Psychosis Flashcards
What is Psychosis?
A description of symptoms rather than a diagnosis
What are the core symptoms of psychosis?
Hallucinations Delusions Ideas of reference Formal thought disorder Thought interference Loss of insight Passivity phenomena
What mental disorders can result in psychosis?
Bipolar affective
Schizoaffective
Schizophrenia
How can an organic issue result in psychosis?
Damage to the area of the brain that controls perception of reality
How can substance use result in psychosis?
Acute use
Or withdrawal
What are primary delusions?
Arrive in the consciousness fully formed without need for explanation.
What are secondary delusions?
Often an attempt to explain the psychotic experiences e.g. hallucination
What is a Capgras delusion?
Belief that people are being switched with identical doubles.
What is a Fregoli delusion?
Misidentification delusion
Belief that two separate individuals are in fact the same person just in-disguise.
What is a De clerambault delusion?
Belief that a public figure is infatuated with them and communicating with them through media.
What is the Othello delusion?
That there significant other is cheating on them
How can you see if a patient has a thought disorder?
Unable to directly observe, Can be inferred from patterns of speech.
Someone with a thought disorder often has what pattern of speech?
Clanging and punning
Loosening of association
Tangents
Circumferentiality
What are the types of thought interference?
Thought insertion
Thought withdrawal
Thought Broadcasting
Thought blocking
What is thought insertion?
Thoughts in your head that don’t belong to you
What is thought withdrawal?
Information is extracted from your brain by someone
What is thought broadcasting?
Every knows what you are thinking all the time
What is thought blocking?
Halfway through thinking something when the thought just disappears.
What can a psychotic patient have passivity in?
Volition
Affect
Impulse
What is passivity of volition?
Someone is controlling their movements
What is passivity of affect?
Someone is controlling their feelings
What is passivity of Impulse?
Someone is controlling their urges
Why does someone with psychosis have loss of insight?
reality testing is broken down so ability to interpret external world is hindered.
Why is lack of insight an issue?
Creates disharmony between patient and Dr as they can’t see that they need treatment
What should you think about when consulting a patient with psychosis?
Recognise importance of their experience
Don’t give impression you think it is all in their head
Don’t jeopardise fragile rapport by being confrontational
Don’t play along as at some point say you will have to say you believe they are unwell as you will need to treat them.
How can you satisfy it is psychotic beliefs in a consultation with a potentially psychotic patient?
“do you think it could be”
“what would you think if your friend came and told you what you just said to me?”
What are the commonest causes of psychosis?
Organic
Substance misuse
paranoid psychoses
Mood disorders
Delirium
Acute transient disturbance from persons normal cognitive function.
What are some common causes of delirium?
Infection Inflammation Endocrine Drug use Steroids Hypoglycaemia
How does someone with delirium present?
Clouding of consciousness
Impaired concentration and short term memory
Visual hallucinations
Persecutory delusions
Drug induced psychosis
Very florid acute or insidious onset
Short lasting if drug is removed
In a suspected drug induced psychosis what must you take into account?
There is a high incidence of drug misuse in disorders i.e. schizophrenia and Bipolar affective disorder.
A patient with depressive psychosis can presents with?
Delusions of worthlessness guilt poverty nihilism
Hallucinations of accusatory threatening 2nd person
Cottards syndrome - already dead
A patient presents with Mania with psychosis.
Delusions of grandeur special purpose and special ability
Hallucinations tend to be 2nd person e.g. gods voice
Flight of ideas
Schizotypal
Eccentric behaviour and anomalies of thinking bt no definite schizophrenic anomalies
How does someone with schizotypal disorders present?
Cold inappropriate affect
Odd eccentric
Socially withdrawn
Paranoid or bizarre ideas not quite amounting to true delusion.
Persistent Delusional Disorder
Fixed well describe delusions
Causes of Delirium
IWATCHDEATH I- Infection W - Withdrawal A - Acute causes T - Toxins/drugs C - CNS pathology H - Hypoxia D - Deficiencies E - Endocrine A - Acute vascular T - Trauma H - Heavy metals
Delirium - Infection
UTI
Pneumonia
Encephalitis
Delirium - Withdrawal
Alcohol
BDZ
Delirium - Acute causes
Electrolyte imbalances
Dehydration
Alkalosis/ Acidosis
Delirium - Toxins/Drugs
Opiates
Salyciliate
Indomethicin
Delirium - CNS pathology
Stroke TIA Seizures Haemorrhage Infection
Delirium - Hypoxia
Anaemia
Pulmonary or cardiac failure
Hypotension
Delirium - Deficiencies
Thiamine (alcoholics)
B12
Delirium - Endocrine
thyroid
Hypo/Hyperglycaemia
Adrenal dysfunction
Hyperparathyriod
Delirium - Acute Vascular
Hypertensive Encephalopathy
Delirium - Trauma
Head injury
Post operative
Hyper/Hypothrmia
Delirium - Heavy metals
Lead
Mercury
Managanese
