Category: Psychosis - Beyond The Body

Beyond The Body

Think Like A Psychiatrist - Psychotic Symptoms and A Previous Diagnosis of Neurosyphilis

8/24/2016

Put your knowledge and skills to the test with the case of Mr. C, a 61 year old man, who presents to clinic for follow-up on his antipsychotic medications that are used to manage psychosis and depression. He currently uses chlorpromazine 100mg/day and has had no psychotic symptoms in the last 3 years.

In terms of his psychiatric history, Mr. C first began to experience auditory and visual hallucinations at age 48, as well as a decline in cognition that led to his retirement from employment shortly thereafter. He has had 3 inpatient psychiatric admissions, and has continued to be treated with antipsychotics as discontinuation often leads to relapse of his psychosis.

While Mr. C has a history of aortic regurgitation, CHF, HTN, and sensorineural hearing loss, he also describes a history of cocaine abuse from 21-45. More interestingly, he also reveals a diagnosis of syphilis at 48yo, which went untreated for many months until he was diagnosed with neurosyphilis (tertiary syphilis) after developing abnormal gait, blurred vision, and general weakness.

Do you think Mr. C's psychiatric symptoms are related to his diagnosis of neurosyphilis? What tests would you order? What would you advise him on further management/treatment?

"Psychosis in Treated Neurosyphilis: Is Now The Time To Stop His Antipsychotic?" by Kamalika Roy, Richard Balon, and Varma Penumetcha.

Exploring Why Psychosis Occurs More in Urban Populations

8/2/2016

In addition to a positive family history, certain drug use including marijuana use particularly in adolescence, and prenatal infections, living in an urban area has also been identified as a possible risk factor for ‪schizophrenia ‬and ‪‎psychosis‬. Though many studies have identified this association, it is still unclear why. As such, there has been great controversy over whether "cities cause madness’ or whether those affected by ‘madness’ just tend to end up in cities".

In the article below, we learn of some of the hypotheses surrounding the association between urban living and psychosis, including the impact of genetics, social drift, and the negative psychological impact of living in a big city.

"The link between psychosis and city living was first noticed by American psychiatrists in the early 1900s who found that asylum patients were more likely to come from built-up areas. This association was sporadically rediscovered throughout the following century until researchers verified the association from the 1990s onwards with systematic and statistically controlled studies that tested people in the community as well as in clinics.

One particularly extensive study using health records for almost the entire population of Denmark found that the risk of being diagnosed with schizophrenia increased in a small but proportional way as people spent more time spent living in urban environments. Many studies have since replicated this finding, with neighborhood levels of social deprivation seeming to amplify the association and levels of social integration seeming to reduce it."

For the full story click here:
http://www.theatlantic.com/health/archive/2016/07/the-enigma-of-urban-psychosis/491141/

What It's Like To Experience Psychosis

3/30/2016

Sally Buchanan-Hagen, an ‪‎emergency‬ medicine nurse, has become a passionate ‪‎mental health‬ advocate since being diagnosed with ‪bipolar disorder‬ in her early 20s. Recently, Sally described what her behaviours and thoughts were like while manic, as well as her first experience with psychotic symptoms, which for some people can manifest as part of their mood disorder.

In her article (link below), Sally shares her experiences as a way to improve our understanding of what individuals living with psychosis go through. She also encourages us to avoid holding judgment or being fearful of those affected, as often they are the ones who are terrified and confused, and require early support and treatment.

"Psychosis is poorly understood by the general public and this leads sufferers to experience stigma and discrimination. Adding to the stigma, films and TV shows often misrepresent what psychosis is really like, making it something to be feared. I was guilty of not having an accurate understanding of psychosis. However, that quickly changed after my first psychotic episode. Although for a small portion of that time I may have been feared, I can guarantee I was the one who was terrified. Terrified of the unpredictable turmoil in my head, I would have harmed myself well before harming others."

For the full article, click here: http://themighty.com/2016/03/what-its-really-like-to-experience-psychosis/_

Poetry Friday - Paranoid

11/6/2015

In this poem, an individual describes the dark and confusing feelings that accompany ‪‎paranoia‬, an experience common to those diagnosed with ‪#psychosis‬ or ‪‎schizophrenia‬.

"I have heard you
voices screaming shadows' at me
insidious: the indelible mark
left as an imprint upon me

deluded and still falling..."
Read the full poem here:
http://allpoetry.com/poem/10094089-Paranoid-by-myriad-dark

Think Like A Psychiatrist - A Case of Drug Use and Psychosis

11/4/2015

Put your knowledge and skills to the test with the case of Mr. D, a 23 year old male, who presents with new-onset ‪psychosis‬ with auditory and visual ‪hallucinations‬ and ‪catatonia‬ 10 days after taking 2C-B, a new designer drug. Specifically, Mr. D reported that he and his friends obtained 2C-B off the internet, and while his friends recovered well after using the drug, Mr. D instead has been decompensating. He reported abruptly quitting his job and thinking he is in alien in a spaceship over the last few days.

