Disordered Thinking Flashcards
(42 cards)
Definition of a hallucination
Perceptions which, to the patient are indistinguishable from reality, and occur in the absence of an external stimulus. They can take the form of visual, auditor (most common), taste, smell and tactile hallucinations.
Definition of delusion
False beliefs which are held with conviction by the patient despite contradictory evidence. Can take the form of delusions of reference, of control and of persecution.
Definition of thought disorder
impairment in the ability to form thoughts from logically connected ideas. Presents clinically in the patient’s speech.
Definition of an illusion
Misperceptions fo real external stimuli. Can occur in healthy people
Types of auditory hallucinations
Elementary e.g. buzzing, whistling. Complex e.g. first, third, second person.
Charles Bonnet Syndrome
Presence of complex visual hallucinations with no other psychiatric symptoms or consciousness impairment. Associated with loss of vision.
Hypnagogic hallucinations
Occur as patient goes to sleep
Hypnopompic hallucinations
Occur as patient wakes up.
Mood congruent and mood incongruent delusions
Congruent = contents of the delusion are appropriate to the patient’s mood. Incongruent are not in line with the patient’s mood.
Capgras syndrome
Delusion that a familiar person has been replaced by an imposter.
Fregoli syndrome
Delusion that a stranger is actually a person the patient is familiar with.
Nihilistic delusions
Delusion that the patient or other or the whole word are going to end or that nothing actually exists.
Primary delusions
Cause of delusion is not understandable, invade all aspects of patient’s life. Patient becomes suspicious and perplexed.
Secondary delusions
Consequence of a pre-exisiting psychopathological state.
Extracampine hallucination
Altered perception outside the sensory field.
Differential diagnosis of a psychotic patient
Schizophrenia Manic episode of bipolar disorder Schizoaffective disorder Lewy body dementia Drug or alcohol abuse Drug or alcohol withdrawal Delirium PTSD Autism spectrum disorder
Risk factors for psychosis/schizophrenia
Genetics esp 1st degree relative. Stress, traumatic life experience. Cannabis misuse Migration Birth complications. Brain abnormalities such as reduced size.
Prodromal period/At risk of mental state
Emotional and behaviour change leading to social withdrawal and impaired functioning of patient.
Subclinical psychotic symptoms may occur. or transient psychotic symptoms which are brief and intermittent. The period occurs before episode of full-on psychosis.
First rank symptoms of schizophrenia
1) Delusions of perception e.g. communicate with aliens, have superpower.
2) Delusions of thought (insertion, broadcast, echo).
3) Delusions of control (something making their body move or act)
4) Auditory hallucinations (audible, arguing voices running commentary).
Other symptoms of schizophrenia
Over-valued ideas.
Breaks or interpolations of thought flow.
Catatonic behaviour (fixed posture, rigid, stupor)
Echopraxia.
Tics
Negative symptoms of schizophrenia
Apathy
Reduced speech
Blunting or incongruity of emotional response.
Social withdrawal.
Diagnosis of schizophrenia
1 or more of the first rank symptoms or any two of the other symptoms.
Must be present for most of 1 month or more.
Marked impairment on patient’s functioning.
In absence of organic brain disorder. – > Investigations might include: LFT+gamma GT, FBC, urine drug screen, b12&folate, head CT, U&E.
Management of first episode of psychosis
Refer to crisis team or early intervention psychiatry team. May need to use Mental Health Act to admit.
Identify suicide risk.
Individual CBT
Trial antipsychotic medication.
Care plan for crisis event, advance statement, close contact information.
Topics for discussion of routine psychosis review
Care programme approach. Social needs. Mental health and symptom control. Treatment adherence. Physical wellbeing. Drug and smoking use. Re-assess risk. Continuity of care. Adverse effects of any medication.
