Psychosis Flashcards
what is definition of psychosis
The presence of hallucinations or delusions
Describes symptoms, not a diagnosis in itself
what is definition of 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 Hypnogogic hallucinations ?
Hypnopompic ?
hallucinations before going to sleep
waking up
these are normal
what are delusions ?
abnormal belief,
outside of cultural norms,
unshakeable
what is organic psychosis ?
causes >
abnormal brain function with known physical abnormalities
Steroids L-dopa Hyperthyroidism Encephalitis Drugs/alcohol Hypercalcaemia cerebral lupus delirium - infections , tremens
what are first rank symptoms of schizophrenia ?
Auditory hallucinations passivity experiences thought withdrawal , broadcast or insertion delusional perceptions somatic hallucinations
what kind of auditory hallucinations are seen in schizophrenia?
thought echo - hearing thoughts aloud
Running commentary - third person and multiple voices
what is passivity experiences ?
patients believes actions or feeling is caused by external force
what is Thought withdrawal, broadcast and 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?
attribution of new meaning,
usually in the sense of self-reference,
to a normally perceived object.
e.g traffic lights were red = aliens will come
what are somatic hallucinations ?
Mimics feeling from inside the body
- ‘there is snake in my stomach ‘
what are positive symptoms in schizophrenia ?
Delusions, hallucinations, thought disorder, lack of
insight
Added symptoms
what are negative symptoms in schizophrenia ?
Underactivity, low motivation, social withdrawal,
emotional flattening, self neglect
Symptoms that take away from the patient
what is the ICD 10 diagnosis of schizophrenia ?
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
what are the types of schizophrenia ?
Paranoid schizophrenia Simple Hebephrenic Undifferentiated Catatonic
define paranoid schizophrenia
delusions or hallucinations
prominent
define 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
define 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
what pathways are affected in Schizophrenia ?
dopamine pathways -
Mesocortical and mesolimbic
where does the mesolimbic pathway start/ finish?
From Ventral tegmental area To Limbic structures (amygdala, septal area, hippocampal formation) and Nucleus accumbens (large cell group in basal forebrain)
what is the ventral tegemtal area ?
midbrain collection of dopaminergic neurones
what does the mesolimbic pathway do? how active in schizophrenia ?
Motivation, reward, pleasure
overactive
where does the mesocortical pathway start/ finish?
From Ventral tegmental area To Frontal cortex and Cingulate cortex
what does the mesocortical pathway do? how active in schizophrenia ?
Cognition, motivation, emotional response
under active
what are brain changes in schizophrenia ?
Enlarged ventricles
reduced hippocampus, amygdala , prefrontal cortex
what type of Encephalitis is seen in schizophrenia ? where is it seen mostly ?
why does it occur ?
treatment
Anti-NDMA- sudden onset (1-3wks) seen in women with ovarian teratoma antibodies bind to NMDA= hypofucntion corticosteroids and IV immunoglobulin can lead ot coma
what do typical antipscychotics do ?
Block D2 receptors in all CNS
dopaminergic pathways- mesolimibic/ cortical
what do atypical antipsychotics do ?
Low affinity for D2 receptors
Milder side effects as dissociate rapidly
from D2 receptor
where are D2 receptors found in the brain ?
Striatum
Substantia nigra
Pituitary gland
what side effects are seen in Anti-psychotics ?
parkinosonian symptoms e.g. acute dystonia
what is catatonia ?
more than 2 wks of 1 or more:
stupor / mutism , excitement , posturing, negativism, rigidity, waxy flexibility , command automatism
what causes catatonia ? how is it treated ?
less GABA binding = loss of inhibitory effect
Lorazapam = benzo
what is the ICD 10 criteria of drug indued psychosis ?
Onset of psychotic symptoms during or within two weeks of substance use
Persistence of the psychotic symptoms for more than 48 hours
Duration of the disorder not exceeding six months
what is affective psychosis ?
experiences are congruent with mood
E.g manic patients = hear voice of God
What is PP psychosis ?
very severe Can present in patients with no previous psychiatric history More common if previous bipolar disorder or psychotic illness, or mother or sister suffered Onset within days to weeks of delivery Can develop over hours to days
