persistent delusions of other kinds that are culturally inappropriate and completely impossible
Or at least 2 of the following
e) Persistent hallucinations in any modality, when occurring every day for at least one month, when accompanied by delusions
f) Neologisms, breaks or interpolations in the train of thought, resulting in incoherent or irrelevant speech
g) Catatonic behaviour
h) Negative symptoms such as marked apathy, paucity of speech and blunting or incongruity of emotional responses
What are types of schizophrenia
Paranoid schizophrenia –
delusions or hallucinations prominen
Simple schizophrenia – loss of drive and interest, aimlessness, idleness, self absorbed attitude and social withdrawal. Marked decline in social, academic or work performance. No hallucinations/delusions
Hebephrenic schizophrenia – definite and sustained flattening or shallowness of affect or incongruity/inappropriateness of affect, aimless and disjointed behaviour or thought disorder affecting speech Hallucinations/delusions must not dominate
Undifferentiated schizophrenia – insufficient symptoms to meet criteria of any subtypes or so many symptoms fit more than one criteria
Catatonic schizophrenia
Describe the pathophysiology of schizophrenia
Dopamine pathways
Brain changes
Limbic system
Mesolimbic pathway is involved in reward, pleasure, motivation; thought ot be overactive in scizophrenia:
From Ventral tegmental area To Limbic structures (amygdala, septal area, hippocampal formation)
and Nucleus accumbens (large ceell group in basal forebrain)
Mesocortical pathway involved in cognition, motication, emotional response; thought to be underactive in scizophrenia
From Ventral tegmental area To Frontal cortex and Cingulate cortex
What is the ventral tegmental area
The ventral tegmental area (VTA) is a structure in the midbrain which sends dopaminergic neural projections to both the limbic and cortical areas
