Psychosis Flashcards
What is psychosis?
- Patient cannot tell the difference between subjective experience and objective reality
- Lack of insight
Is reality always perceived in the same way by people without psychosis?
No
Our brains filter information differently, but cant process fast enough
Everyone makes different shortcuts to avoid information overload
What are the two main types of psychosis?
Paranoid - e.g. schizophrenia
Affective - Bipolar, unipolar depression
What organic causes are there for psychosis?
Delirium
Dementia
Brain Injury
Stroke
How can substance misuse cause psychosis?
Intoxication (e.g. Delirium Tremens in alcohol)
Withdrawal
What symptoms indicate a patient is having a psychotic experience?
- Hallucinations
- Ideas of Reference
- Delusions
- Formal thought disorder
- Thought interference
- Passivity phenomena
- Loss of insight
Describe the difference in normal brain processing of a stimulus, and how patients with hallucination process a stimulus.
Normal Brain:
Stimulus -> sensory organ -> brain processing -> perception of object
Hallucination
Aberrant brain processing (without stimulus) -> perception of object that is not there
Hallucinations can take the form of what sensory modalities?
Visual Auditory Olfactory Gustatory Tactile (physical contact with imaginary object e.g. bugs)
Describe what the brain thinks when it is trying to interpret psychotic symptoms
Hallucinations - brain cannot consider it is an internal perception
Thought insertion - someone else is putting these thoughts in my head, they are not my own
Passivity of action - someone else is moving my arm rather than myself
What is meant by ideas of reference?
- Words/ messages jumping out at them
- Has a different meaning to them, often persecutory towards them
- usually from TV, radio, newspapers
What is paranoia?
- The belief that external events are related to oneself
- Can be brief OR can have delusions of reference - e.g. patient thinks they are the second coming of Christ etc
What is a delusion?
- falsely held belief
- patient is adamant regardless of contrary evidence
- usually held outwith the social, cultural and educational background of the patient
- Can be bizarre or impossible
What is the difference between a primary and secondary delusion?
Primary - fully formed whilst patient is conscious and they require no explanation for it
Secondary - patient is trying to explain another experience e.g. hallucination
Give examples of types of delusion
• Paranoid
• Persecutory
• Grandiose
• Religious (pt often thinks they are religious figure)
• Misidentification
- Capgrass - pt thinks certain people = spying on them
- Fregoli - pt thinks people are changing their appearance to spy on them
• Guilt
• Sin - pt is worried about something they have done in the past
• Poverty
• Nihilistic
• Erotomanic - pt thinks celebrity/incorrect person is in love with them
• Jealousy - “othello syndrome” - believe infidelity in significant other
What does it mean that the content of delusions is culturally defined?
e.g. by a disease prevalent at that time in history
Nowadays by technology/ satellites
What symptoms heard in a patients speech, would indicate they had a thought disorder?
- Neologisms (new words that pt has created)
- Tangentiality
- Clanging and punning
- Loosening of associations
- Knight’s move thinking
- Word Salad
What are the main types of thought interference and what do patients complain of in each?
Thought insertion - thoughts being put into my head
Thought withdrawal - take my thoughts out of my head
Thought broadcasting - everyone knows what I am thinking
Thought blocking - I get halfway through thinking something and the thoughts just dry up
What are the different types of passivity that patients may experience?
- action (someone else made them make an action)
- feelings (someone else made them feel something)
- urge
- influence on body (other person made them move)
How should you challenge/confront patients about their psychotic symptoms?
CLARIFY:
“I just want to check that I am understanding this correctly, I don’t want to misunderstand you, I think what you are saying is that ……”
Creative ways to challenge:
• “What would you say if someone said to you that [these beliefs] are not true?”
“Explain to me how this is possible?”
IF ALL ELSE FAILS
“agree to disagree”
What are the possible differential diagnoses for psychosis?
Drug induced
Depressive
Mania with Psychosis
Delirium
How is a depressive psychosis noticed?
- content of delusions are usually depressive themes e.g. guilt/worthlessness
- auditory hallucinations are 2nd person, directed at depressed patient
What differences from normal psychosis are seen in an episode of drug-induced psychosis?
- acute onset and short duration
- especially if psychoactive substance removed
What symptoms are typical of mania with psychosis?
- Content of delusions = grandeur / special ability / persecution / religiosity
- Hallucinations: auditory (e.g. God’s voice)
- Flight of ideas
What symptoms would indicate psychosis is potentially due to a delirium?
- Clouding of consciousness
- ranges from drowsiness to unresponsive
- disorientation in time, place and person
- lucid intervals
- worse at night
- Impaired concentration / memory (e.g. new info)
- agitation or psycho-motor retardation may be present
