Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

okay of this. I'm gonna add another copy of that workbook so that people can download it from the chat bar. Uh, when people join, so I have to keep sending it through. Now, what would be really helpful for me? Because, actually, I don't I don't want to run this in the way of me Just giving you a dry eye. Boring lecture. I really like to be able to see you guys, um, on the screen. Now I'll spot like myself so that I'm the number one person here so everyone can see me. But I would, uh, if I can. I'd really like to see you guys. The reason for that is because I need to see whether or not it looks like your understanding what I'm saying. I need to see if you look really bored like I've got it wrong. Uh, and I want to get a good experience for you. Do you blur your backgrounds if you want put on a different background, But it's quite tricky to do. Uh, what I'm hoping is going to be a lively interactive session if I can't see you. But I'm not gonna I'm gonna spotlight myself. so that everyone can see me now people are joining us. Um uh, as everyone got the, uh, workbook. I'm going to keep putting it in the chat bar guys so that anyone knew who joins can get it. So you don't have to download it every time it comes up. It's just so that everyone can do it. And the first place that I'd like to start is I'd like to just put this out there to you and say, Ask a question of you. What? What is psychosis? Any thoughts on what psychosis might be? Uh, maybe it's some sort of health nations and people. Yeah, here's something that other people don't hear. Great. So you picked up on one really important part of psychosis, which is that people can have auditory hallucinations, uh, when they become psychotic. And that's a really important feature that we see in a lot of cases of psychosis. Very good. Any other thoughts on on what psychosis is? Maybe a state of mind when people act don't lie, uh, as they should be as they, uh, see the world in another way. They act like, uh, see something they or here or they perceptions they is really distorted. Great. So I picked up so many things that you really relevant and important things that that there's something that's going on with the person's understanding of the world around them. Um, and I see, uh, I'm going to mispronounce your names. I really apologize for that. But all of her has put in, um, you know, uh, sent something. You can put it out in the chat bar if you want to. People you have to directly message me, put it out to one. Um, when people lose contact with reality, and I think that's covering what you're saying and I'm, um sorry, I can't read Cyrillic alphabet, so I can't say your actual name, But, um, yeah, I think you're right. So psychosis we can think of as a failure of reality testing. So what do I mean by that? Well, what I mean is that, um if I saw a yellow car outside of my house, I looked out the window. I would, you know, and I saw it there, lots of days in a row. Uh, then I would probably be able to come up with a reasonable explanation of why that might be, I would say, Well, that car is there because, you know, the neighbors have, you know, have bought a new car, something like that. Someone with psychosis might not be able to test reality in that way. They might think as a yellow car. That means that the CIA a trying to harm me, Uh, and they have, you know, that's a car of theirs, and they won't be able to go back and look at alternative explanations for that. And if we think of psychosis as a failure of reality testing at its heart, and I think we're in a good place, uh, to understand it. Now, look, I'm going to pop the workbook in here one more time, and I'm going to start us going through this workbook now. So do download that. Do you have a look at it as we go through. Now what? You'll see my first question, What on that workbook is what is psychosis? So we've covered that, um, and part of their failure. Reality testing is like we've we've heard about auditory hallucinations. Uh, and being able to tell those apart from real now, one of the things that I think is really helpful for us to think about is what is that experience of having auditory hallucinations like So what I'm gonna do is I'm going to try and, um, share a, uh, video with you. Uh, I'm gonna share the sound. Um, I'm going to share the sound with you as well, and I'm going to do two things. Oh, you right. The first thing that I'm gonna do I'm gonna play this video, uh, of So I'm sharing my screen here. And so I'm gonna share a video which hopefully you can see and I've clicked that the sound is going to go on, and I'm going to give you a sense of what it's like to experience hearing voices, which is a very common symptom of psychosis. So, headphone speakers up, Um, I'm going to start talking to you, and you're going to have the experience of hearing voices, and at the same time, I'm going to talk to you, and I'm gonna give you some information, and I want to see how well you can distinguish what I'm saying versus the voices. And hopefully the sound is going to come through for this I'll start off just with the