Psychosis and the MSE Flashcards
Define delusion
A stubborn belief that cannot be shaken despite contradiction from reality
Define hallucination
Seeing things that don’t exist
What is the difference between a delusion and a hallucination?
Hallucinations involve external stimuli whereas delusions arise internally
Are delusions or hallucinations present in schizophrenia?
Both
What are the positive symptoms of schizophrenia?
Hallucinations
Delusions
What are the negative symptoms of schizophrenia?
Alogia
Avolition
Anhedonia
Affective flattering
What is alogia?
Poverty of speech
What is avolition?
Poor self care eg hygiene, lack of motivation etc
What is affective flattering?
Unchanged facial expressions and no expressive gestures
At what ages is psychosis most likely to develop?
Transition from childhood and adolescence
What are main components of a psych history?
History of presenting concern Past psych history Background history (family, personal, social) Past medical history Medications
Which medicine can be brought over the counter for depression and can interfere with other medication?
St John’s wort
What acronym is used to remember the mental state exam?
ASEPTIC Appearance and behaviour Speech Emotion/mood Perceptions Thoughts Insight Cognition
What is examined in the appearance and behaviour section of the MSE?
General appearance
Facial expressions (depression, anxiety)
Posture (hunched shoulders? head looking down? gripping the chair?)
Movements (overactive, restless, immobile, slow, mannerisms etc)
Social behaviour
Eye contact
What is examined in the speech section of the MSE?
Quantity
Rate
Spontaneity
Volume
What is examined in the thoughts section of the MSE?
Stream Form Content Preoccupations Morbid thought- always ask if they are suicidal Delusions
What is folie a deux?
When 2 people play into the delusion
What is examined in the perceptions section of the MSE?
Illusions
Hallucinations
Distortions
Define illusion?
Misperception of an external stimulus
Define pseudo hallucination
When there is self awareness about the hallucination
What is examined in the cognition section of the MSE?
Consciousness Orientation Attention and concentration Memory Language functioning
What is examined in the insight section of the MSE?
Awareness of whether they are presenting with something other people would consider abnormal
Do they accept that this abnormal behaviour is caused by mental illness
Do they accept specific treatment options
What are the different types of delusions?
Persecutory Control Reference Mind reading Grandiosity Religious Guilt/sin Somatic Thought broadcasting Thought insertion Thought withdrawal
What is congreuncy?
Whether things match up eg do their facial expressions match their speech, does their body language match their thoughts
What is lability?
How often they change eg their tone of speech, their body language, their flow of thoughts
What are the 2 types of hallucinations?
Visual and auditory
What are some risk factors in developing psychosis?
Family history of schizophrenia Childhood trauma Previous psychiatric history of conditions eg anxiety Cannabis use Prenatal and birth complications Socioeconomic deprivation
What are some of the prodromal symptoms of psychosis?
Change in social behaviour
Impairments in functioning
What are some other sources for patient information you may use?
Family Friends Workplace Place of eduction GP records Mental health service records
What is the main underlying pharmacology of anitpsychotics?
They are usually dopamine receptor antagonists or partial agonists, they work because psychosis is caused by excess dopamine in the brain
What neurotransmitter causes psychosis and what level of it?
High levels of dopamine
What are the EPSEs of dopamine blockade?
Parkinsonism:
Rigidity
Slow/shuffling gait
Lack of arm swing
Dystonia= increased motor tone that can occur shortly after starting medication, is frightening
Tardive dyskinesia= repeated oral/facial/buccal/lingual movements
Akathisia= inner restlessness where you feel compelled to move but moving doesn’t alleviate anything, most commonly affects the legs
What do ESPEs stand for in terms of psychosis?
Extra pyramidal side effects (that are caused by dopamine blockade)
How are ESPEs avoided?
By giving atypical antipsychotics as first line treatment instead of dopamine antagonists
What are other side effects of antipsychotics besides ESPEs?
Gastrointestinal eg constipation
Haematological eg agranulocytosis and neutropenia
Metabolic eg increased appetite, weight gain, diabetes
Pituitary eg increased prolactin release (release is usually suppressed by dopamine)
Cardiac eg dysrhythmia
What does psychological management for psychosis involve?
CBT and new therapies like avatar therapy
What does social support for psychotic patients involve?
Supportive environments, housing, benefits, support with budgeting and employment
