Psychosis and Sz Flashcards
Define Psychosis?
A mental disorder in which there is severe loss of contact with reality, evidenced by delusions, hallucinations, disorganized speech patterns, and bizarre or catatonic behaviour.
Psychotic disorders are common features of schizophrenia, bipolar disorders, and some affective disorders
Describe the onset and presentation of psychosis?
Onset:
- Can come on suddenly or gradual
- Can last days, weeks or months
- After the episode, some people will never have one again, others will return to normal but have recurrent episodes, others still will have a personality change (hence never return to normal) + recurrent episodes
Presentation:
- Importantly the patient has no insight into their condition, therefore unlikely to present to psych services
- More likely to be reported by family, friends or the police
How would you assess a patient with suspected psychosis?
- Full medical history
- Mental State Exam
What are the principle symptoms of psychosis?
- Hallucinations
- Delusions
- Formal Thought Disorder
- Fragmentation of the Boundaries of the Self
Define a Hallucinations?
Perception of an object in absence of an external stimulus.
N.B: Can be in any of the 5 modalities but auditory is most common (visual is more likely to be delirium- organic brain problems)
Are voices heard in the head a form of psychosis?
No, this is considered a pseudo-hallucination.
Auditory hallucinations are heard OUTSIDE the head, must refer to the perception of external stimuli.
What does an Olfactory hallucination suggest?
Could be psychosis but could also indicate frontal lobe pathology
Define a Delusion?
A delusion is a fixed, firmly held belief that is false, that cannot be reasoned away and that is held despite evidence to the contrary. Must be out of keeping with a person’s sociocultural norms.
What factors of a belief must be present for it to be considered a delusion proper?
- False
- Fixed (not fluctuant)
- Firmly held (patient will argue it)
- Cannot be reasoned away
- Cannot be shown to be incorrect with contrary evidence
- Is out of keeping with a person’s sociocultural norms
What is the key distinction between hallucinations and delusions?
Hallucinations = Disordered perception of the external world
Delusions = Disordered thinking, perception of the internal world
Give 3 examples of types of Delusions?
- Persecutory = beliefs people are coming after you.
- Grandiose = belief you are somehow more important than you are
- Reference = belief that things that couldn’t possible refer to you (e.g. the news, the bible) are referring to you specifically
- Erotomanic = belief that someone is in love with you
- Hyperchondriacal = belief you have some horrible disease
What two questions should you ask anyone with Delusions?
- What makes you think that? Looks for evidence
- Well could it not be something else? Looks for fixedness
Define Formal Thought Disorder (FTD)?
A problem of speech (and the flow of thought) which means that each sentence (or phrase or word) does not follow on from the next.
A flight of ideas with no connections.
Define Disorders of the Self?
When an individual has lost the ability to distinguish between themselves (and their internal mental space) and the outer world e.g.
- Thought broadcast
- Thought insertion
- Passivity phenomena (essentially believing your actions aren’t your own, you are being controlled by some puppet master somewhere).
A normal person has a clear understanding of themselves as independent from others, themselves as constant through time and themselves as independent agents. People with psychosis might not.
How common are the respective symptoms of Psychosis?
Hallucinations and Delusions are very common.
Formal Thought Disorder less so.
Disorders of the Self is quite rare.
