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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