Psychosis

• Psychosis = encompasses a number of symptoms associated with significant alternations to a persons perception, thoughts, mood, and behaviour
• Individuals experiencing psychosis will have a different combination of symptoms:

  • Positive symptoms - hallucinations, delusions, disordered behaviour/speech/thoughts
  • Negative symptoms
• Delusions:

  • Fixed or falsely held beliefs
  • Delusions of reference - belief that an unconnected events of details in the world directly relate to them
  • Delusions of control - belief the persons thoughts, feelings, or behaviour are being controlled by others
  • Thought insertion
  • Thought withdrawal
  • Thought broadcasting - other people can hear their thoughts
  • Delusions of persecution
  • Somatic passivity - believing an external entity is controlling their sensations and actions
• Negative symptoms:

  • Emotional blunting
  • Reduced speech - Alogia
  • Lack of motivation - avolition
  • Self-neglect
  • Social withdrawal
• Thought disorders:

  • Alogia - poverty of speech
  • Blocking - interrupt themselves abruptly mid-sentence
  • Circumstantiality - excessive irrelevant details
  • Clanging - word choices based on the sound of the word - use rhymes - common symptom of mania
  • Distractible
  • Echolalia - repeat noises and words they hear
  • Neologism - creating new words
• Prodromal phase:

  • Psychosis may be preceded by a prodromal period that can last from a few days to 18 months
  • Identifying the prodromal stage offers a critical treatment window to delay or prevent transition to frank psychosis
  • Transient, low-intensity psychotic symptoms
  • Reduced interest in daily activities
  • Problems with mood, sleep, memory, concentration, communication, affect, and motivation
  • Anxiety, irritability, or depressive features
  • Incoherent or illogical speech
  • A positive family history - particularly a first degree relative
• Management:

  • Determine the level of risk
  • For people judged to be at high risk of harm to themselves or others - same day specialist mental health assessment by the early intervention in psychosis service
  • If this service is not available/cannot provide urgent intervention - refer to a crisis resolution and home treatment team
  • not thought to be high risk but experiencing psychosis - refer to early intervention in psychosis service
  • In prodromal psychosis - refer to early intervention is psychosis service or secondary care
  • Do not start antipsychotic drug treatment whilst awaiting assessment
• Organic causes:

  • HIV and AIDS
  • Malaria
  • Syphilis
  • Alzheimer's disease
  • Parkinson's disease
  • Hypoglycaemia
  • MS
  • Brain tumour
  • Stroke
  • Sudden illness or injury e.g. head injury or sepsis
  • Hyperthyroidism
  • Huntington's disease
• Iatrogenic causes:

  • Alcohol misuse
  • Substance misuse - hallucinogens, cannabis, opioids, cocaine, methamphetamine
  • Corticosteroids