Session 11 - Psychosis Flashcards
What is psychosis?
The presence of hallucinations or delusions
Describes symptoms, is not a diagnosis itself
What are hallucinations?
Perception without a stimulus
Can be in any sensory modality
Visual hallucinations are usually organic (caused by problem with brain or eyes)
When are hallucinations experienced in the normal population?
Immediately before falling asleep - Hypnogogic
Immediately before waking up - hypnopompic
What is a delusion?
Abnormal belief, outside of cultural norms, unshakeable
What are the symptoms of schizophrenia?
Auditory hallucinations Passivity experiences Thought withdrawal, broadcast or insertion Delusional perceptions Somatic hallucinations
Thought disorder Lack of insight Under-activity Low motivation Social withdrawal Self neglect Emotional flattening
Give examples of auditory hallucinations.
Thought echo - hearing thoughts aloud
Running commentary - voices referring to the patient in third person and conversing with each other about the patient
What are passivity experiences?
Patient believes that an action or feeling is caused by an external force
E.g. ‘MI5 have been moving my leg’
What is thought withdrawal, broadcast and insertion?
Thought withdrawal - thoughts are being taken out of the mind
Thought broadcast - thoughts are being made known to others e.g. via radio
Thought insertion - thoughts implanted by others
What is delusional perception?
Attribution of new meaning, usually in the sense of self-reference, to a normally perceived object.
E.g. ‘the traffic lights went red and i knew this was a sign that the aliens were going to land soon’
What are somatic hallucinations?
Mimics feelings from inside the body
What are the different types of schizophrenia?
Paranoid schizophrenia Simple schizophrenia Hebephrenic schizophrenia Undifferentiated schizophrenia Catatonic schizophrenia
Describe paranoid schizophrenia.
Delusions or hallucinations prominent
Describe simple schizophrenia.
Loss of drive and interest, aimlessness, social withdrawal.
Marked decline in social, academic or work performance.
No hallucinations/delusions.
Often mistaken for depression.
Describe hebephrenic schizophrenia.
Aimless and disjointed behaviour or thought disorder affecting speech.
Hallucinations/delusions must not dominate.
Describe undifferentiated schizophrenia.
Insufficient symptoms to meet criteria of any subtypes or so many symptoms that fit into more than one criteria.
What pathways are affected in schizophrenia?
Dopamine pathway
Mesolimbic pathway
Mesocortical pathway
Where does the mesolimbic pathway run from and to?
From: ventral tegmental area
To: limbic structures (amygdala, septal area, hippocampal formation) and nucleus accumbens
Where does the mesocortical pathway run from and to?
From: ventral tegmental area
To: frontal cortex and cingulate cortex
What macroscopic brain changes are seen in schizophrenia?
Enlarged ventricles Reduced hippocampal formation Reduced amygdala Reduced parahippocampal gyrus Reduced prefrontal cortex
Where does the nigrostriatal pathway run from and to?
From: substantia nigra pars compacta
To: striatum (caudate nucleus and putamen)
What is catatonia?
More than two weeks with one or more of:
- stupor/mutism
- excitement
- posturing
- negativism
- rigidity
- waxy flexibility
- command automatism
Probably due to less GABA binding so loss of inhibitory effect.
Why is mortality twice as high in schizophrenics than the general population?
Higher incidence of CVS disease, respiratory disease and cancer Suicide risk 9x higher Death from violent incidents 2x higher Substance misuse problems Higher rates of cigarette smoking
What is drug induced psychosis?
Psychosis induced by psychoactive substances.
E.g. methamphetamine, cannabis, cocaine, ecstasy etc.