sound. Stupid, pointless, touching, worthless touch that stupid, uh, the dopamine hypothesis of psychosis attempts to explain the pathophysiology of psychotic illness by breaking the clinical presentation down into positive and negative symptom groups. It is thought that positive symptoms are due to hyper activity of dopamine D two receptor neuro transmitter subcortical. And on the other hand, negative symptoms are thought to be hypo functionality of dopamine D one receptor neuro transmission in the prefrontal cortex. Okay, guys. So hopefully you've got the sounds in your ears with that. What was it like to have to try and concentrate on what I was saying? And at the same time, have those voices going on pretty hard to concentrate. Of course, it's pretty hard. Mhm. Yeah. So it's hard to really to pay attention to what I'm saying. Yeah, and I didn't hear it. To be honest, I didn't understand what you said. Just sounds, Yeah. So you so you even struggled even to pick out anything that I was saying? They will follow anything that I was saying. Yeah, absolutely anyone else. Yes, I agree that it's very hard also, maybe some of sounds make make you to do something that you don't want. And you It's hard to concentrate on your main activity. And you don't understand what is going on and what you should to do. So yes, really hard. So yeah. Good. So it could be really confusing for you. You might not understand what's really going on, And it can be hard to distinguish what's real and what isn't. I'm real. If this was happening to you in real life, what do you How? How would you expect? Or let me ask a different question? What might you do? Sorry. Maybe you maybe you can repeat question because it was better. So I didn't hear a connection. Maybe. Okay, so let's ask a different question. What might you do in the circumstance? If you were hearing those voices, what would your response be? Mm. Maybe maybe stop and wait until they stop to Doctor. You maybe just take time. Just take time till this, um, connection with them stops. And then you can go make your main things. So you might wait until you've got a break from those voices. So you might hope that actually, they're not there. all the time that they come and go, and that does sometimes happen. Make some. Maybe trying to stop it at the cost may be, I don't know. People sometimes, uh, broke the ears because they hear it's all time. It's it's an anxiety. They don't want to hear it. So maybe it depends on what voices says of what loud they are. So some people will use things like distraction techniques, and they'll put really loud music on to try and drown out the voices and get some peace and quiet. Absolutely some people might stuff their ears with paper, but that doesn't work because the voices are, even though they sound like they're coming from outside. They are from in here so that so the music's good. But But that doesn't I also heard him. I said You might do the things that they tell you to do in the hopes that they go away and which sometimes people do do. Yeah, mhm. Maybe start using the tranquil is eight hours. I don't know. Maybe it will help. Mhm. Yeah, So what? What I'm hearing is, I might I might, you know, use a substance that might help relax me to manage it. So some people might say, You know, we've got a small number of people who go Oh, gosh, this something's happening. I'm not well, I'm ill. But most people with psychosis don't realize that they're not well. And so they This is very real to them. And so they so what? But what they might say won't normally take medication. What they'll do is they might drink alcohol. They might smoke cannabis, take other drugs in the in the hopes that this quieted down and makes it more manageable. That's really common, actually, to see people what we call self medicating to manage their psychotic symptoms. Really good point. So think about this stuff about when you're seeing someone who's got auditory hallucinations and thinking about the causes of psychosis. You know, lots of, you know, predisposition. So you've got factors that make you more likely to get it. But high stress environments, the places where psychosis develops, you know. So, you know, thinking about you know, you guys finding ourselves within, um, war times and it's the kind of environment where psychosis can grow. So think about how you would respond to someone who was experiencing auditory hallucinations. What? How would you want to be treated in that circumstance? I'm going to move this on a little bit. In that workbook, you'll see the there's a heading called Positive second page positive and negative symptoms of psychosis. So we'll start talking about positive symptoms. Now. They call these positive because these are things that are added to a person, so things that people who don't have psychosis don't have. And then people with psychosis do have. And the as it says in that workbook, the dopamine hypothesis relates to this that there is overactivity dopamine receptors in those specific brain regions. And you've already really brilliantly picked up hallucinations. Uh, and you picked up about auditory hallucinations, which are very