psychosis "tutorial" Flashcards
what is psychosis
psychosis is a clinical syndrome: a descriptive term that refers to a difficulty in percieving and interpreting reality.
its not a diagnosis and can be caused by multiple diseases.
what is the disease most commonly causing psychosis
schizophrenia although sometimes too much weight is put on it, used to be centre of research for psychosis as if its the only thing, this changing now
what are some other causes of psychosis other than schitzophrenia
drug induced,
depression with psychotic symptoms
bipolar I
schitzoaffective disorder
delusional disorder
what are the three domains of symptoms of psychosis
positive (gain of function) , negative (loss of function) and disorganisation- umbrella term for everything else
what are the 2 main types of positive symptoms in psychosis
hallucinations and delusions
what is a hallucination
The perception of an experience in the absence of stimulus
what is a delusion
a fixed false belief that is not conventional with social/ cultural norms. delusions have a theme/ flavour (means there are types, discussed in other flash)
what sensations can there be hallucinations in?
all sensations, auditory, gustatory, olfactory, visual, somatic
how do we categorise auditory hallucinations
1) person
1st (echos) second or third person
2) some content types:
running commentary
command hallucinations
what are some types of delusions
erotomanic
nihilistic/: guilt related
pathological jealousy
paranoid/ persecutory ( thinking someone wants to hurt you)
reference (thinking someone on tv is talking abt them)
grandiosity (thinking you are specially smart or smth)
passivity experiences : thought insertion, thought broadcasting (believing your thoughts are transmitted to others and they know what ur thinking), thought withdrawal
what does it mean that passivity experiences are “first rank “ symptoms
means that they are characteristic of schitzophrenia
negative symptoms of psychosis
alogia - slow and little speech
avolition/ apathy - lack of motivation- poor self care
anhedonia/ asocialty - few friends and hobbies - impaired social functioning
affective flattening- unchanging facial expressions, few expressive gestures, poor eye contact, lack of vocal intonations, limited emotional range
do positive or negative symptoms arise first in psychosis?
positive, negative at later stages
which symptom are these presentations describing:
Unchanging facial expressions
Few expressive gestures
Poor eye contact
Lack of vocal intonations
Limited emotional rang
affective flattening
what is it called when someone has Few close friends
Few hobbies/interests
Impaired social functioning
anhedonia/ asocialty
what is it called when someone has Paucity/poverty of speech (little content)
Slow to respond to questioning
alogia
what is it called when someone presents with Poor self-care
Lack of drive/persistence at work/education
Lack of motivation
Avolition/apathy
what are the two categories of disorganisation symptoms
bizzare behaviour and formal thought disorder - disorder of thought FORM- means lack of logical connection between thoughts (not content theoritika)
which are the progressive stages of formal (As in form not as in episimo) thought disroder
1circumstantial thought— 2tangential thought—
3flight of ideas—
4derailment/ loosening of association —
5word salad
at what age is the peak incidence for psychosis? can it occur at other ages or not rl?
early adolescence/ early 20s (women bit after men) but CAN occur at any age
describe the course of psychosis
often chronic and episodic but prognoses vary- 1/3 do well 1/3 relapse 1/3 dont respond
explain how morbidity increases in psychotic people
both bc of disorder itself and bc of incr risk of other health cond such as heart disease
examples of morbidity
significant impact on education, employment and functioning
how does psychosis influence mortality
1) all-cause mortality x2.5 higher—- 15 yrs lost from life expecatncy
2) risk of suicide higher in SCITZOPHRENIA specifically —- 28% od excess mortality in scitz is suicide
what is excess mortality in a population for ex in scittz ppl
extra deaths compared to equivalent population without the factor
what are the 3 aspects of psychosis management and which one is often the mainstay of treatment
pharmacological!!- mainstay, social and psychological
examples of psychological support for psychosis
CBT
newer therapies like avatar therapies
illustrate social support for psychosis
supportive environments, structures and routines
housing, benefits
support with budgeting/ employment
What neurotransmitter system is most implicated in the mechanism of antipsychotics? can antipsychotics act on other neurotransmitters?
dopamine, but antipsychiotics vcan also act on serotonin, acetylcholine, histamine receptors
Which drug actions on dopamine receptors would be most likely to improve psychotic symptoms?
antagonist, partial agonist or agonist
antagonist
Andy agrees to take an antipsychotic medication (Risperidone). A few weeks later, his symptoms improve but he develops some movement symptoms;
What are these symptoms and why have they occurred?
Extrapyramidal Side Effects (EPSEs)
Caused by dopamine BLOCKADE in the nigrostriatal (extrapyramidal) dopamine system (parts of the brain that enable us to maintain posture and tone)
what does the term extrapyramidal side effects refer to
Umbrella term for side effects outside the traditional pyramidal movement pathway
what are some examples of Extrapyramidal Side Effects (EPSEs)
Includes;
Parkinsonism- the quadret of park sympt
Acute dystonic reactions- stiff
Tardive dyskinesia - infections
Akathisia- internal sense of restlessness
what is parkinsonism
basic parkinsonian symptoms, tremor, bradykinesia, postural instability ect ( this was in green box so “ for own reference”)
what are the management principles for extrapyramidal side effects
Counsel about risk
Use lowest therapeutic dose
Use atypical as first line
Change medication to a more movement sparing agent
Anticholinergic medications can help (e.g. procyclidine)
what type of thought disorder is it if ideas are linked by sounds or rhythmic puns
flight of ideas
what thought disorder is it when someone says “I like the sky. I’m having pasta for lunch. How are you doing?”
derailment, train of thought has gone off tracks, unrelated train of thoughts, one level before word salad
what the difference between tangential and circumstantial thought disorder
in circumstantial althought the responces are longwinded, questions are eventually answered. in tangential they are not
what kind of hallucination is it if someone can feel a chip inside their head
tactile
what is really important to do with a patient experiencing hallucinations
find out as much as you can about the hallucination, the voice the person, where it comes from, other room ect
how do you clinically assess someone who looks like they are having psychotic episode
MSE - mental state examination
what are the categories of MSE
speech, insight, mood and affect, thought content, thought form,
perceptions (hallucinations)
cognition
