Positive and Negative Symptoms of Psychosis + EPS related content

Positive symptoms

symptoms that are not normally there but are present in psychosis, such as hallucinations, delusions, altered speech, and disorganized thoughts.

Negative symptoms

absence of things that are normally present.

Affect

the expression of feelings and emotions in a person’s demeanor or behavior.

ex. Flat affect expression of the face or blunt

Alogia

reduction in speech like mumbling or responding vaguely

Anergia

a lack of energy

Anhedonia

lack of pleasure or joy in activities that are typically enjoyable or fulfilling.

Avolition

a lack of motivation in activities or hygiene

Alterations in thought (delusions)

false alterations in thought and beliefs that are firmly held despite contradictory evidence.

ex. ideas of reference, persecution, magical thinking, religiosity, somatic delusion, or grandeur.

Ideas of reference

believing that others who are discussing something else are talking about you (paranoia)

Persecution

the belief that someone is out to harm youor conspire against you; a common type of delusion in which an individual feels threatened or victimized.

Magical thinking

the belief that one's thoughts, words, or actions can influence events in an irrational way, often linked to superstitions.

ex. wearing a certain hat makes them invisible to others or will give them special powers.

Jealousy

the belief that someone is taking away something you value, often leading to feelings of insecurity and resentment.

ex. their partner is having relations with another individual even though there is no evidence

Somatic delusions

the belief that their body is changing in an unusual way or that they have a physical illness despite lack of medical evidence

ex. believing that they are infested with parasites or growing a third arm

Religiosity

the over obsession with religious beliefs

Alterations in speech

Refers to changes in the way an individual communicates.

ex. associative looseness, neologisms, echolalia, clang association, circumstantiality, and tangentiality

Associative looseness

a thought pattern characterized by a lack of logical progression in speech, where ideas are connected in a loose or disjointed manner.

ex. What did you have for breakfast? I had eggs this morning. Birds fly high in the sky you know. My uncle used to live in Seattle. Rain is very cold when it hits the ground.

Circumstantiality

including multiple and unneeded details during a conversation, but the question is eventually answered.

ex. What did you have for breakfast? Well I woke up at 6:45 am because my alarm went off but its very annoying. But anyway I had eggs and toast, and then I fed my cat because she was meowing loudly.

Tangentiality

a communication style where responses are irrelevant and do not directly answer the question posed, leading the conversation off-topic.

ex. What did you have for breakfast? Breakfast is the most important meal of the day and I always think about what to eat while watching the news. My cousin wanted to be a news anchor but he ended up going to medical school.

Neologisms

made-up words that have meaning only to the client

ex. How are you doing today? I feel very gulibub and fittled.

Echolalia

repetition of words spoken to a person

ex. How are you today? How are you today. Im ok. Im ok.

Clang Association

a pattern of speech where words are chosen for their sound rather than their meaning, often resulting in rhyming or pun-like statements. ex. It is a bright night, quite right, what a sight!

Alterations in perception (hallucinations)

sensory experiences that occur without a corresponding external stimulus

ex. auditory (command), visual, olfactory, gustatory, and tactile

Auditory hallucinations

hearing voices or sounds, they can be command or non-command in nature.

ex. “Someone keeps telling me to kill myself.” or "I hear music when no one is playing."

Visual hallucinations

seeing persons or things that are not really there

Personal boundary difficulties

disenfranchisement with one’s own body, identity, and perceptions

ex. depersonalization and derealization

Depersonalization

a feeling of disconnection from one's body or thoughts, often described as feeling like an outside observer of oneself.

ex. "I feel like I'm watching myself from a distance."

Derealization

the sensation that the external world is not real, often accompanied by feelings of detachment from one's surroundings.

ex. "The world feels dreamlike or unreal." or “Why is everything shrinking?”

Alterations in behavior

changes in how a person acts, which can include unusual or inappropriate responses to situations. They may demonstrate either heightened energy or lethargy, affecting their social interactions.

ex. waxy flexibility, echopraxia, and catatonia

Waxy flexibility

maintaining a specific position for an extended period

ex. "An individual may be posed by others and remain in that position without resistance."

Echopraxia

the involuntary repetition of another person's actions or gestures.
ex: "An individual mimics the movements of someone else without conscious intention."

Catatonia

a state of psychological and physical immobility, often accompanied by stupor or rigidity. It may involve a lack of response to external stimuli, extreme agitation, or the maintaining of postures for long periods.

ex. "An individual may remain unresponsive for hours or exhibit extreme restlessness and agitation."

EPS: Extrapyramidal Symptoms

1. Dystonia: sudden muscle spasm; early onset

2. Parkinsonism: tremors, shuffling gait, pill-rolling movements

3. Akathisia: restlessness and inability to stay still (ex. pacing)

4. Tardive dyskinesia: smacking lips, repetitive tongue or chewing movements

abnormal movement-related adverse effects associated with antipsychotic medications

Tx: Benztropine (Cogentin)/anticholinergic

Agranulocytosis

a potentially serious side effect of antipsychotic medications that leads to dangerously low white blood cell counts, increasing the risk of infections.

Medication risk: Clozapine (Clozaril)

Interventions: Weekly CBCs upon initiation of treatment

AIMS: Abnormal Involuntary Movement Scale

a tool used to measure and evaluate involuntary movements in patients taking antipsychotic medications. It assesses movements to identify the presence and severity of extrapyramidal symptoms.

ex. tardive dyskinesia

NMS:

Neuroleptic Malignant Syndrome; a life-threatening reaction to antipsychotics

ex. F.A.R.M: Fever, Autonomic dysfunction (tachycardia, hypertension), Rigidity, and Mental alterations