Psychosis Tutorial Flashcards
What is psychosis?
difficulty perceiving and interpreting reality.
It is a clinical syndrome of an underlying disorder
What psychotic disorders can cause psychosis?
- Schnizophrenia
- Bipolar
- Schizoaffective disorder
- Substance related
- Delusional disorder
- Medical condition
- Depression with psychotic features
What positive sypmtoms are there?
Hallucinations
- Percepts in absence of a stimulus
Delusions
- Fixed, false beliefs ( out of their normal culture/social background )
What negative symptoms are there? ( four As )
- Alogia: poverty of speech
- Avolition/apathy : poor self care and motivation lack
- Affective flattening : unchanging mood and expressions + vocal intonations
- Anhedonia/Asociality : few close friends, hobbies
What disorganised symptoms are there?
- Bizarre Behaviour : Bizarre social behaviour Bizarre clothing/appearance Aggression/agitation Repetitive/sterotyped behaviours
- Thought disorder Derailment Circumstantial speech Pressured speech Distractibility Incoherent/illogical speech
Describe the epidemiology of psychosis?
- can occur at any age altho more common in early 20s ( due to life events at this time )
- often chronic and episodic, very variable
- morbidity: Substantial, both from disorder itself and increased risk of common health problems e.g. heart disease
Significant impact on education, employment and functioning - Mortality:
Substantial
All-cause mortality 2.5x higher, ~15 years life expectancy lost
High risk of suicide in schizophrenia – 28% of excess mortality
What is included in psychiatric history?
- History of Presenting Concern
- Past Psychiatric History
- Background History (Family, Personal, Social)
- Past Medical History and Medicines
- Corroborative History
Describe history of presenting concern?
The patient’s description of the presenting problem – nature, severity, onset, course, worsening factors, treatment received
Circumstances leading to arrival to hospital
- why did they come in now
Describe past psychiatric history?
- Any known diagnosis?
- Any treatment?
- Known to a community team?
- Any previous admissions to hospital?
Describe family history?
- Age of parents, siblings, relationship with them
- Atmosphere at home
Mental disorder in the family, abuse, alcohol/drugs misuse, suicide - heritablity of mental disorders
Describe the personal history?
- Mother’s pregnancy and birth
- Early development, separation, childhood illness
- Educational and occupational history
- Intimate relationships
Describe the social history?
- Living arrangements
- Financial issues
- Alcohol and illicit drug use
- Forensic history
Describe why need to take a medical history and medicine history
Medical problems = a cause or consequence of
mental disorder or psychiatric treatment
any regular medications and complience with it
- over the counter?
- Interactions
Describe the corrobative history?
Informants: relatives, friends, authority
Confidentiality
- need for consent
What is checked in the mental state examination?
- Appearance and Behaviour
- Speech
- Mood
- Thoughts
- Perceptions
- Cognition
- Insight
What to look out for in appearance and behaviour- General appearance
- Neglect with self care : alcoholism, drug addiction, dementia, depression, schizophrenia
- Weight loss :anorexia nervosa, depression, cancer, hyperthyroidism, financial issues/homelessness
What to look out for in appearance and behaviour- Facial expression?
depressive, anxious,
“wooden” parkinsonian
What to look out for in appearance and behaviour- posture?
hunched shoulders, downcast head and eyes – depressive
sitting upright, head erect, hands gripping the chair – anxious
What to look out for in appearance and behaviour- movement?
overactive, restless – manic inactive, slow - depressive immobile, mute – stupor tremors, tics, choreiform movements, dystonia, tardive dyskinesia mannerisms, stereotypies
What to look out for in appearance and behaviour- social behaviour?
disinhibited, overfamiliar
withdrawn, preoccupied
signs of impending violence: raised voice, clenching fists, pointed fingers, intrusion into personal space
What to look out for with speech?
Quantity
Rate
Spontaneity
Volume
What to look out for with mood?
Subjective Objective Predominant mood Constancy Congruity
What to look out for with the px’s thoughts?
- Stream
- Form
- Content
- Preoccupations
- Morbid thoughts, suicidality
- Delusions, overvalued ideas
- Obsessional symptoms
- rare folie a deux
What are illusions?
Misperception of a REAL external stimulus
What are hallucinations?
Perception in absence of external stimulus
true perception + 2) coming from outside the head
pseudohallucination = 1) OR 2)
hypnagogic, hypnopompic
auditory – second person, third person visual – Charles Bonnet syndrome olfactory gustatory tactile, of deep sensation
Why is insight important?
Awareness of oneself as presenting phenomena that other people consider abnormal
Recognition that these phenomena are abnormal
Acceptance that these abnormal phenomena are caused by mental illness
Awareness that treatment is required
Acceptance of the specific treatment recommendations
What types of support are available?
- Pharmacological
- Psychological
- Social support
Give examples of
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