Psychosis - Neurobiology & Clinical Features Flashcards
What is psychosis?
A severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality.
Characterised by loss of reality & loss of insight.
What is an hallucination?
A perception in the absence of a stimulus
What are 2nd and 3rd person voices?
2nd person - voice/person talking to you
3rd person - voice talking about you
Why do Ps have delusions in relation to their hallucinations?
Is an attempt to rationalise what is happening to them and make sense of their perceptions in light of the reality they know.
What is a delusion?
Where a patient has an unshakeable belief in something that is untrue.
A belief that is fixed, false and not in keeping with socio-cultural milieu.
- Cannot be shaken by evidence to the contrary
- Not shared by others of similarity
What are First Rank Symptoms pathogenic of?
Schizophrenia
What are the First Rank Symptoms identified in Ps with schizophrenia?
Auditory hallucinations
Somatic hallucinations
Thought insertion / withdrawal or broadcast
Passivity phenomena
Delusional perception
What is it termed when a patient has a belief that one’s thoughts or actions are influenced or controlled by an external agent - e.g. they observe their arm moving but feel like it is being controlled by a third party?
Passivity phenomena
What type of auditory hallucinations can you have?
Thoughts being spoken aloud
Third person hallucinations
Running commentary
What is it called when a patient has a feeling of being touched without anyone touching them?
Somatic hallucinations
What is it called when patients believe someone else is planting thoughts in their head?
Thought insertion
What is thought withdrawal?
Patient feels that their thoughts are being taken out of their mind.
What is thought broadcasting?
Patients feel that their thoughts are being broadcast for everyone to hear
Which symptoms are deemed to be positive symptoms of mental illness?
Hallucinations
Delusions
Disordered thoughts
Which symptoms are deemed to be negative symptoms?
Flat affect
Poor motivation
Loss of social skills / social withdrawal
Poverty of thought
Increased self neglect
What is flat affect?
A negative symptom of schizophrenia - P doesn’t how emotions in their expressions
What are the cognitive symptoms of mental illness?
Poor attention
Poor memory
Poor planning ability
Does everyone agree that psychosis has a negative impact to society?
No - some ppl argue that psychosis is linked to creativity and for a limited number of people they can function in life, even though they are suffering with psychosis.
What are the primary features of psychosis? How long do these symptoms need to persist?
Delusions
Hallucinations
Conceptual disorganisation
Negative symptoms
Cognitive disorder
At least 1 week duration of any of these with significant severity
What types of delusion are there?
Primary (delusional perception)
Secondary
Persecutory - out to get me
Reference - everyone looking at you and talking about you
Grandiose
And lots more
What is termed when thought processes are confused, disconnected or disorganised - can tell this from the P’s speech.
Is observed and not known by the individual (who thinks they are thinking normally).
Conceptual Disorganisation
What are other terms for conceptual disorganisation?
Loosening of associations
Knight’s move thought
Schizophrenic thought disorder
Disorder of form of thought
Formal though disorder
Which type of hallucination is most commonest in psychosis?
Auditory hallucinations
What do we think auditory hallucinations are caused by?
When we speak the brain recognises our voice as our own and dials back certain parts of the brain in response. Recognition of “self” mechanisms.
Scientists believe that dysfunction with this recognition of self and failure to recognise a voice as one’s own is what causes auditory hallucinations.
What percentage of schizophrenic patients experience auditory hallucinations?
60-70%
What percentage of patients make suicide attempts who have auditory hallucinations?
25%
What have scientist detected regarding white matter tracts in Ps who have hallucinations?
That Ps who were prone to developing hallucinations had differences in their white matter tracts which connect the speech areas.
Why do we think schizophrenia occurs?
Healthy Ps - attenuate the somatosensory cortex when they plan movements that they make.
Schizophrenic Ps dont attenuate the somatosensory cortex in the same way = their cortex is activated as if it was an external stimuli.
What did monozygotic twins show regarding genetic risk of schizophrenia?
That if you had an identical twin with psychosis you have a 50% chance of developing it too
What is the interplay between genetic and environmental causes of psychosis?
50% genetic causes
50% environmental causes
Which main factors can adversely affect normal development?
Obstetric complications
Childhood trauma
Immigration status
Cannabis use
What is the most common age to develop psychosis?
18-24 years
What role do glutamate and GABA have with psychosis?
Young = lots of glutamate because you are learning new stuff & lots of new connections are being made.
13+ = GABA increases and Glutamate decreases - this is because you are learning less and the GABA increases as it is involved in fine tuning and pruning.
By 18-24 - these levels should be stage and there should be a good balance between glutamate and GABA levels.
However - in psychosis the Ps dont have a good balance = psychotic symptoms
What is the stage called before any symptoms of psychosis are seen?
Premorbid stage
What is the stage called bwhen some abnormalities are starting to be seen, but no formal psychosis diagnosis can be made?
Prodromal stage
What are the three possible outcomes that can result from the prodromal phase?
Can have full remission of prodromal symptoms
Can have maintained symptoms that remain sub-threshold of psychosis (quirkiness)
Can have progression to full psychosis
