Psychosis and Schizophrenia Flashcards
Define psychosis
- Out of touch with reality
- Experiences a different reality to everyone else but feels very true to them
Symptoms of psychosis
- Hallucinations
- Delusions
- Formal thought disorder
- Passivity phenomena
- They often lack insight
Perception and thought - what 3 steps does the brain go through when seeing/hearing something
- Sense data
- Object in space
- Meaningful object
Problem with one of these = psychosis
What is sense data?
- Raw sensory input received by brain
- Pre-processed before brain assigns any meaning
- Eg seeing set of colours and shapes before recognizing object
What is an object?
- Processed perception of sense data
- Brain organises it into recognisable form
- Recognises an object but does not assign meaning to it
- eg recognise structure as a chair based on its shape without considering function
What is meaningful object?
- Brain interprets what it has seen based on past experiences, context and emotions
- Object becomes significant and shapes thoughts and behaviours
- eg seeing chair, understand to sit on chair or in psychosis see as threatening entity
Psychosis and perception - what happens to perception with sense data and object
- In psychosis there is often disruption at level of interpreting sense data or assigning meaning
- In hallucinations brain creates sense data
- Delusions - neutral object (eg passing stranger) is given distorted meaning
What is hallucination?
- Perception of object in absence of an external stimulus
- Can be in any of 5 senses
Types of hallucinations vs pathology
- Auditory commonest in psychosis
- Visual more likely delirium
- Olefactory possible frontal lobe pathology
Features of true of abnormal perception
Hallucinations:
* Outside space
* Clear boundaries - with perception, feels real, exists without them
* Vivid colour
* Exists independent of me
* 3D - rotates, light
Pseudohallucination vs
- Pseudohallucination - voices coming from inside head - not psychosis, often personality disorders
- Hallucination - as if another person talking to them
Types of hallucination
- Auditory, Gustatory, Visual, Olefactory, Somatic
- A - 2nd person (another person in room) - affective
- A - 3rd person - two people talking about them, could be schizophrenia (includes command)
- O - check frontal lobe
- V - check organic causes eg delirium
- A - can be normal
Define delusions
- Fixed, firmly held belief that is usually false
- Cannot be reasoned away
- Held despite evidence to the contrary and is out of keeping with sociocultural norms
- Primary (true delusions) or secondary
What is important to do when someone has delusions?
- Challenge their beliefs
- Interested scepticism without denying experience
- eg what makes you think that, couldn’t it just be a coincidence
- If true delusions - often can not be persuaded could be incorrect
Delusional perception
- Normal perception with delusional meaning
- eg there is a stimulus but associated a new meaning to it (eg traffic light does turn red but it’s a sign the world is ending)
Types of delusions
- Reference - special messages for me from normal world
- Grandiose - special powers
- Persecution - somebody is out to harm me
- Erotomania - somebody is in love with me
- Capgras - familiar people have been replaced
- Depression - guilt, hypochondriasis, nihilism (intenstines rotting etc), poverty (thinks has no money)
What is formal thought disorder?
- Problem of speech and flow of thought meaning each sentence does not follow on from the next
- = Incomprehensible speech
- Similar to flight of ideas but no connections
What is passivity phenomena?
- Patient feels that their thoughts, actions and emotions are being controlled by external force
- eg MI5 are controlling my body movement
- Self can disintegrate - no boundary of self
Disorder of self (thought) - symptoms of passivity phenomena
- Thought insertion and withdrawal - someone putting thoughts or taking thoughts away from mind
- Thought broadcasting - other people can hear what thinking
Psychotic episodes - typical timing
- Onset can be days/weeks
- Lasts weeks-months
- Most recover eventually
Schizophrenia different - longer
What happens after psychotic episode in terms of follow up?
- Early intervention psychosis team
- Follow up patients for few years to check for further episodes and manage recovery
Management of psychotic patient - overall
- Where should they be managed - assess risk? (risk to themselves, others)
- Rule out organic causes - eg delirium
- Consider sectioning
- Consider drug misuse - stimulants
- Treatment - biopsychosocial model
- Antipsychotics, psychological support, social and drug issues addressed
What is schizophrenia?
- A disorder (or group of disorders) characterised by psychotic episodes (positive symptoms eg delusions etc) and/or negative symptoms
Schneiders first rank symptoms of schizophrenia
- 3rd person auditory hallucination
- Running commentary - what they’re doing
- Thought echo - have thought, can hear it being spoken aloud
- Thought insertion/withdrawal/broadcast
- Passivity phenomena
- Delusional perception
Epidemiology of schizophrenia and contributors
- 1%
- Genetics
- Obstetrics complications
- Migration - one country to another, lots of stressors
- Urban areas
- Cannabis use
- Childhood adversity
- Stressful life events
Negative symptoms of schizophrenia
- Amotivation
- Anhedonia
- Flattened affect - no emotion
- Alogia - problem with speech
- Ambivalence
Types of schizohphrenia
- Paranoid - hallucinations, delusions, FTD
- Hebephrenic - affective symptoms, speech and behavioural problems
- Catatonic - movement and behaviour affected
- Simple - chronic, negative symptoms often
Biopsychosocial model for schizophrenia
- Bio - Antipsychotics, Clozapine (if used 2 antipsychotics for adequate time and no response)
- Psychological support - supportive counselling, family therapy, CBT
- Social - housing, activities, drug work, benefits, debt management
Assessment of someone with ?schizophrenia
- Bio - bloods, drug testing
- Psychological - MSE, collateral history
- Social - speak with carers, housing
