Pyschosis Flashcards by Anouk Wijeratne

What is psychosis?

difficulty perceiving and interpreting reality

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What can cause psychosis?

Schizoaffective disorder 
Bipolar
Schizophrenia
Delusional disorder
Substance related
Depression with psychotic features 
Due to other medical condition

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What are the three symptom domains in psychosis?

Postitive symptoms
Negative symptoms
Disorganisation

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What are positive symptoms?

Hallucinations

Delusions

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What are the main features of hallucinations?

Percepts in absence of a stimulus

Auditory
Voices commenting on you
Voices talking to each other
Visual
Somatic/tactile
Olfactory (rare)

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What are the main features of delusions?

Fixed, false beliefs, out of keeping with social/cultural background

Persecutory
Control
Reference
Mind reading
Grandiosity
Religious
Guilt/sin
Somatic
Thought broadcasting
Thought insertion
Thought withdrawal

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What are negative symptoms?

Alogia
Anhedonia/Asociality
Avolition/Apathy
Affective flattening

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What is alogia?

Poverty of speech

Paucity of speech, little content
Slow to respond

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What is anhedonia?

Few close friends
Few hobbies/interests
Impaired social functioning

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What is avolition?

Poor self-care
Lack of persistence at work/education
Lack of motivation

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What is affective flattening?

Unchanging facial expressions
Few expressive gestures
Poor eye contact
Lack of vocal intonations
Inappropriate affect

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What are disorganisation symptoms?

Bizarre behaviour

Thought disorder

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What characterises bizarre behaviour?

Bizarre social behaviour
Bizarre clothing/appearance
Aggression/agitation
Repetitive/sterotyped behaviours

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What characterises thought disorder?

Derailment
Circumstantial speech
Pressured speech
Distractibility
Incoherent/illogical speech

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Describe the onset of psychosis

Can occur at any age
Peak incidence in adolescence/early 20s
Peak later in women

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Describe the course of psychosis

Often chronic & episodic

Very variable

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Describe morbidity with psychosis

Substantial, both from disorder itself and increased risk of common health problems e.g. heart disease

Significant impact on education, employment and functioning

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Describe mortality with psychosis

Substantial

All-cause mortality 2.5x higher, ~15 years life expectancy lost

High risk of suicide in schizophrenia – 28% of excess mortality

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What comprises a psychiatric history?

History of Presenting Concern
Past Psychiatric History
Background History (Family, Personal, Social)
Past Medical History and Medicines
Corroborative History

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How do you explore the history of the presenting complaint?

The patient’s description of the presenting problem – nature, severity, onset, course, worsening factors, treatment received
Circumstances leading to arrival to hospital
WHY NOW?

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How do you explore past psychiatric history?

Any known diagnosis?
Any treatment?
Known to a community team?
Any previous admissions to hospital?

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What do you explore when taking a family history?

Age of parents, siblings, relationship with them
Atmosphere at home
Mental disorder in the family, abuse, alcohol/drugs misuse, suicide

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What do you explore when taking a personal history?

Mother’s pregnancy and birth
Early development, separation, childhood illness
Educational and occupational history
Intimate relationships

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What do you explore when taking a social history?

Living arrangements
Financial issues
Alcohol and illicit drug use
Forensic History

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What do you explore when taking a past medical history?

Medical problems = a cause or consequence of | mental disorder or psychiatric treatment

What do you explore when asking about medication?

Regular medications? Compliance? Over the counter medications? Interactions?

What do you need to consider when taking a corroborative history?

Need for consent! Informants: relatives, friends, authority Confidentiality

What do you look at in a mental state examination?

``` Appearance and Behaviour Speech Mood Thoughts Perceptions Cognition Insight ```

What do explore when looking at appearance and behaviour?

``` General appearance Facial expression Posture Movements Social behaviour ```

What issues may there be with someone's general appearance?

neglect: alcoholism, drug addiction, dementia, depression, schizophrenia weight loss: anorexia nervosa, depression, cancer, hyperthyroidism, financial issues/homelessness

What issues may there be with someone's facial expression?

depressive, anxious, | “wooden” parkinsonian

What issues may there be with someone's posture?

hunched shoulders, downcast head and eyes – depressive sitting upright, head erect, hands gripping the chair – anxious

What issues may there be with someone's movements?

``` overactive, restless – manic inactive, slow - depressive immobile, mute – stupor tremors, tics, choreiform movements, dystonia, tardive dyskinesia mannerisms, stereotypies ```

What issues may there be with someone's social behaviour?

disinhibited, overfamiliar withdrawn, preoccupied signs of impending violence: raised voice, clenching fists, pointed fingers, intrusion into personal space

What do you look at when exploring someone's speech?

Quantity Rate Spontaneity Volume

What issues could there be with quantity of speech?

less, more, mutism

What issues could there be with rate of speech?

slow, fast, pressure of speech (cannot stop them they go at 100 miles an hour)

What issues could there be with spontaneity of speech?

Latency

What do you look at when you consider mood?

``` Subjective Objective Predominant mood Constancy Congruity ```

What is subjective mood?

What the patient feels

What is objective mood?

How you think the patient feels

What do you look for specifically with constancy of mood?

emotional lability/incontinence reduced reactivity/blunting/flattening irritability

What is congruity?

cheerful while describing sad events

What do you explore when looking at thoughts?

Stream Form ``` Content Preoccupations Morbid thoughts, suicidality Delusions, overvalued ideas Obsessional symptoms ```

What issues can there be with stream of thought?

pressure, poverty, blocking

What issues can there be with form of thought?

flight of ideas, loosening of associations, preservation

What are primary and secondary delusions?

primary – occurs suddenly | secondary – arises from previous abnormal idea/experience (hallucination/mood/delusion)

What is folie à deux?

Shared delusion

Give examples of delusional ideas?

``` paranoid of reference grandiose/ expansive of guilt/ worthlessness hypochondriacal of jealousy sexual/ amorous religious of control concerning the possession of thought (insertion, withdrawal, broadcast) ```

What are obsessional symptoms?

obsessional thoughts: dirt and contamination, aggressive actions, orderliness, disease, sex, religion compulsions: checking, cleaning, counting, dressing rituals

What are perceptions people may have?

Illusions Hallucinations Distortions

What are illusions?

misperception of a real external stimulus

What are hallucinations?

perception in the absence of external stimulus

What are the different types of hallucinations?

true perception coming from outside the head (pseudohallucination)

What senses can hallucinations affect?

``` auditory – second person, third person visual – Charles Bonnet syndrome olfactory gustatory tactile, of deep sensation ```

What do you look at exploring cognition?

``` Consciousness Orientation Attention and concentration Memory Language functioning Visuospatial functioning ```

What are the main features of insight?

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

How can you make it seem to the patient that you are on the same page?

Mirror their language

Where else can you get information?

Family Friends Work/Education Healthcare records GP Mental Health

How can psychosis be managed pharmacologically?

Antipsychotic medications | Often mainstay of treatment

How can psychosis be managed psychologically?

CBT for psychosis | Newer therapies like avatar therapy

What social support can you give to those with psychosis?

Supportive environments, structures and routines Housing, benefits Support with budgeting /employment

What are the side effects of anti-psychotics?

``` Sedation Constipation Increased prolactin (release is suppressed by dopamine) Increased appetite Weight gain Diabetes Dysrhythmia Long QTc ```

What is word salad?

Stream of words | No grammatical sense

Pyschosis Flashcards

(64 cards)