PSYCHOSIS - schizo Flashcards
(70 cards)
1
Q
what is psychosis?
A
mental d.o but not a DX
- Qualitatively diff. from normal experiences
- inability to distinguish subjective internal exper. from objective reality
- lack insight
- harmful to individual’s functioning and interpersonal relations
2
Q
What psychotic experiences may one have?
A
- HALLUCINATIONS
- DELUSIONS
- formal thought d.o
- thought interference
- passivity phenomena
- loss of insight
3
Q
How do sensory organs impair reality?
A
- they are fallible
- brain is therefore limited in processing capabilities
- why there is NO direct interface when interpreting reality
4
Q
What does it mean when a innocuous/coincidental events will be ascribed a significant meaning by the person?
A
Ideas of Reference
5
Q
What is Primary delusions?
A
- arise FULLY formed in consciousness WITHOUT the need of an explanation
6
Q
What becomes impaired in Psychosis?
A
- embodiment
- volition (movement of the body
- time
- memory
- consciousness
7
Q
How does a hallucination occur?
A
- aberrant brain PROCESSING without an external stimulus triggers perception.
- sleep deprivation may trigger hallucinations
8
Q
What about hallucinations makes it seem so real? (3)
A
- holds the SAME qualities as NORMAL perception
(vivid, solid, compelling) - not subject to conscious manipulation
- can occur in any sensory modality
- experienced as originating in REAL space (NOT just in thoughts)
9
Q
Provide examples of ideas of reference?
A
- pt thinks there are MESSAGES in the newspaper about them
- think the tv is talking TO them/ commenting on their life
- radio station songs trying to tell you something
10
Q
What does it mean to have persecutory beliefs?
A
- pt believes that someone is OUT to harm them
11
Q
What is self-referential experiences?
How varied in intensity may the thoughts be self-referential experiences?
Give an example.
A
- belief that external events are related to oneself
- brief thought
- frequent, INTRUSIVE thoughts> delusional intensity
= feeling that others are talking about them
12
Q
What are delusions?
A
- fixed, FALSELY held belief
- held with unshakeable conviction
- —can’t accept evidence to the contrary
13
Q
What may delusions be a/w?
A
- with the usual social, cultural and educational background of the pt.
14
Q
Distinguish between primary and secondary delusion.
A
Primary: arises SPONTANEOUSLY without any precedent cause
Secondary : arises based on some logical extension (external factors)—-ATTEMPTS to EXPLAIN anomalous experiences (hallucinations)—-“because of mafia”
15
Q
What is Nihilistic delusion?
A
- the fear that they LOST everything
16
Q
What are the 2 ways in which Misidentification delusion may take form as?
A
- Capgrass
- Fregoli (diff. people are in fact the same single person –wearing other clothes)
17
Q
Name 5 diff. forms of delusions.
A
- paranoid
- persecutory
- grandiose
- misidentification
-Nihilistic (nothing is nothing) - guilt
- reference
jealousy/love/poverty/ sin
18
Q
Why do delusions change from person to person?
A
- the delusional content is usually culturally defined
(evil spirits/ISIS/devil/spies)
19
Q
How to pick up on presence of thought d.o?
A
- inferred from the pts’ speech
20
Q
How does Clanging thought d.o sound like?
A
- non-sensical rhyming #
- “ding dong bell. Got to hell”
> seen in BPD and Schizophrenia
21
Q
How does circumstantial thought processing appear?
A
- person talks in circles (A LOT of excessive detail)
- they get to the point
22
Q
How does tangential thinking appear?
A
- person moves from one thought to another
- never gets to the point
23
Q
How does loosening of associations appear as a thought pattern?
A
- Severe thought disorder
- thoughts LOOSE connection from one another
24
Q
What are neologisms?
A
-made-up words
25
What are 4 ways in which thoughts may be interfered?
- thought INSERTION
- thought WITHDRAWAL
- thought BROADCASTING
- thought BLOCKING "can't think of anything for a while"
26
What is meant by passivity of volition?
- pt believes his actions are under the control of external forces
- he feels like he is the passive observer in his own body
27
What is meant by passivity of affect?
- pt experiences FEELINGS that are not his own
28
What is somatic passivity like ?
- pt experiences BODILY sensations as being produced by an external force
29
How may a pt react to passivity of impulse?
- surprised as they believe the impulse to carry out an action was not his own
30
What may the thought processing behind loss of insight be? And why?
- pt feels as though everything seems as real as it always did
- the filtering of information about the world around us (and interpreting its relevance) is impaired
31
What are important points to collate when diagnosing Psychosis?
- nature of psychotic experiences
- associated Psychiatric symptoms
- natural hx of symptoms
32
Which conditions present with Visual hallucinations?
- substance misuse
| - delerium/ dementia
33
What 2 conditions present with auditory 2nd or 3rd person hallucinations?
- schizo
| - substance misuse
34
The passivity phenomena occurs in 2 conditions. What are they?
- Schizo
| - Substance Misuse
35
When does formal thoughts disorder manifest?
- Schizo
| - Mania
36
Name all the symptoms of Schizophrenia.
- formal thought d.o
- self-referential delusions
- grandiose delusions
- Persecutory delusions
- passivity phenomena
- auditory hallucinations (2nd and 3rd)
37
What to keep in mind for suspected drug-induced psychosis?
- some underlying co-morbidities
| schizo and BPD
38
How does depressive psychosis present as?
- delusions of WORTHLESSNESS/ guilt/ hypochondriasis/poverty
| - hallucinations of acusing/ insulting/ threatening voices (in 2nd person)
39
How does mania with psychosis present as?
