Essentials of Psychosis Flashcards
Definition of neurosis
A relatively mild mental illness that is not caused by organic disease, involving symptoms of stress (depression, anxiety, obsessive behaviour, preoccupation with physical illnesses) but not a radical loss of touch with reality.
Define psychosis
Psychosis can be defined as grossly impaired reality testing .i.e. persons incorrectly evaluate the accuracy of their thoughts and perceptions and make incorrect inferences about external reality, even in the presence of contrary evidence.
Characteristics of psychosis
Psychosis is a broad term but is generally associated with severe impairment of social and personal functioning characterised by social withdrawal and inability to perform the usual social and household occupational roles
Lack of insight is a key feature
Empathy as a tool to understand a patient’s symptoms include:
this involves observation, questioning, re-phrasing and checking if you’ve got it right.
Explain the phrase “psychosis occurs on a continuum”
Occur on a continuum
One pole
Grossly disorganised speech and behaviour. Difficult or impossible to get a coherent account of the symptoms.
The other pole
Symptoms are mild and difficult to distinguish from “normal”
Can be very subtle and difficult to elicit
Between the poles fall the patients who’s symptoms are easier to spot.
List clinical features of psychosis
None of the symptoms alone is definitive of any disorder
Always entertain a differential diagnosis for each symptom, then settle on a diagnosis that fits the pattern best.
Delusions Hallucinations Disorganised thinking (speech) Grossly disorganised or abnormal motor behaviour (including catatonia) Negative symptoms
List examples of psychotic disorders
Schizophreniform psychosis Schizophrenia Schizoaffective disorder Bipolar disorder Brief psychotic disorder Psychosis secondary to another medical condition Substance-induced psychosis
Define delusion
fixed, firmly held, false belief which is not amenable to change even in the face of contradictory evidence
The belief is out of keeping with that of the individual’s cultural group
And is not an article of faith or a religious belief
Distinction between a strongly held belief (overvalued idea) and a delusion is sometimes difficult to make and depends on the degree of conviction with which the belief is held despite clear or reasonable contradictory evidence regarding its veracity.
Name some of the themes of delusions
persecutory religious grandiose somatic referential nihilistic
Explain non-bizarre delusions
Within realms of possibility but patently untrue
E.g. a belief that one is under surveillance by the police, despite a lack of any convincing evidence.
Explain bizarre delusions
If clearly implausible and not understandable to same culture peers and do not derive from ordinary life experiences
E.g. A belief that someone has implanted a chip in one’s brain and that this “other” is controlling one’s actions or behaviour.
Bizarre delusions include:
- Thought withdrawal
- Thought insertion
- Delusions of control
- Thought broadcasting
Delusions may be:
Systematized and fragmentary
Systematized forms an association of ideas that fit into a coherent narrative, even though implausible
Fragmentary are bits of poorly, or non- associated ideas
Name causes of delusions
Schizophrenia Bipolar Disorder Delusional disorder Schizoaffective disorder Dementia Delirium Neoplasms Epilepsy Traumatic brain injury Vitamin deficiencies (pellagra) Endocrinopathies (thyroid, etc.)
Define hallucinations
A sensory perception that has the compelling sense of reality of a true perception but that occurs without external stimulation of the relevant sensory organ.
Hallucinations should be distinguished from illusions, in which an actual external stimulus is misperceived or misinterpreted.
Describe features of hallucinations
Vivid and clear with full force and impact of normal perceptions
Not under voluntary control
May occur in any sensory modality
Auditory commonest
Sensorium must be clear
Hypnagogic (falling asleep) and hypnopompic (waking up) normal
May occur in religious context in certain cultures.
Types of hallucinations
Auditory - One or more voices, familiar or unfamiliar, Commentate, command, echo thoughts
Visual - Bizarre, transient, usually terrifying, not cinematic
Gustatory - Unexplained taste
Olfactory - Unexplained smell
Tactile - ‘crawling sensation’ on skin
Somatic - Sensations within the body – electric shocks, etc.
Causes of hallucination
Auditory - Schizophrenia, bipolar mood disorder, schizoaffective dis., substance abuse/intoxication, dementia, tumours
Visual - Delirium (e.g. DT’s), stroke, neoplasm
Olfactory - Epilepsy (aura)
Gustatory - Epilepsy (aura)
Tactile - Alcohol withdrawal (DT’s)
Somatic - Substance abuse/intoxication, schizophrenia, BPAD
Explain/define disorganized thinking
- Formal thought disorder- a loss of the normal flow of thought; typically inferred from the individual’s speech.
- Derailment/loosening of associations- jumping from topic to topic
- Tangentiality-answer to a question may be obliquely related or completely unrelated
- Incoherence/word salad – speech that is so severely disorganised as to be incomprehensible
Thought disorders: What is meant by “flight of ideas”?
A nearly continuous flow of accelerated speech with abrupt changes from topic to topic that are usually based on understandable associations, distracting stimuli, or plays on words. When severe, speech may be disorganized and incoherent.
- Characteristic of MANIA
Thought disorder: What is meant by “loosening of associations”?
- A disturbance of thinking shown by speech in which ideas shift from one subject to another that is unrelated or minimally related to the first.
- Statements that lack a meaningful relationship may be juxtaposed, or speech may shift suddenly from one frame of reference to another. The speaker gives no indication of being aware of the disconnectedness, contradictions, or illogicality of speech.
Characteristic of SCHIZOPHRENIA
Thought disorder: What is meant by “circumstantially”?
Pattern of speech that is indirect and delayed in reaching its goal because of excessive or irrelevant detail or parenthetical remarks. The speaker does not lose the point.
What are the features of catatonia?
Decreased reactivity to the environment
Decreased mobility to complete unawareness or …
Purposeless and unstimulated excessive motor activity (‘catatonic excitement’)
Rigidity and maintenance of postures (‘waxy flexibility’)
Negativism: active resistance to instructions or attempts to move them
Posturing: assuming bizarre postures
Echolalia and echopraxia
Causes of catatonia
Schizophrenia Depression Neurological disorders: - CVA, neoplasms, head trauma, encephalitis, Metabolic: - hypercalcaemia, diabetic ketoacidosis, homocystinuria, hepatic encephalopathy Dementia Delirium
Features of disorganized behaviour
Poor self care
Unkempt appearance
Poor self hygiene and inability to perform activities of daily living (e.g. shopping, cooking etc)
Inappropriate and bizarre behaviour
- E.g. public masturbation, exhibitionism, unusual dress (layers
of mismatching clothing)
Child-like silliness to gross agitation
