Psychosis and schizophrenia Flashcards
What is psychosis ?
- Mental disorder in which the thoughts, affective response or ability to recognise reality and the ability to communicate and relate to others are sufficiently impaired to interfere grossly with the capacity to deal with reality.
- Essentially when your thoughts are so disturbed that you lose touch with reality, Involve inability to distinguish between subjective experience and reality
What are the 3 classic characteristics that someone experiencing psychosis may experience one or more of ?
- Unusual beliefs called ‘delusions’. These are very strong beliefs which are obviously untrue to others, but not to you. e.g. when you are ill you may think that there is a plot to harm you or that you are being spied on by the TV or being taken over by aliens. Sometimes you may feel you have special powers.
- Thought disorder. This is when you cannot think straight. Your ideas may seem jumbled, but it is more than being muddled or confused. Other people will find it very difficult to follow what you say.
- Unusual experiences called ‘hallucinations’. These are when you can see, hear, smell or feel something that isn’t really there. The most common hallucination that people have is hearing voices. Hallucinations are very real to the person having them. This can be very frightening and can make you believe that you are being watched or picked on.
Can also experience Passivity Phenomenon. The core feature is the belief that one is no longer in control of one’s own body, feelings or thoughts. The individual feels that some external agent is controlling them to feel emotions, to desire to do things, to perform actions or to experience bodily sensations.
Do people experiencing an psychotic disorder usually have insight ?
NO - they don’t usually realise they have one
Define a hallucination
- A perception which occurs in the absence of an external stimulus, it can occur in any sensory modality - auditory, visual, gustatory, or tactile sensations
- It is experienced as originating in real space, not just in thoughts (e.g. is not like inner speech).
- Can be simple, e.g. a formless sound or complex, e.g. a voice or a face
Define Hypnagogic or hypnopompic hallucinations
visual, tactile, auditory, or other sensory hallucinations that occur on going to sleep or waking (they are non-pathological)
Are hallucinations always pathological ?
- No as mentioned about hypnagogic/hypnopompic
- Also hallucinations can be induced in most people e.g. by sensory deprivation
So is depends on the other relevant symptoms
What are the different types of auditory hallucinations ?
- Second person voices which directly address the patient e.g. ‘’you are useless’’
- Third person voices which discuss the patient or provide a running commentary on his actions – speak about the person e.g. ‘’we are going to get him’’
- Thought echo: the patient experiences his own thoughts spoken or repeated out loud
Other than auditory what are the other types of hallucinations that a patient may experience ?
Visual: often associated with altered consciousness / organic impairment
- simple e.g. flashes of light
- complex e.g. face or figure
Olfactory (smell)
Gustatory (taste)
Somatic (tactile): bodily sensations
- e.g. insects crawling under the skin
- e.g. being touched
Describe what passivity phenomena is
The core feature is the belief that one is no longer in control of one’s own body, feelings or thoughts. The individual feels that some external agent is controlling them to feel emotions, to desire to do things, to perform actions or to experience bodily sensations.
Can affect:
- *thoughts** - thought insertion (people putting thoughts in their head), thought withdrawal (someone is taking the thoughts out their head), thought broadcasting (believes people already know what their thinking e.g. you ask them a question and they reply you already know)
- *actions** - i.e. controlling actions
- *feelings** - i.e. controlling their feelings
Define a delusion
A belief that is clearly false but is held unshakably, irrespective of counter-argument
What are the typical delusional themes experienced in each of these disorders that can result in delusions:
- Depression
- Schizophrenia
- Mania
- Depression typically - delusions about disease, nihilism (rejection of all religious and moral principles, in the belief that life is meaningless), poverty, sin, guilt
- Schizophrenia typically - control, persecution, reference, religion, love
- Mania typically - grandiosity, persecution, religion
Give examples of what each of the following types of delusions are often about:
- Persecturoy delusions
- Control delusions
- Disease delusions
- Persecturoy delusions - often recognisable to society/culture as a danger/threat e.g. IRA, mafia, MI5, KGB, CIA, devil, evil spirits
- Control delusions - control is by ghosts / spirits in the past, but also now by XRay / radio transmitters
- Disease delusions - plague, syphilis, cancer, AIDS
What are self-referential experiences and what disorder are they more associated with ?
More associated with schizophrenia (put down as reference in the list of common schizo delusions)
It is where a neutral event is believed to have a special and personal meaning for the person
Can vary in intensity from a brief thought, to frequent & intrusive thoughts to delusional intensity (self-referential delusions or delusions of reference)
For example:
- the feeling that others are speaking about me / laughing at me
- The belief that TV or the radio are transmitting message for me
- The belief that car registration numbers contain hidden codes
How do you manage a psychotic patient with delusions (talking specifically about how you approach the subject of the delusions)
It is important to recognise the importance of the experience & not give the impression that it is “all in your head”. Make the effort to understand as best you can what the patient is explaining in their own words:
- “I just want to check that I am understanding this correctly, I don’t want to misunderstand you, I think what you are saying is that ……
Think of creative ways to challenge:
- “What would you say if someone said to you that [these beliefs] are not true?”
- “Can you just explain to me how this is possible?”
It is possible to “agree to disagree”
What happens once youve as previously mentioned been able to establish that the patient is in fact experiencing delusions ?
There does come a time to say “I think that this is evidence that you are actually unwell and I think you need to be in hospital & receive treatment – although I recognise that you disagree with this” - as they will lack insight
What are the core symptoms of schizophrenia ?
Schniders first rank symptoms
Auditory Hallucinations:
- Hearing thoughts spoken aloud
- 3rd person voices e.g arguing/discussing
- In form of running commentary
Passivity Phenomena:
- Made acts / impulses / volition/ feelings (thought insertion, thought withdrawal, thought broadcasting)
- i.e. being imposed or controlled by an external agency
Delusional Perception
- A fully formed delusion which arises from a real / genuine perception
What are the outcomes following an episode of schizophrenia ?
- 20% have just one episode and go back to normal baseline afterwards
- <40% have multiple episodes and then go back to normal baseline afterwards
- >40% have multiple episodes and then have significant chronic impairment afterwards
What is the biggest risk factor for developing schizophrenia ?
A positive family history
- Monozygotic concordance 31-58%
- Dizygotic concordance 4-27%
- MZ reared apart concordance 58%
In diagram 1st degree relative refers to
Due to problems with the frontal lobe what test may some people with schizophrenia have a problem with ?
Stroop test
What are the 3 dopaminergic pathways and are each of them involved in ?
- NIGROSTRIATAL - extrapyramidal (motor control)
- MESOLIMBIC/CORTICAL - motivation and reward systems
- TUBEROINFUNDIBULAR - control of prolactin release