- delusions of grandeur/ special ability/ persecution/ religiosity
- auditory hallucinations
- flight of ideas
40
What is delirium?
| What meds cause delirium?
- acute, transient DISTURBANCE
- steroids, digoxin, diuretics, anticholinergics
- withdrawal from benzodiazepines!
41
What other conditions may cause delirium?
- septicaemia
- organ failure
- hypoglycemia
- post-op hypoxia, post-ictal, SOL, encephalitis
42
What are the symptoms of Delirium?
-Change in consciousness (subtle drowsiness-> unresponsive)
- disorientated
- lucid intervals (fluctuations)
- worse at night
- impaired conc./memory
(ESP. new info.)
43
What may delirious pts experience?
- visual hallucinations/illusions +/- auditory hallucinations
- persecutory delusions
- psychomotor distrubance
(agitation, retardation)
- insomnia
44
What are the core psychotic symptoms of Schizo?
- delusions
- hallucinations
- thought interference
- passivity
45
What are the subtypes of Schizophrenia?
1. Paranoid - most common form
2. Hebephrenic (disorganized schizo)
3. Catatonic -- more movement d.o
4. others: simple, residual, undifferentiated
46
Name 4 other paranoid psychosis.
1. Persistent Delusional d.o
2. Schizotypical d.o
3. acute and transient psychotic disorder
4. Schizoaffective d.o
47
What are the demographics like in the schizo patients?
M:F is 1.4:1
- peak incidence in men: 15-25 years
- 25-35 years in women
Higher incidence in Lower socioeconomic class
48
Do genetics play a role in schizo?
- 40-60% chance is MZ twins
- 15% if one parent
- 50% chance is BOTH parents have it
- some mutations'
- higher rates in some ehtnic gr. (african-caribeean)
49
What birth complications may arise in a schizophrenic pt?
- prematurity
- prolonged labor
- fetal DISTRESS
- hypoxia
50
What is hypothesized to increase the risk of scizophrenia prenatally?
- exposure to VIRAL infections (toxoplasmosis, chlamydia)
- maternal stress (hemorrhage, pre-term labor)
- malnutrition
(any maternal prenatal complications)
51
What external factors are said to cause increased risk of schizophrenia developing?
- heavy, regular CANNABIS use (^2-4x risk)
- urban dwelling
- social deprivation
52
How may schizophrenia develop through out one's life?
- in childhood: subtle motor, cognitive and social deficits (becomes greater later)
- delay in speech and walking
- prodromal: -gradual onset/ odd ideas and experiences
- eccentricity, altered affect and off behaviours
53
What may suggest bad prognosis to schizophrenia?
- insidious onset
- early onset
- cognitive impairment
- enlarged Vs
- long duration of untreated psychosis
54
What may contribute to good prognosis?
= older age onset
- F
- marked MOOD disturbance (esp. elation)
- family hx of MOOD disorder
55
What is the rule of thirds in Schizo outcomes?
- a third have a stand alone episode and would recover and return to their normal functioning
- a thirds would hve a relapsing- remitting pattern
- a third would have chronic residual symptoms; and they would progressively worsen.
56
How are symptoms of psychosis categorized as?
1. Positive Symptoms
2. Negative Symptoms
3. Mood Symptoms
57
What is the diff. between ACUTE and CHRONIC schizophrenia?
- Acute: presents with the sudden onset of positive symptoms (hallucinations, delusions and confused thoughts)
- Chronic: characterized by negative symptoms
58
What are Schneider's 1st rank symptoms? (4)
- hearing thoughts spoken ALOUD
- 3rd person hallucination and hallucinations as running commentary
- Thought withdrawal, insertion and broadcasting
- Delusional perception
- passivity
59
What is schizophreniform d.o?
- meets the dx of 1 or 2 symptoms display
| - but lasts LESS than 6 MONTHS
60
What is Schizoaffective d.o?
- schizophrenia with Mania or Depression
- BUT times with ONLY PSYCHOSIS alone
(diff. from mania or depression with psychotic episodes- they present psychotic episodes with mania or depression)
61
What is a delusional disorder?
- person has ISOLATED delusions
- for one month or LONGER
- Folie a Deux: person with delusional disorder shares the delusion with friend
62
Who is usually predisposed to Postpartum Psychosis?
- women with KNOWN psychiatric disorder
- often BIPOLAR d.o
- ---or also schizoaffective d.o, depression with psychosis, schizophrenia
- those who stopped MEDS before pregn.
63
What occurs in Post-partum Psychosis?
- delusions, halluc., disorganized thoughts
| - delusions INVOLVES the baby
64
How to manage Post-partum Psychosis?
- women MUST be HOSPITALIZED
- antipsychotic drugs
- ECT (good for a pt who just delivered)
65
MOst common hallucination in Schizophrenia?
- AUDITORY hallucination
66
Gustatory and Olfactory hallucinations are commonly seen in what condition?
- Partial complex seizures
67
What is seen in Schizotypical d.o?
- eccentricity
- social withdrawal
- MAGICAL thinking
- transient AUDITORY hallucinations
- aloofness
68
What is seen with persistent Delusional d.o?
- systematised, FIXED delusions
| only ft
69
What occurs in Transient/Acute Psychotic d.o?
- schizophrenia-like symptoms lasting <1month
70
What neurological changes occur in a pt with Schizophrenia?
- -enlarged Vs and thinnner cortices
| - altered dopamine signalling