much the most common type of hallucination in psychosis. But what other types of hallucinations can people experience? Um, I heard that, uh, some people during hallucination, they can see some other person, or I know that one girl with, uh, the holidays has hallucination like some angels and then talk to her. And sometimes the angel is like, um, mechanism, which protect her from the world and something like this, and angels can be evil, so it depends on the type. So great. So you picked up on a couple of things that linked together there so that auditory hallucinations So hearing the angels talking to them and then some delusional content as well. That's around what the Angels do. Very good. So in terms of hallucinations, that is a perception in the absence of a stimulus. So you experience something, even though that that actual thing isn't there, so you can see things that's visual now. Visual hallucinations are quite uncommon in psychosis. They're more common in things like organic conditions. So there's an underlying physical health problem. Delirium probably being are most common cause of visual hallucinations. So if I hear someone seeing things, I think hang on. I need to think about their physical health. First off goes we've got seeing things, hearing things, smelling things. Yes, yep. So all factory hallucinations not particularly common, but it does happen. Yeah, also, uh, sensory host nations, Yes, so tactile or somatic, and that that can be a real range, so that can range of kind of feeling, things touching you on your arm through to having weird bodily sensations, all kinds of things that can happen there. So that's that's that one. And the last one is gustatory, which is tasting things, but that's not very common. The most common ones we'll see in psychosis are auditory and tactile. So that feeling things. And of course, this can happen in other conditions as well. But we're going to focus on psychosis today and then on the next one below that, you can see you've got delusions. And here we've got someone who's saying, I'm the emperor of Scotland. So what is a delusion? Well, maybe it's a false idea that the patient believes to be absolutely good. Excellent. So you've got something really important in there, so it's false. So this isn't based in reality. Yes, so we heard about those that those angels. That's a delusional belief. It's a complicated, delusional system, so it's false, and yours have held very intensely, so it's also fixed. So, uh, an intensely held or fixed false belief and people who hold that belief, even if you give them evidence that it isn't true. So you know, there's all kinds of stories people will tell you about. I mean, one of my colleagues early in his career. There was a a patient, and they were convinced that under the hospital was a series of walkways and they were torturing people under the hospital and things like that. And so he's all we'll look. What I'll do is I will take them downstairs and I'll show them. But it's just some storage. There's nothing very exciting there. So he took the patient downstairs and he said, You know, have a look around. There's nothing here gave him the full tour of the basement and the guy said, Well, you Well, you moved it because seeing the evidence of it didn't prove to him, uh, that that was a, uh that that that he was wrong. Uh, and the other thing is that it can't be in keeping with the person's, uh, culture cultural beliefs. Have lots of people believe it to be true? Uh, then it's not, uh, then we we don't consider it delusional. Right? Um great. I can see a couple more people have joined, so I'm just gonna pop the work, but back in the oh, sorry. Uh, I'll pop the work, but back in the chat bar, uh, so that you guys can, uh, see what we're doing, and you can keep up. But what I'm gonna do now is I'm going to share with you again a different video. Now, if you look at the page, uh, fit that startle negative symptoms, okay? We're just whiz through those really quickly, and I'm gonna show you a video of someone We're going to see if we can spot the negative symptoms. So we talk about negative symptoms being things that are a loss to the patient. So things that we normally are able to do someone with negative symptoms loses the ability to do so. If we go through those, the first one is affective deficits. So effect meaning mood or emotional response, and you might see flattening of affect. So So not very much display of emotion. And her adonia, which is a lack of enjoyment. You then see communication deficits. So things like alogia or poverty of speech. Which is where there isn't very much in the way of spontaneous speech. You don't say very much. You can see relational and social deficits. So withdraw social withdrawal, losing motivation, lack of interest or enthusiasm in general, uh, neglect, which is poor self care and not really knowing that their their self care isn't very good, getting quite neglected. And then cognitive deficits so problems with their attention being reduced, their memory can be poor and their thoughts can get very disorganized. So I'm going to share with you now. Video. It's only going