week 6 Flashcards
What is psychosis?
There is a group of illnesses which disrupt the functioning of the brain so much, they cause a condition called psychosis.
When someone experiences psychosis they are unable to distinguish what is real — there is a loss of contact with reality.
Most people are able to recover from an episode of psychosis.
Determining psychosis
Disturbances in thought content (what people think) – delusions
Disturbances in perception – hallucinations
Disturbances in the thinking process (how people think and hence what they say) – disorganised thinking (speech)
Disturbances in behaviour - grossly disorganised or abnormal motor behaviour
Negative symptoms – affective flattening, avolition, alogia, anhedonia and asociality
PsychosisPositive
Symptoms
Positive does not mean good (“positive” as in addition of a disturbance)
Abnormal behaviour
Hallucinations
Delusions
Thought disorder (speech)
Negative Symptoms
Avolition (loss of drive/motivation)
Affective flattening (dampening of emotional expression)
Alogia (diminished speech)
Anhedonia (decreased ability to experience pleasure from stimuli)
Asociality (lack of interest in social activities)
Abnormal Behaviour
Grossly disorganised and abnormal motor behaviour:
–Can go from childlike “silliness” to unpredictable agitation
Too much activity
- -Hyperactive, restless, not goal directed
- -Aggression, destruction of property
- -Catatonic excitement = purposeless and unstimulated excessive behaviour with no obvious cause
Too little activity
- -Limited speech and even mute (complete lack of verbal responses)
- -Catatonic stupor (no reactivity to environment and complete unawareness)
Inappropriate activity
–Funny postures (catatonic posturing)
Catatonia =
decreased reactivity to environment
Psychosis Delusions
Delusions -2 categories!
All types of delusions can be separated into two categories!
Non-bizarre delusions – could occur in real life (person believes police is after them) – could be true (drugs, speeding tickets)
Bizarre delusions - not clearly probable or understandable (TV calling out to person and giving them information OR a microchip has been inserted in their neck despite no evidence of surgery or scars)
There are 6 primary Types of delusions
- Persecutory delusions
(aka paranoid delusions) – belief that one will be harmed, harassed by a person, group or organisation
Example: police after them, Centrelink is after them, someone is out to get them
- Referential delusions
aka delusions or reference) – belief that a message of highly personal nature is being conveyed from phone, TV etc
- Grandiose delusions
– belief that person has wealth, fame, exceptional abilities, religious connections (do see in Bipolar Disorder)
- Somatic delusions
focus on health and bodily organs (some part of body has changed or is diseased)
- Nihilistic delusions
belief that some major catastrophe will occur (typically associated with severe depression)
- Jealousy & Erotomanic delusions
partner is being unfaithful and that another person is in love with them
Psychosis Hallucinations
We perceive the world with five senses: See – visual hallucinations Hear – auditory hallucinations Smell – olfactory hallucinations Touch – tactile hallucinations Taste – gustatory hallucinations
Hallucinations – occur when one experiences something through the senses that is not there (perceive something to be there and it is not there)
- -Hearing voices – “do you see hear things outside of your head with your ears, that others don’t hear?”
- -Seeing things – “do you see things that other people do not see” (strange objects, people, angels, demons etc)
Auditory Hallucinations
This is the most common hallucination
The patient hears sounds or voices but there is no one making the sounds or talking. The voices may talk to the person, talk about the person or give a running commentary about what the person thinks or does.
You will explore auditory hallucinations much more in the tutorials
Delusions & Hallucinations
Delusions are often congruent with the hallucinations the patient is experiencing
- –The paranoid delusion that others are trying to poison them, along with an olfactory hallucination of poison gas.
- –The religious/grandiose delusion that one has been appointed by God, accompanied by auditory command hallucinations.
