Psychosis (Signs and symptoms MSE (thought content (delusions there is an…
Signs and symptoms MSE
thought form disorder
When the flow of ideas, symbols and associations initiated by a problem/ task are not goal-directed. Neologisms, word salad
Derailment, loosening of associations
Perseveration, verbigeration, clang association
Flight of ideas
there is an
. an overvalued idea is a sustained false belief which is maintained less firmly than a delusion. a delusion is a fixed false belief based on incorrect inference about external reality. firmly head despite evidence to the contrary and 'out of keeping with the patients cultural background'.
disorder of thought content
can be bizarre or systemised, mood can be congruent or in congruent, delusion of poverty. control of thought: thought broadcasting, insertion or withdrawal.
Cooperation and rapport
Some examiners report a precox feeling. Inability to establish emotional rapport with the patient. Patient may or may not be cooperative.
mood and affect
Blunting of affect/ mood
Isolation or dissociation of affect
In-congruent affect- may be a mood disorder, or mania- congruent with psychosis.
Appearance and behaviour
Can range from dishevelled, screaming, agitated, to obsessively groomed, immobile, may exhibit bizarre postures. Bizarre dress, appearance, Catatonia, Poor impulse control, Anger, agitation
May be absent or monosylabalistic, or monotonous, or normal. they may be pressured in their rate of speech or alogia.
false sensory perceptions not associated with real external stimuli. there may or may not be delusional interpretation to the experience.
Auditory, tactile, visual, olfactory, somatic, gustatory
Judgement and insight
May exhibit poor judgement and will not have insight
May exhibit problems with orientation, memory attention and executive functions.
Most common DEMENTIA AND DELIRIUM
: Neoplasm, cardiovascular disease, trauma, heart disease, epilepsy
: cushings, thyroid, B12 deficiency, porphyria, CO, CJD, HSE, neurosyphilis, HIV, NPH, SLE, Wilsons.
Medications and substances: amphetamines, barbituates, cocaine, withdrawal sates, hallucinogens, alcohol PCP., steroids
visual hallucinations, hyperactivity, hypersexuality, confusion and incoherence.
not drug induced present formal thought disorder and blunted mood and affect.
Bipolar affective disorder which is mania with psychosis or major dperessive episode with psychosis. mood and affect usually brief. mood congruent delusions may indicate a mood disorder.
PTSD with traumatic hallucinations, dissociative disorders, traumatic stressors, anxiety symptoms to suggest anxiety disorder, realisation and depersonalisation.
Schizoid, schizotypal, paranoid, borderline, OCD, PD. by definition are nor psychotic disorders but can have some similar features.
Malingering and factitious. culture bound syndromes, a delusions is something in out of keeping with a persons background.
primary psychotic disorder
Brief psychotic episode, schizophreniform, schisophrenia, schizoaffective disorder, delusional disorder, shared psychotic disorder. all of these conditions can be co-morbid with schizophrenia.
Primary psychotic disorders
Presence of phychotic symotoms for at l
month less than
including prodrome. (delusions, hallucinations, speech, disorganised or catatonic behavior, negative symptoms (absence of blunted affect), good pre-morbid features, confusion on perplexity at the height of the episode, onset of psychotic symptoms in 4 weeks..
Schizophrenia: 1. psychotic symptoms for at least one month. (delusions, hallucinations, disorganised speech, disorganised or catatonic behaviour, negative symptoms). 2. functional impairment. 3. continuious disturbance for 6 months. 4. not explained by any other disorder,.
signs and symptoms
lack of insight, auditory hallucinations, ideas of reference, suspiciousness, flattness of affect, voices speaking to patient, delusional mood, delusions of persecution, thoughts spoken aloud.
most likely to present with positive and affective symptoms. >45 years old, F>M, good premorbid functioning, predominance of paranoid symptoms.
many associations but all have low PPV because of high prevalence in the community. e.g. famine, migration and paternal age.
Point previous (one month) 5 per 1000 in Australia. Lifetime prevalence .5 - 1.5% worldwide.
Onset male mid 20s female mid late 20s (peak in 40s) 3:2 M:F
$1.4 billion to government
UNKNOWN: many theories, many genes, perinatal factors, childhood development, sex and age, social, psychodynamic and interpersonal, life events, biological e.g. neuro development or degenerative.
30% receive complete or partial remission between episodes
25% negative symptoms between episodes
45% decrease with frequent or continuous psychotic symptoms
Positive psychotic symptoms tend to remit in FEP (87%), medial time to remission is 9 weeks this is not a functional recovery
suboptimal treatment, poor adherence, side effects of medications, substance abuse, HEE via the camberwell family interview: hostile, criticise, over inclusive)
Catatonic type: rare
disorganised type: characterised by speech, behaviour and affect.
paranoid: preoccupied with one or more delusions or frequent hallucinations.
undifferentiated and residual type
. non-bizarre delusions based on things which could happen in real life. hallucinations may be present if they are to go with the theme of the delusion. functioning and behaviour are NOT markedly impaired. if mood episodes occur they are brief. not related to substance of BMC.
Anuninterrupted period of illness with a MDE,
manic or mixed episode
, concurrent with symptoms of schizophrenia. during same time hallucinations and delusions for 2 weeks in the absence of prominent mood symptoms. but the mood symptoms are present for a substantial proportion of the illness. not due to substance or GMC. can be BIPOLAR OR DEPRESSIVE TYPE.
Folie a Deux
Delusion develops in an individual in the context of a close relationship with a person who already has a established delusion.
The delusion is similar in context
Not better accounted for by another psychotic disorder, mood disorder or direct affect of a substance.
presence of psychotic symptoms for one day to one month, eventual full return to normal functioning. not better explained by any other psychiatric disorder, substance use or medical disorder.
Mechanisms of psychosis
disorder (decrease). loss of NMDA receptors in the prefrontal cortex
neuron loss in hippocampus
: RA:AP effect
a fixed brain lesion from early life interacts with certain maturational events that occur much later
Structural brain abnormality from early neurodevelopmental insult. decreased inhibitory pathways, excessive pruning of excitatory pathways, altered excitatory : inhibitory balance in the PFC.
underlying vulnerability (genetic or acquired) is acted upon by a stress and disease onset ensues. 60-90% inherit-ability. impaired genes which impair brain development.
dorsolateral prefrontal cortex circuitory abnormalities. brain changes progress over the course of the illness. from a series of brain insults.
include a complete family history, of any medical and neurological disorders.
tests and investigations
FBC, UEC, TFT, B12, folate, ESr, CRP, consider CMP, vitamin D, iron studies, syphilis, hepatitis and HIV if indicated. urine analysis for UDS, if indicated: CT or MRI, EEG, and LP
Anxiety: OCD, PTSD, panic disorder. Substance use. depressive disorder
diabetes, dislipidaemia, hypertension, obesity, arrythmia.neoplasm,HIV, Hep C, OP, hyperprolactinaemia.
All populations around the world have schizophrenia, between 15-45 years old, 1 -3.5% of the population.
dementia 2. depression. 3. delirium. medical causes, BPAD, delusional disorder, schizophrenia.
: A problem with brain functioning which results in a loss of reality, testing and impairment of mental function. patients incorrectly evaluate their perceptions and thoughts and make incorrect inferences about external reality.