Psychosis Flashcards
What does psychosis mean?
No accepted definition
Being out of touch with reality / experiencing a different reality
Lack of insight
“The dreamer awake”
What are 4 main psychotic symptoms?
Delusions
Hallucinations
Formal thought disorder
Disorders of the self
What are hallucinations?
Perceptions in the absence of an external stimulus
Can be in any of the 5 sensory modalities
Are true hallucinations in the external or internal space (in your head) ?
External space
What is the most common type of hallucinations psychosis?
Auditory is the commonest
Tactile
Visual hallucinations often accompany…
Delirium
Olfactory hallucinations should make you think of what?
Frontal lobe pathology
What is a delusion?
A fixed firmly held belief that is usually false, that is held despite evidence to contrary, that cannot be reasoned away and that is out of keeping with their sociocultural norms
What examples of delusion classifications are there?
Grandiose, persecutory, hypochondriacal, reference, guilt, erotomanic
When questioning delusions what approach should be taken?
Gently probing in attitude of interested skepticism around the evidence for the beliefs and the patient’s attitude for alternative explanations
Describe formal thought disorder
When speech, and therefore thought incoherent
Each sentence does not follow on from the next or even each phrase or word.
Similar to flight of ideas but here the ideas are related
What are some examples of specific thought disorders?
Derailment, poverty of speech, thought blocking, perseveration, tangentiality
What does disorders of the self mean?
Those aspects of the self that include distinguishing self from other, continuity in time, self as agent, self as unity of experience and self as private space are altered.
Disorders of the self include symptoms such as..
Thought insertion
Thought broadcasting
Thought withdrawal
What is the differential diagnosis?
Delirium Epilepsy - TLE Space occupying lesion Dementia Endocrine - Cushings, hyperthyroidism Drug induced - steroids, L-dopa, stimulants, hallucinogens, alcohol Hypercalcaemia Hypoglycaemia
Functional psychosis
What is schizophrenia?
A disorder or group of disorders characterised by positive symptoms (delusions, hallucinations, formal thought disorder) and negative symptoms (lack of will, interest, isolation…)
These may occur separately or together in same patient
Give some examples of negative symptoms seen in schizophrenia
Amotivation Apathy Flat affect Alogia (poverty of speech) Social withdrawal Self neglect Autism
What are first rank symptoms of schizophrenia?
Auditory hallucinations Somatic hallucinations TW, TB, TI Delusional perception Passivity experiences
Can first rank symptoms occur in other disorders?
Yes they can occur in mania or delirium
What are the different types of schizophrenia?
Paranoid Hebephrenic Catatonic Simple Undifferentiated
What are some characteristics of auditory hallucinations seen in schizophrenia?
Running commentary e.g “he’s brushing his teeth, he’s sitting down”
Voices referred to the patient in third person and conversing with each other about the patient
What are passivity experiences?
Believing an action or feeling is caused by an external force
What does delusional perception mean?
Attributing a new meaning, usually in the sense of self reference, to a normally perceived object
What is the prevalence of schizophrenia?
1% of population