Disorganised Thinking (Speech)
Aka Formal Thought Disorder – process of thinking
If the process is impaired then we don’t understand what the person says, partially or totally
If we don’t understand parts of the conversation = loosening of thought association (disorganised speech)
If we don’t understand the entire conversation = incoherence (“word salad”)
Switching from one topic to the next = derailment
loosening of thought association (disorganised speech)
If we don’t understand parts of the conversation
incoherence (“word salad”)
If we don’t understand the entire conversation
Switching from one topic to the next
derailment
tangential
Answers to questions may not fit or be unrelated
If the thinking process is impaired there may be reduction in thinking and speaking
poverty of speech
Neologisms
false words (“it has been creatised by my doctor”)
Echolalia
repeating what others around them are saying
Clang associations
“pass me the spoon, moon, I am cocoon”
Schizophrenia
Lasts at least six months, with at least one month of two or more of the following:
-delusions
E.g., I know that Illuminati is controlling University book content
-hallucinations
E.g., I saw death yesterday and she ensured me that I am immune
-disorganised speech
E.g., I know that yester was illuminati’s ensured Immunity of day for death
-grossly disorganised or -catatonic behaviour
E.g., forced hand shake
negative symptoms
Schizophreniform Disorder
Equivalent to schizophrenia except the disturbance is of lesser duration (one to six months)
Schizoaffective Disorder
The co-occurrence of the symptoms of schizophrenia and a major mood episode, in addition to at least a two-week period of delusions or hallucinations without mood disturbance. Mood symptoms are present for the majority of the total duration of the disorder
Delusional Disorder
At least one month of delusions
Brief psychotic disorder
A psychotic disturbance lasting more than one day but less than a month with eventual return to premorbid level of functioning
Psychotic disorder due to another medical condition
Prominent hallucinations or delusions that are the direct physiological consequence of another medical condition
Substance/medication-induced psychotic disorder
Delusions and/or hallucinations that develop during or soon after substance intoxication or withdrawal or after exposure to medication
Medical Treatment
History of the Antipsychotics
Typical (First-Generation) Antipsychotics
- Chlorpromazine, Haloperidol
- block receptors in the brain’sdopamine pathways – less reward and activity less psychosis
Atypical (Second-Generation) Antipsychotics
- Clozapine (Clozaril)
- Risperidone (Risperdal)
- Olazapine (Zyprexa)
- Also block receptors in the brain’sdopamine pathways – less reward and activity less psychosis
- Initially marketed as less harmful (less extrapyramidal side-effects)…recent research has raised doubts about this
Extrapyramidal Side-Effects
- Akinesia – Stiffness or lack of movement
- -May lead to drooling with reduced muscle tone around mouth
- Dyskinesias – Abnormal movements
- -From fine tremors to more gross shaking
- Tardive Diskenesia – Late onset dyskenesia
- -Abnormal involuntary movements of face and mouth
- -May endure after drug is ceased
- Dystonia – Abnormal muscle tone
- -Muscle spasm, typically of eyes, mouth and jaw
- Akathisia – Restlessness, nervousness, agitation
- Demotivation – Reduced interest
Therapy
Cognitive Therapy concerning how intrusions into consciousness are interpreted (Morrison, 2001)
Cognitive Behavioural Therapy
Overview
What is psychosis? Inability to distinguish what is real Negative Symptoms of Psychosis When normal function is diminished Positive Symptoms of Psychosis When sensory experiences are added Psychotic Disorders Schizophrenia and Delusional Disorder the largest categories!
- Delusions (thought content)
A fixed false belief (not accepted by others)
Ex. “I am Jesus” (not what everyone else believes)
REMEMBER: what is normal for one person may not be for another based on culture, background, religion etc
Grades of thinking:
-Normal – ex. Jealous when other flirt with partner
-Strange – ex. Jealous that partner is flirting with others and vice versa in absence of any signs
-Grossly abnormal – ex. Jealous that partner is cheating on you. She and her lover will flee to another country leaving you abandoned. Absence of signs to this effect! Nevertheless, the person regularly checks phone, bags, notes, and more!
