Psychosis and Schizophrenia Flashcards
what is psychosis?
this is where judgement of reality is significantly disturbed
usually accompanied by a loss of insight- so the pt is unaware that they are unwell, they may be unwilling to accept tment as they don’t understand why they need it, and can’t make a rational decision about treatment.
the 3 key psychotic symptoms?
hallucinations
delusions
thought disorder
what is an hallucination?
a perception occurring in the absence of an external stimulus
this is believed to be real by the patient
how is an hallucination different from a pseudohallucination?
a pseudohallucination is located inside the pt’s subjective/internal space e.g. they hear voices which are inside their head, like their own thoughts, rather than hearing somebody next to them talking to them.
shakeable- can be recognised by the pt as unreal
tend to occur at times of heightened emotion
tend to represent the pts own thoughts and feelings
in which conditions are pseudohallucinations common?
personality disorders- pseudohallucinations can be a way in which the pt manifests their distress e.g. via the voices in their head.
questions you need to consider to explore the presentation of hallucinations?
modality-auditory, visual, gustatory, olfactory, tactile and somatic
nature?- e.g. if auditory- what is being said? who by? more than 1 person? talking to you or about you? voice inside your head?-pseudohallucination.
auditory hallucinations are common in which conditions?
schizophrenia- voices tend to talk in the 3rd person
mania
depression-voices tend to talk in the 2nd person
visual hallucinations are common in which conditions?
delirium tremens-an acute organic brain syndrome that may develop 3-5 days after alcohol-dependent people stop drinking, hallucinations characteristically lilliputian (of small creatures or figures)
delirium
dementia
space occupying lesions (SOLs)
causes of olfactory hallucinations?
depression
tumour
causes of tactile hallucinations e.g. insects crawling over the skin or of heat/cold on skin?
cocaine intoxication
schizophrenia
causes of somatic hallucinations e.g. of organs being pulled out or twisted?
schizophrenia
what is an illusion?
a misperception of an external stimulus- so the stimulus is there but you don’t perceive it as what it actually is e.g. walking in the dark and thinking you can see a man when it’s a tree.
what is a delusion?
a false unshakeable belief that is not in keeping with the person’s cultural and religious background.
different types of delusions?
persecutory (paranoid)-somebody out to get them, cause harm to them, occur in schizophrenia and mania
delusion of reference- objects, events of people are in some way of personal significance to them e.g. crossword clues are trying to convey a message specifically to them. occur in schizohprenia.
passivity-pt believes an outer agency is controlling their thoughts and actions. occurs in schizophrenia.
grandiose-beliefs of exaggerate self-importance e.g. special powers, god. occurs in mania.
nihilistic-belief that something has ceased e.g. the world is about to end, they are dead or their bowels have stopped working. occurs in depression.
guilt-pt believes they are unduly responsible for something they can’t possibly have cause e.g. a tsunami. occurs in depression.
poverty-pt believes they have no money. occurs in depression and the elderly.
how are overvalued ideas different from delusions?
these are ideas which tend to overly occupy a person and may affect their actions
overvalued ideas are shakeable and can be understood culturally e.g. body image.
2 aspects of thought?
form- how is thought ordered. if disorder, may be disturbance in structure or flow.
content-what the pt is talking or writing about. a disorder may occur with delusions and obscessions.
what is a formal thought disorder?
an abnormality in the structure of thinking
includes flight of ideas, loosening of associations-complete loss of normal structure of thinking-there is no logical link between ideas, and neologisms-words/phrases constructed by the pt, although not consciously, which are used with meaning in their conversation.
pts with a formal though disorder may have a flight of ideas. what is this and what conditions might it be seen with?
ideas follow each other rapidly and are connected to one another but the associations appear to be due to chance-they are not expected, but may be explained by rhyming, puns, clangs or an environmental distraction.
seen in mania
what would a pt with insight be able to do?
know that they are unwell
understand that they need treatment
will accept the treatment or be able to make a rational decision about the treatment
positive symptoms of schizophrenia?
hallucinations
delusions
thought disorder
these happen often when the pt is acutely unwell, and an be gotten rid of with tment, but often the pt is left with their negative symptoms.
negative symptoms of schizophrenia?
the pt doesn't engage with what they would have done previously: apathy-loss of interest/enthusiasm social withdrawal loss of motivation neglect
what other name be used to describe the delusion a pt has where they think they are dead?
cotard delusion