Psychosis Flashcards
What is psychosis
severe impairment of thoughts and cognitions that contact is lost with reality
Causes of psychosis
Schizophrenia
depression
Bipolar
Drugs and alcohol
What are schizophrenia first rank symptoms
- Auditory hallucinations
- Thought possesion
- Loss of control
- Delusions of perception
What are considered positive symptoms of schizophrenia
Delusions
What is considered mani
- Mania is sustained >7 days
- If hospitalisation is required
- Marked impairment in social or occupational functioning
- Psychotic features
What are considered negative symptoms of schizophrenia
Blunted mood
Reduced speech
Poor self care
Low motivation
What are features of psychosis
- Delusions of grandeur
- Hallucinations: auditory more common in schizophrenia and depression
- Nihilistic: more common in depression
What criteria must you meet to diagnose depression
ICD10: ○ Mild = 4 symptoms (2 core) ○ Moderate = 5-6 symptoms (2 core) ○ Severe = ≥7 symptoms (3 core) ● If psychotic symptoms -> severe depression
What is the treatment of depression
- Medications: SSRIs, TCAs, MAOs
- Talking therapy: CBT/counselling
- ECT
Features of Bipolar
- Good mood spells last multiple days not change in a day
- Delusions of Self-grandeur
- risky behaviour(Risk Assess?)
- little sleep/nutritional intake.
- Pressure/fast speech (think MSE).
- Mania vs Hypomania?
What is the treatment of schizophrenia
- Antipsychotics, olanzapine most common (5-HT and D2 antagonist)
- Clozapine for treatment resistant schizophrenia (what is risk?)
What is the treatment for bipolar
lithium
What are the common features of auditory hallucinations in a schizophrenic patient
- two or more voices discussing the patient in the third person
- thought echo
- voices commenting on the patient’s behaviour
What is passivity phenomena
- bodily sensations being controlled by external influence
actions/impulses/feelings - experiences which are imposed on the individual or influenced by others
What are the negative symptoms of schizophrenia
- incongruity/blunting of affect
- anhedonia
- alogia (poverty of speech)
- avolition (poor motivation)
Non first rank features of schizophrenia
impaired insight incongruity/blunting of affect (inappropriate emotion for circumstances) decreased speech neologisms: made-up words catatonia
What is type 1 bipolar disorder
mania and depression (most common)
What is type 2 bipolar
hypomania and depression
What is the management of bipolar
- Mood stabeliser: lithium
- address co-morbidities - there is a 2-3 times increased risk of diabetes, cardiovascular disease and COPD
How to treat mania in bipolar
consider stopping antidepressant if the patient takes one; antipsychotic therapy e.g. olanzapine or haloperidol
How to treat depression in bipolar
talking therapies (see above); fluoxetine is the antidepressant of choice
When & where to refer
- hypomania: routine referral to the community mental health team (CMHT)
- mania or severe depression: urgent referral to the CMHT