Important thought content abnormalities:
–Suicidal thoughts – from mild ideation to definite plan
–Homicidal thoughts – from strong dislike to definite plan of harm
Types of delusions continued
Other bizarre delusions –
- -Thought withdrawal – thoughts are being pulled out of one’s mind
- -Thought insertion – thoughts not belonging to the person are being placed in their mind
- -Thought broadcasting – a person’s private thoughts are being heard by others
- -Thought control – thoughts are being manipulated by some outside force
Hallucinations & possible causes
Temporal lobe lesions --E.g., Temporal lobe responsible for much of hearing! Complex partial seizures --E.g., Creating false stimuli through neurons firing Migraine --E.g., Aura’s -Brain injury --Sleep disorders ---Hypnopompic – while waking up ---Hypnagogic – while falling asleep --Illicit drugs – ecstasy, ketamine, ice
Other specified schizophrenia spectrum and other psychotic disorder
Symptoms of psychosis that cause clinically significant distress or impaired functioning which do not meet full criteria for any other psychotic disorders. Specific reasons for why the criteria for another disorder are not met must be specified by the clinician (e.g., persistent auditory hallucinations in the absence of other psychotic features)
Unspecified schizophrenia spectrum and other psychotic disorder
Symptoms of psychosis that cause clinically significant distress or impaired functioning which do not meet full criteria for any other psychotic disorders. The clinician is not required to specify the reasons that the criteria for this diagnosis are met.
Medical Illnesses related to experience of psychosis
Many medical illnesses can present similarly to psychosis:
Progressive neurological diseases (e.g., MS, dementias)
CNS infections (e.g., encephalitis, neurosyphilis)
Space occupying lesions and tumors
Metabolic disorders (e.g., Wilson’s disease)
Endocrine disorders
Deficiencies (e.g., Thiamine)
Temporal Lobe Epilepsy
More side-Effects of antipsychotic medication
α adrenoreceptor E.g., Nasal drying Dry mouth Constipation Blurring of vision Agitation, confusion and hallucinations in some elderly patients
H1 histaminic receptor blockade
Sedation and weight gain
Anticholinergic effects often wear off after several weeks.
More side-Effects of antipsychotic medication 2
Muscarinic (“Cholinergic”) Dry mouth Constipation Urinary retention / hesitancy Blurred vision ECG changes
Often managed with anti-cholinergic medications
Benztropine (Cogentin)
More side-Effects of antipsychotic medication 3
Sympathetic (α1) effects Sedation Hypotension Tachycardia / palpitations Erectile dysfunction
Hormonal changes
-D2 receptor actions of -antipsychotics influence prolactin levels
—May increase lactation in women already breast-feeding
Weight gain
John has 2 weeks of hallucinations and then they stop. Following this he has no more hallucinations and all goes back to normal.
Brief Psychotic Disorder
Tina has depression and has frequently discussed these problems with Elfs and continued to do so even when her depression momentarily stopped.
Schizoaffective disorder
Tom has depression and believes that the world holds no hope for him and that everybody dislikes him and he is destined to fail at whatever he does
Major Depressive Disorder
Janet has always believed that she will become something important because of her relationship with the creator
No psychotic disorder
Tate speaks to goblins, believes he is commanded by orcs, sees spiders crawling on his arms at night and has done so for 20 years.
Schizophrenia
Jane is given medication by her GP and begins to hear voices. The voices stop when she stops taking medication.
Medication induced psychotic disorder
Barbara has had poor self-esteem the past year. She is often anxious in social situations and often believes that everybody judges her in social situations. She functions well at school, at work, and in her relationships.
No disorder
Ben speaks to trolls, believes he is commanded by elves, sees cockroaches crawling on his arms during the day and has done so for 4 months
Schizophreniform Disorder
Jim has a brain injury and reports is afraid that is controlling his actions.
Psychotic disorder due to another medical condition