While his family and friends report that Mr. D has been acting strange, sleeping only 2-3 hours a night and talking rapidly since the use of the drug, they deny any other recent stressors in his life. They report that Mr. D is an Ivy-League educated man and has no significant medical or psychiatric history, and no family history of psychiatric disorders. About 1 month ago however, Mr. D began to smoke marijuana daily.

What is your differential for this patient? What work-up would you order? How would you treat his psychosis and catatonia?

"Psychosis and catatonia after dancing with a dangerous partner" by Surbhi Khanna, Jordan Rosen, Derek Blevins, and Pamila Herrington (Current Psychiatry)

Choosing Wisely Canada - Psychiatry Recommendations

11/3/2015

As part of the Choosing Wisely Canada campaign, in June, 13 recommendations were made by the Canadian Psychiatric Association and its working group partners, the @Canadian Academy of Child and Adolescent Psychiatry (CACAP) and the Canadian Academy of Geriatric Psychiatry (CAGP) for the field of ‪‎psychiatry‬.

One of the main recommendations included how first-line treatments for ‪‎insomnia‬ should not include routine use of antipsychotics, and rather should be focused on non-pharmacological options including sleep hygiene and behavioural techniques.

Other recommendations also comment on treatments for ‪ADHD‬, ‪depression‬, and ‪‎dementia‬, as well as on using benzodiazepines in acute care, and ordering toxicology screens on psychiatric patients. For the full list check out the link here: http://www.cpa-apc.org/media.php?mid=2240

Psychiatric Assessments - Managing Psychosis

8/4/2015

An anonymous writer shares their immensely valuable first hand experience of what it's like for patients with psychosis undergoing a psychiatric assessment in a recent article for the BMJ.

Through this unique perspective, we can learn how to better manage these emergent psychiatric crises and assessments, as well as provide better support to these patients through developing greater understanding, appreciation, and empathy.

In this article, the author provides us with tips and advice on assessing and handling patients with mental health‬ issues in the ED, including how to be mindful of time, noise, delivery of our questions, and especially of our nonverbal behaviours.

"You find my thinking jumbled and confused, the quantity and register of my speech is fluctuating wildly. But I’m also hyper-attentive to language, as anyone would be in a high stakes situation (was that “talk to” or “torture”?). In an idle moment a nurse at the foot of my bed has concluded an anecdote with a hearty “I could have killed him,” and perhaps she thought that was boring or inaudible, but I heard it. And I thought you wanted me to hear it, that it was in the script. (Just as I’m sure you wanted me to hear the sounds of pain just the other side of that curtain.) Because for now, you and I differ about what we think this building, this institution, is for.

In such a state, someone like me may seem beyond reassurance. But you can help—there are ways you can avoid reinforcing my fears ..."

How Mental Illness Affects Relationships

1/14/2015

In the powerful article, "My Lovely Wife In The Psych Ward", Mark Lukach shares his wife's struggles with depression and psychosis and discusses how mental illness can affect relationships ...

"But even during our best moments as husband and wife, father and mother, we can feel lingering traces of our roles as caretaker and patient. Psychiatric crises are episodic, but they cut deep into relationships and the lacerations take years to mend. When Giulia was sick, I acted for her in what I believed was her best interest, because I loved her and she wasn’t capable of making decisions for herself ...

And now, if I suggest that she to go to bed, she complains that I’m telling her what to do, micromanaging her life. Which makes sense, because I did tell her what to do and micromanaged her life for months at a time. Meanwhile, I’m quick to gripe that she’s not taking care of herself well enough. This dynamic isn’t unique to us—it exists in countless other families who lived through a psychiatric crisis. The onetime caregiver continues to worry. The former (and perhaps future) patient feels trapped by paternalistic patterns."

A Mother Shares Her Experience With Postpartum Psychosis

12/12/2014

In the article, "I Had Postpartum Psychosis - More Must Be Done To Help Others Like Me" a mother from Scotland describes her frightening experience with postpartum psychosis, and discusses the challenges she faced in seeking help, as well as the frustrations with first being labeled as malingering. Ultimately, the author Vonny Moyes, pushes for enhanced awareness of postpartum mental health issues and calls for improved screening and increased support for others like her.

"Psychosis doesn’t live up to its Hollywood image; instead it’s often a silent erosion of your own existence, which makes it hard to spot. When delusions and reality blend so seamlessly, you don’t have the self-awareness to shout out. The voices are your reality. And the toxic thoughts. You become caged inside yourself so abruptly that you simply cannot find the fortitude to reach out."

Mental Illness & Violence

12/10/2014

In follow-up to yesterday's post about a physician being attacked during a psychiatric assessment, Dr. Sandy Simpson, chief of forensic psychiatry at the CAMH - Centre for Addiction and Mental Health helps us to better understand mental illness and violence, in this brief but informative blog post.