Eleni Palazidou MD PhD MRCP FRCPSYCHEast London Foundation Trust
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Psychosis Mood Anxiety Obsessive/compulsive
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Psychosis
= losing touch with realityPresents most commonly with: abnormal beliefs and experiences: - delusions and hallucinations thought disorder (schizophrenia)
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(Abnormal) belief: - fixed, unshakeable, held with
conviction despite evidence against it - not shared by others of same
background – religious, cultural, educational
Content can be bizarre, religious, science fiction, persecutory, guilt, hypochondriacal, grandiose etc
Mood congruent/incongruent24/01/11 4
Illusions
Hallucinations
Pseudohallucinations
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Illusion perceived visual images in the presence of a
stimulus
Hallucination – perception of images/other senses in the absence
of any stimulus which are real to the subject - any sensory modality – visual, auditory, tactile,
olfactory, gustatory
Pseudohallucinations – abnormal perceptions experienced but subject
able to accept they are not real 24/01/11 6
Disruption of thought processing by relevant brain circuit:
- loosening of associations - knights move - word salad - concrete thinking - neologisms
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Anxiety
Psychic Psychic Inner tension, edginess, thoughts racing, difficulty
focussing, fearful, worrying, unable to relax
PhysicalPhysicalMuscle tension, sweating, hyperventilation,
palpitations, chest aching, stomach churning, tingling, numbness, carpopedal spasm
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Generalised Anxiety Disorder (GAD)
Phobic Anxiety Disorders
Panic Disorder
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The presence of the following symptoms for at least 2 weeks, present most of the time
1. One or both of the core criteria: Low or sad mood and / or loss of interest or
pleasure (anhedonia)
2. Several of the following: Disturbed sleep Guilt or worthlessness or pessimism Fatigue or low energy Disturbed appetite or weight change Poor concentration or indecisiveness Psychomotor retardation or agitation Recurrent thoughts of death/suicidal ideas
/attempts24/01/11 11
A change from person’s normal state!
Low moodLow mood Quality Pervasiveness Reactivity
AnhedoniaAnhedonia24/01/11 12
Cognitions/evaluationCognitions/evaluationself
environment future
SuicidalitySuicidality
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Physiological symptomsPhysiological symptoms sleep
appetite libido
Somatic symptomsSomatic symptoms tiredness
aches and pains constipation
other
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Psychomotor statePsychomotor state
Energy levelEnergy level Retardation (stupor)Retardation (stupor)
Agitation, restlessnessAgitation, restlessness ConcentrationConcentration
Racing thoughts – worryRacing thoughts – worry
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Psychotic SymptomsPsychotic Symptoms Delusions
Hallucinations
!Mood congruent!
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AnxietyAnxiety Co-morbid
Secondary/symptom of depression
Obsessive/compulsive disorderObsessive/compulsive disorder
Substance misuse (alcohol)Substance misuse (alcohol)24/01/11 17
A. Mood elated, expansive or irritable and definitely abnormal for the individual sustained for at least a week
B. At least three of the following must be present leading to severe interference with personal functioning in daily living:
(1) Increased activity or physical restlessness(2) Increased talkativeness ('pressure of speech‘)(3) Flight of ideas or the subjective experience of
thoughts racing(4) Loss of normal social inhibitions resulting in
behaviour which is inappropriate to the circumstances
(5) Decreased need for sleep(6) Inflated self-esteem or grandiosity
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(7) Distractibility or constant changes in activity or plans;
(8) Behaviour which is foolhardy or reckless and whose risks the subject does not recognize e.g. spending sprees, foolish enterprises, reckless driving;
(9) Marked sexual energy or sexual indiscretions. C. Perceptual disorders may occur (e.g. subjectivehyperacusis, appreciation of colours as specially vivid,
etc.)
D. Exclusion criteria: psychoactive substance use or
any organic mental disorder.
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Obsessions -Involuntary, intrusive, against one’s wishes,
thoughts, images, or impulses - occur over and over again in one’s mind - do not make sense; can’t be stopped
Compulsions - behaviors or rituals the subject is driven to
repeatedly act out - performed in response obsessions ie repeated
cleaning for fear of contamination - compulsive behaviors become increasingly
elaborate and time-consuming. 24/01/11 21
Common obsessive/compulsive behaviours:
Washing/cleaningWashing/cleaning fear of contamination. Repetitive checkingRepetitive checking fear of harm or danger. Obsessive thoughts Obsessive thoughts associated with
elaborate rituals rituals fear something terrible will happen to
themselves or loved ones, if not carry out rituals
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ArrangersArrangers obsessed with order and symmetry,
colours, or arrangements. Counters Counters superstitions about certain numbers HoardersHoarders fear they miss something if they throw
anything away; compulsively hoard things they do not need/use
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