Psychosis Flashcards
What is psychosis?
A mental state in which reality is greatly distorted. The person experiences things differently to those around them.
What is a delusion?
Fixed false belief which is firmly held despite evidence to the contrary
Goes against normal social and cultural beliefs
What are the types of delusions a patient may have?
Grandiose - special powers, wealth, talents etc.
Persecutory - other people conspiring against them
Reference - Random events or others behaviour have special significance
Guilt - belief they have done something shameful
Hypochondrial - belief they have illness
Morbid jealousy - belief spouse is being unfaithful
What is a hallucination?
Perception in absence of an external stimuli
What types of hallucinations are there?
Visual - seen in organic causes or substance misuse
Auditory
Olfactory
Gustatory (taste)
Somatic - e.g. feeling of insects crawling
What are the types of auditory hallucination?
Second person - voice talk to patient
Third person - voices talk among themselves about patient
Running commentary - voice give account of patients actions
What are the types of thought disorder?
Broadcasting - internal thoughts can be heard out loud by others
Insertion - thoughts being put into your mind
Withdrawal - thoughts are being removed
What is a thought disorganisation?
Impairment in ability to form thoughts from logically connected ideas
What are some types of thought disorganisation?
Loosening of associations - loss of normal structure of thought
Tangential disorder - person divert from original thought but never return
Circumstantiality - Thinking proceed slowly with many unnecessary details before getting to the point
Neologisms - Words and phrases devised by patient
Alogia - little information conveyed by speech
Word salad - real words but linked incoherently i.e. talking nonsense
What are the organic causes of psychosis?
Illicit drugs especially cannabis Medical drugs - steroids, antimalarials, levodopa Huntingtons Parkinsons Dementia and delirium Deficiency - B12
What are the non-organic causes of psychosis?
Schizophrenia
Depression
Mania
Puerperal psychosis
How does schizotypal disorder appear?
No hallucinations or delusions
Eccentric behaviour, suspiciousness and unusual speech
What is schizoaffective disorder?
Symptoms of schizophrenia and a mood disorder in the same episode
What is persistent delusional disorder?
Single delusion lasting >3months with other areas of thinking well preserved
What are the main risk factors for schizophrenia?
Genetic
Cannabis
What prodrome may indicate schizophrenia?
Patients show:
- Loss of interest
- Social withdrawal
- Self-neglect
- Depression and anxiety
- Brief psychotic episodes
Aside from first rank symptoms, what other symptoms are there of schizophrenia?
- Avolition - decreased motivation towards any goal
- Anhedonia - lack of pleasure from previously liked activities
- Alogia - quantitative and qualitative decrease in speech
- Affect blunted
- Neologisms
- Catatonia
What are Schneider’s first rank symptoms for schizophrenia?
- Delusional perception - delusion in response to real perception - e.g. traffic light turn red, I am a genius
- Auditory hallucinations: thought echo, running commentary or 2 people discussing pt. in 3rd person
- Thought interference: insertion, withdrawal or broadcasting
- Passivity phenomenon: body movements and feelings are controlled by external force
What is important to consider in the preliminary management of schizophrenia? (before the actual management)
Risk assess
Use mental health act
How is schizophrenia managed?
Atypical antipsychotics
- risperidone/olanzapine
- Depot if non-compliant
ECT - if pharmacologically resistant
CVS risk management (pt. at much higher risk due to drugs and often smoke)
CBT and family education
What is Charles Bonnet syndrome?
Persistent or recurrent complex hallucinations occurring in clear consciousness - auditory or visual
Background of visual impairment
No neuropsychiatric disturbance
What are the risk factors for Charles bonnet syndrome?
Advanced age Visual impairment - AMDR, glaucoma, cataracts Social isolation Sensory deprivation Early cognitive impairment
What is Cotard syndrome?
Believe they or some part of their body is dead
Patients stop eating/drinking as deem it unnecessary
Associated with depression
What is De Clarembault syndrome?
Paranoid, amorous delusion - e.g. famous person in love with them
What are the factors associated with a poor prognosis with schizophrenia?
Gradual onset
Low IQ
Prodromal phase of social withdrawal
What is a pseudohallucination
Hallucination that the patient knows is not real.
It is commonly seen in grief.
