Psychosis PDF

576 SEC TION III PSYCHIATRY ` PSYCHIATRY!PATHOLOGY Psychosis Distorted perception of reality characterized by delusions, hallucinations, and/or disorganized thought/speech. Can occur in patients with psychiatr...

576 SEC TION III PSYCHIATRY ` PSYCHIATRY!PATHOLOGY Psychosis Distorted perception of reality characterized by delusions, hallucinations, and/or disorganized thought/speech. Can occur in patients with psychiatric illness or another medical condition, or secondary to substance or medication use. Delusions False, !xed, idiosyncratic beliefs that persist despite evidence to the contrary and are not typical of a patient’s culture or religion (eg, a patient who believes that others are reading his thoughts). Types include erotomanic, grandiose, jealous, persecutory, somatic, mixed, and unspeci!ed. Disorganized thought Speech may be incoherent (“word salad”), tangential, or derailed (“loose associations”). Hallucinations Perceptions in the absence of external stimuli (eg, seeing a light that is not actually present). Contrast with misperceptions (eg, illusions) of real external stimuli. Types include: ƒ Auditory—more commonly due to psychiatric illness (eg, schizophrenia) than neurologic disease. ƒ Visual—more commonly due to neurologic disease (eg, dementia), delirium, or drug intoxication than psychiatric illness. ƒ Tactile—common in alcohol withdrawal and stimulant use (eg, “cocaine crawlies,” a type of delusional parasitosis). ƒ Olfactory—often occur as an aura of temporal lobe epilepsy (eg, burning rubber) and in brain tumors. ƒ Gustatory—rare, but seen in epilepsy. ƒ Hypnagogic—occurs while going to sleep. Sometimes seen in narcolepsy. ƒ Hypnopompic—occurs while waking from sleep (“get pomped up in the morning”). Sometimes seen in narcolepsy. Contrast with illusions, which are misperceptions of real external stimuli (eg, mistaking a shadow for a black cat). Mood disorder Characterized by an abnormal range of moods or internal emotional states and loss of control over them. Severity of moods causes distress and impairment in social and occupational functioning. Includes major depressive, bipolar, dysthymic, and cyclothymic disorders. Episodic superimposed psychotic features (delusions, hallucinations, disorganized speech/behavior) may be present at any time during mood episodes (other than hypomania). MDE MDE with psychotic Bipolar I Bipolar II Schizoaffective disorder features Mania Hypomania Euthymia Dysthymia Depression Psychosis only occurs Requires 1 episode of mania. Requires 1 episode of Psychosis overlaps with mood episodes with mood episodes Psychotic features possible hypomania and 1 MDE. but must occur by itself for > 2 weeks Psychotic features during manic or depressive Psychotic features possible Mania/hypomania episodes. during MDE, but does not Euthymia occur with hypomania Major depressive episode (MDE)