Psychosis Flashcards
What is psychosis?
Severe mental disorder in which thought, and emotions are so impaired that contact is lost with external reality, severely confused personality and loss of touch with reality
What is schizophrenia?
Long term mental disorder of a type involving a breakdown in the relation between thought, emotion, and behaviour, leading to a faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation
What is schizoaffective disorder?
Symptoms of a mood disorder and schizophrenia (mania, depression, and psychosis)
What is mania?
Unreasonable euphoria, intense moods, hyperactivity, and delusions
What are the different types of psychosis?
Schizophrenia Schizoaffective disorder Schizophreniform disorder Brief psychotic disorder Delusional disorder Substance induced psychotic disorder Psychotic disorder due to a medical condition Paraphrenia (schizophrenia in elderly)
What are the different types of schizophrenia according to the ICD-10?
Paranoid - paranoid delusions and auditory hallucinations
Hebephrenic - mood changes, unpredictable behaviour, shallow affect, fragmentary hallucinations
Catatonic - psychomotor features, posturing, rigidity, stupor
Undifferentiated - symptoms not fitting with other classifications
Residual - negative symptoms when positive symptoms burnt out
Simple - negative symptoms
What questions is it important to ask in a schizophrenia history?
Hearing people speak to them? What do they think about their thoughts? Delusions? Is it just happening to them? What do they think is wrong with them? Physical health?
What are the risk factors for psychosis?
Age - late teens to early 30s FHx (heritability of 60%) Brain injury during foetal development/childhood Cannabis use - also, amphetamines, LSD Malnutrition and viral infections during pregnancy Pre-eclampsia Emergency c-section Lower socio-economic background Stressful life experiences Migrants (1st and 2nd generation) Abuse as a child Afro-Caribbean
How common is schizophrenia?
Prevalence 1%
Equal gender distribution
Rare before puberty
Peak age of onset early 20s
Most often affects teens to early 30s (15-35) - onset slightly earlier in men
Higher incidence in lower socioeconomic classes and urban areas among migrants
What are the differential diagnoses of schizophrenia?
Neurological disorders - partial complex epilepsy Mood (affective) disorders - mania Drug psychoses/intoxication Personality disorders - schizotypal Other causes - UTI causing delirium - Delirium - HIV - Syphilis
How does psychosis present?
Positive schizophrenia - change in behaviour/thought - Better outcome - Thought echo - Thought insertion/withdrawal - Thought broadcasting - 3rd person auditory hallucinations - Delusional perception - Somatic passivity and feelings - Behavioural disturbances - Thought disorder - Lack of insight Negative schizophrenia - Slow, insidious onset - Relative absence of acute symptoms - Apathy - Social withdrawal - Lack of motivation and poor self-care - Poverty of speech - Blunted affect - Underlying brain structure abnormalities - Poor neuroleptic response
What is the pathology of psychosis?
Disease of neurodevelopmental disconnection caused by an interaction of genetic and multiple environmental factors affecting brain development
Genetic - polygenetic and non-mendelian
Alterations in prefrontal and temporal lobe function
Enlarged lateral ventricles
Disorganised cytoarchitecture in hippocampus
Dopamine D1 abnormalities
Hyperactivity of chemicals in brain that are vital to normal functioning
What investigations should you do for psychosis?
Urine culture to rule out UTI (in elderly)
Urine drug screen
CT scan if neurological cause suspected
HIV testing
Syphilis serology
Lipids (before starting antipsychotics)
Bloods - FBC, TFTs, U&Es, LFTs, CRP, fasting glucose
What is the diagnostic criteria for psychosis?
1st rank (positive) symptoms or persistent delusion present for at least one month No other cause
How is psychosis managed?
Antipsychotics
Psychological management - reassurance, support, doctor-patient relationship, psychotherapy
Social management - CPA
