Psychosis and schizophrenia Flashcards
psychosis define
a person experiencing things differently from those around them
psychosis features
hallucinations (e.g. auditory)
delusions
thought disorganisation
alogia: little information conveyed by speech
tangentiality: answers diverge from topic
clanging
word salad: linking real words incoherently → nonsensical content
psychosis sx occurs in many conditions, including:
schizophrenia - most commonly
depression
BPD
puerpal psychosis
brief psychotic disorder (<1 mth of sx)
parkinson’s
huntington’s
steroids
cannabis
peak age for 1st episode of psychosis
15-30 years
associated conditions of schizophrenia
schizoeffective disorder - severe form of schizophrenia, with mood sx
persistent delusional disorder - without hallucinations
psychotic episode features
can be sudden or gradual
not last for set amount of time
usually individual has no insight
define hallucination
perception of an object in the absence of an external stimulus
- in any of 5 modalities, auditory most common in psychosis
visual hallucination
delirium
olfactory hallucination
frontal lobe pathology - medial meningioma
define pseudohallucination
‘hearing voices in my head’ -> NOT PSYCHOSIS
define delusion
fixed, firmly held belief that is usually false, that cannot be reasoned away, that is held despite evidence to the contrary and is out of keeping with a person’s sociocultural norms
- can be persecutory, grandiose, reference, hypochondriacal
define formal thought disorder
a problem of speech which means that each sentence or phase or word does not follow on form the next
examples of disorders of the self
the individual can no longer distinguish between himself and world
-> thought broadcast, passivity phenomona, thought insertion
3 types of functional psychosis
manic and depression - 2nd erson
schizophrenic - 3rd person
define schizophrenia
a disorder characterised by psychotic episodes (positive sx) and negative sx
examples of negative sx
autism
flat affect
ambivalence
loosening of associations
amotivation or apathy
schneider’s first rank sx schizophrenia
Auditory hallucinations of a specific type:
two or more voices discussing the patient in the third person
thought echo
voices commenting on the patient’s behaviour
Thought disorders
thought insertion
thought withdrawal
thought broadcasting
Passivity phenomena:
bodily sensations being controlled by external influence
actions/impulses/feelings - experiences which are imposed on the individual or influenced by others
Delusional perceptions
a two stage process) where first a normal object is perceived then secondly there is a sudden intense delusional insight into the objects meaning for the patient e.g. ‘The traffic light is green therefore I am the King’.
schizophrenia epidemiology
strongest risk factor - family hx
others - black caribbean, migration, urban environment, cannabis use
1% prevalence
poor prognostic factors schizophrenia
strong family history
gradual onset
low IQ
prodromal phase of social withdrawal
lack of obvious precipitant
schizophrenia management
atypical antipsychotics - 1st line
CBT offered to all
CVD increased - anti-psychotic meds and high smoking rates
mental state examination
see geeky medics
1. appearance and behaviour
2. speech
3. mood
4. thought
5. perception
6. cognition
7. insight
charles bonnet syndrome definition
characterised by persistent or recurrent complex hallucinations (usually visual or auditory), occurring in clear consciousness. This is generally against a background of visual impairment (although visual impairment is not mandatory for a diagnosis). Insight is usually preserved. This must occur in the absence of any other significant neuropsychiatric disturbance.
charles bonnet syndrome risk factors
Advanced age
Peripheral visual impairment
Social isolation
Sensory deprivation
Early cognitive impairment
cotard syndrome define
a rare mental disorder where the affected patient believes that they (or in some cases just a part of their body) is either dead or non-existent. This delusion is often difficult to treat and can result in significant problems due to patients stopping eating or drinking as they deem it not necessary
cotard syndrome associations
severe depression and psychotic disorders
de clerambault’s syndrome definition
a form of paranoid delusion with an amorous quality. The patient, often a single woman, believes that a famous person is in love with her.
delusional parasitosis define
a relatively rare condition where a patient has a fixed, false belief (delusion) that they are infested by ‘bugs’ e.g. worms, parasites, mites, bacteria, fungus
othello’s syndrome define
pathological jealousy where a person is convinced their partner is cheating on them without any real proof. This is accompanied by socially unacceptable behaviour linked to these claims
example of pseudohallucination
hypnagogic hallucination which occurs when transitioning from wakefulness to sleep. These are experienced vivid auditory or visual hallucinations which are fleeting in duration and may occur in anyone. These are pseudohallucinations as the affected person is able to determine that the hallucination was not real
sleep paralysis
paralysis of skeletal muscle, can involve hallucinations
if bad can use clonazepam
typical antipsychotics s/e
tremor, tardive dyskinesia, bradykinesia, rigidy, akathisia
parkisonism
