CC Psychosis
Psychosis
Definition: Mental state, where reality is distorted, result in symptoms of delusion, hallucination &
though disorder
Perceptual disturbance
Auditory hallucination
• Most common type of hallucination in psychiatry
• Types
» 1st person: Own thoughts spoken outloud (Thoughts echo)
» 2nd person (Most common) : Persecutory, Commenting, Commanding
» 3rd person: Voice arguing, discussing about patient
Visual hallcuination
• Most common in organic brain disturbance – delirium, dementia, brain tumor, epilepsy, psychoactive
substance use (LSD, Glue sniffing, Alcohol)
Somatic hallucination
• Tactile: Experience skin being touched, pricked. Suspect substance abuse (cocain use, alcohol
withdrawal)
• Thermal: False perception heat or cold
• Hygric: False perception of fluid feeling
• Visceral: False perception of internal organ, describe as organ throbbing, stretching
• Kinesthatic: False perception of joint or muscle sense, describe as limbs being twisted
Olfactory
• False perception of smell & taste
• Suspect – Temporal lobe epilepsy & other organic brain disease
Abnormal belief
• Delusion – Unshakeable false belief, not accepted by other members of patients culture
• Overvalued ideas
Classification of delusion & typical diagnosis
Primary delusion: Delusion occur not response to any previous Schizophrenia
psychopathological state
Secondary delusion: Delusion occur in response to previous MDD & Bipolar disorder
pscyhopathological state (usually mood disorder)
Mood congruent Delusion: Content of delusion appropriate to MDD & Bipolar disorder
patient mood
Mood incongruent Delusion: Content of delusion inappropriate to Schizophrenia
patient mood
Bizarre delusion: Belief that completely impossible, ex belief that Schizophrenia
alien have planted tracker inside patient brains
Overvalue ideas
• Define as: Possible belief that a patient become obsess with unreasonable extent, causing distress to
patient & surrounding people
• Difference from delusion by: Patient able to give fairly logical reasoning for their belief
• Difference from obsession: No recurrent intrusive thoughts
• Typical features of: Anorexia nervosa, Hypochondriacal d/o, Dysmorphophobia, Paranoid Personalidty
d/o, Morbid jealousy
Abnormal thoughts
Circustantiality & Tangential thinking
Flight of ideas
Loosening of association (‘word salad’)
• Speech become mixture of incoherent word & phrase
• Typical features of Schizophrenia
Thought block
• Sudden cessation of thought flow, usually in mid sentence
• Patient cannot recall back topic & continue talking by switch to another topic
Neologism
• New words created by the patients
Irrelevant answer
• Patient give unrelated answer to question
Echolalia
• Patient repeat words or phrase spoken by others, like a parrot
Perseveration
• Patient unnecessariy repeate previous expressed word or phrase
Negative symptoms
• Apathy (loss of interest)
• Poverty of thought & speech
• Motivation
• Attention
• Affect: Blunt
• Social isolation
• Poor self-care
Commonly, patient having negative symptoms after present with positive symptoms
Differential diagnosis
• Schizophrenia
• Depression
• Side effect of anti-psychotic medication
Psychomotor agitation or retardation
• Rare
• Psychomotor function in schizophrenia commonly caused by extra-pyramidal side effect of anti-
psychotic medication
• Catatonia (extreme muscle tone or rigidity)
» Differential diagnosis: Schizophrenia, Depression, Brain disease, Metabolic abnormality or
psychoactive substances
Differential diagnosis – Psychotic d/o
1. Psychotic d/o
• Schizophrenia
• Schizophreniform
• Schizoaffective d/o
• Delusional d/o
2. Mood d/o
• Manic episode with psychotic features
• Severe depressive episode with psychotic feature
3. Psychosis d/t general medical condition
• Psychosis resolve with treatment of medical condition
• No family history of schizophrenia
• No previous psychotic episode
4. Psychosis d/t psychoactive substance use
• Psychosis resolve with stop substance use
• No family history of schizophrenia
• No previous psychotic episode
5. Dementia, Delirium
• Visual hallucination & delusions – Delirium & Lewy body dementia
Schizophrenia subtype
• Reason: Different subtype, different prognosis
Subtype Features Prognosis
Paranoid • Prominent Delusion & • Good prognosis
hallucination (Positive
symptoms)
• Not prominent negative
symptoms
Disorganized • Thought disorganization • Poor prognosis
• Disturbed behavior
• Affect: Inappropriate or flat
• Not prominent delusion or
hallucination
Catatonic • Rare
• At least 1 catatonic symptoms
Residual • At least 1 psychotic episode
• Later, have at least 1 year of
predominantly negative
symptoms
Assess hallucination
1. Do you hear strange voice when no one else at • Auditory hallucination (AH)
the moment
2. Do you hear you thoughts spoken out loud till • Audible thoughts (1st person AH)
you think someone standing next to you hear it
3. Do you think you thoughts echoed after you • Thoughts echo
have thought them?
4. Do you think the voice talk directly to you or • 2nd person AH
give you command or commenting?
5. Do you think the voice talk with other voice • 3rd person AH
about you?
Delusions
1. Do you think someone trying to harm you • Persecutory delusion
2. Do you think someone is saying something that • Delusion of reference
have special meaning for you?
3. Do you have special ability or power • Grandiose delusion
4. Do you think you have been control by external • Delusion of control
force
5. Do you think you thought have been put into • Thought insertion
your head
