Psychosis - General Flashcards
What happens in psychosis?
The ability to recognise reality and the ability to communicate with and relate to others are significantly impaired which interferes with the capacity to cope with reality
What are the 3 classic characteristics of psychosis?
Hallucinations, delusions and formal thought disorders
Psychosis involves the inability to distinguish between what? This is characterised by what?
Subjective experience and reality, characterised by a loss of insight
What are the 4 major groups of causes of psychosis?
Organic conditions, substance misuse, affective disorders and dementia praecox
What are some organic conditions which can cause psychosis?
Delirium, dementia, brain injury, stroke
What are some aspects of substance misuse that can cause psychosis?
Withdrawal, DT, acute intoxication
Which affective disorder is most likely to cause psychosis?
Bipolar disorder
What is dementia praecox?
Schizophrenia and other paranoid illnesses
What is schizoaffective disorder?
A condition which lies somewhere between affective mood disorders and schizophrenia
How may a formal thought disorder be evidenced?
As disorganised speech
What is a hallucination?
A perception which occurs in the absence of an external stimulus
What is an auditory misperception? What can this lead to?
This is when you hear something which is actually occurring but interpret it as something else. This is not a halucination but can lead to secondary delusions.
Can a person make hallucinations go away?
No - true hallucinations are not subject to conscious manipulation (i.e. you cannot alter the mind to make them go away)
When are visual hallucinations most likely to be seen?
In delirium and sometimes substance misuse
What does a haptic hallucination affect?
Deep sensation- feeling like the organs have moved or something has been placed inside them
Give some examples of simple auditory hallucinations?
Murmuring, formless sound, bangs
Give some examples of complex auditory hallucinations?
Voices, music
What is an idea of reference?
When an innocuous or coincidental event will be ascribed as being significant or meaningful by the person
In ideas of reference, the patient will believe that these messages are being sent to who?
Them, and no-one else
Ideas of reference also include self-referential experiences. What are these?
The belief that external events are related to oneself
If an idea of reference is held very strongly, it can become what?
A delusion of reference
What is a delusion of reference?
A more strongly held idea of reference
Explain briefly the difference between an idea and a delusion of reference?
Someone with an idea of reference may change their mind when evidence dictates they must, while someone with a delusion of reference will believe something refers back to them even in the face of strong evidence to the contrary
What is a delusion?
A fixed, firmly held belief with unshakable conviction, despite logical argument or evidence to the contrary
Delusions are usually held outwith what?
The social, cultural and educational background of the patient (can be bizarre/impossible)
What is a primary delusion?
One that arises out of nothing
What is a secondary delusion?
One that is understandable with the addition of some other psychopathological event (i.e. attempts to explain hallucinations/abnormal mood)
Punning and loosening of associations are seen in which feature of psychosis?
Formal thought disorder
How will the patients speech be in someone with a formal thought disorder?
Difficult to understand and fragmented
What are the 4 different types of thought interference?
Though withdrawal, thought insertion, thought broadcasting and thought blocking
What is passivity?
Patients believe that their thoughts, feelings or acts are controlled by others
Passivity of volition is responsible for what?
Making actions
Passivity of affect is responsible for what?
Making feelings
Passivity of impulse is responsible for what?
Making urges
Somatic passivity is responsible for what?
Making influences on the body
Describe the loss of insight seen in psychosis?
To the patient, everything seems as real as it always did and things make sense, but people are telling them they are unwell
3rd person auditory hallucinations are most suggestive of which diagnosis? What is another cause?
Most likely schizophrenia, can also be caused by delirium/dementia
Describe the clinical course of drug induces psychosis?
Tends to be short lasting if access to the psychoactive substance is removed
What should you be aware of if someone presents with psychosis and is under the influence of a substance?
This doesn’t mean that the psychosis is definitely caused by the substance. Important co-morbidities of substance misuse are bipolar disorder and schizophrenia.
Delusions of worthlessness, guilt, hypochondriasis and poverty are typically features of which differential of psychosis?
Depressive psychosis
What type of hallucinations might occur in depressive psychosis?
Typically 2nd person, accusing/insulting/threatening
Delusions of grandeur, special abilities, persecution or religiosity as well as auditory hallucinations and flight of ideas might occur in what differential of psychosis?
Mania with psychosis
What are some circumstances in which delirium might be seen?
Alcohol withdrawal, infection and hospital inpatients with many different conditions