to be it's under two minutes. Uh, and I'm going to share the sound with you, and I'm gonna show you and ask you to see which ones of those you can see in this patient with catatonic schizophrenia. Okay, here it comes. What is it you're trying to do with your life? Play the piano. Poor people. I'm not clear. How is it that playing the piano for people has eventually resulted in your being here in the hospital? I sit differently when I play the piano. And when I'm away from the piano, I occasionally look differently from other people. And this has caused dislike from people they dislike you because you sit differently at the piano. Yes. What way do you sit at the piano that people would dislike you? I cannot describe an illustration of her I sent and I can't imagine it that it would make people angry at you or at least dislike you. How do you know they dislike you? My father does, And doctors do because of the way I appear. Okay. I want to stop sharing that there. So hopefully you've You've been going through your list of those negative symptoms. Uh, and you picked up a couple that this person is showing. But if you think I'm not sure which one of this is, then you know, even just say, what do we notice that was unusual about the way in which this person acted or communicated? Well, uh, he spoke really slowly and without emotion. Mm. So his voice was very monotone, wasn't it? Yeah. So he can say his tone was very monotone. Yeah. And he did speak slowly. Did you notice anything about I mean, you say he did speak slowly, but there were very long gaps in there, wasn't there? Almost as if his thoughts have switched off. Does anyone know what that's called when you have these very long gaps in in speech like that? So that's a thought disorder that's called thought block. And what happens in those circumstances is that the is that the patient will stop talking, and it's almost as if there's nothing really going on. Their thoughts have stopped, and then they restart where they left off after a little while. And that's very typical in psychotic illnesses, the type of formal thought disorder. What else was unusual about that person that might you might see that negative symptom list. Maybe it's a social dick. It's because he said that he sits different, only piano. So it's like social withdrawal. Yeah, so that could be some hints that there's some social withdrawal that can that this is actually someone who's no longer seeing people. And it's taking taking themselves away. Yeah, and he had no mimic activity at his face. And the second, uh, I noticed that his eyes was were running coal ways. Yeah. So even though his eyes are moving around, there's not much facial expression. Um, and your you know and we call that your affect. So he's got a restricted affect, so there's very little in the way of facial expression, and even with his body language, did you notice there wasn't very much movement there? You know, you normally well, gesture a bit. We'll move around. You know, we'll add a bit of, uh, you know, he just stayed really just very still, Not much going on. Very monotone voice. Absolutely. And he didn't speak very much, and I think that is poverty of speech. So he didn't do anything spontaneous. He only answered questions. He didn't enter into a free blowing conversation. And that's the kind of thing that we might see now with this person. His self care looked good because he's in hospital at this time in the 19 sixties. I think this one was, and they've obviously got him ready for their camera. But in real life, actually, he might be quite neglected. His self care might be quite poor, very good. OK, lovely. Let's move on because that's our negative symptoms that we've talked about their, um, we're going to talk a bit more about these auditory hallucinations and you'll see here on page number, for this is it's heading is types of auditory hallucinations. Now what's important for us to understand first is the difference between 2nd and 3rd person auditory hallucinations. Um, can anyone give a definition of what a second or third person auditory hallucination might be, Or could they pick it out on our our little thing below? Maybe you should get up so someone might say you should You should get up. So that would be an example of a second person auditory hallucination. Because it is you, Uh, and a third person auditory hallucination would be he should get up. So first person I So that's not a hallucination, is it? That's our internal monologue that's normal. I should get up and make a cup of tea. Normal, uh, hearing a voice that says You should get up and make a cup of tea. Second person auditory hallucination. If you hear voices talking amongst themselves and they say he should get up and make a cup of tea, that's a third person order tree hallucination. Why does it matter? Well, third person who auditory hallucinations. He she they are more likely, uh, to correlate people with long term psychotic illnesses like schizophrenia. Now let's go through this sheet. So we've been through. If we look at that again, this is on page four. If we go there, there's this one that's saying your evil no one likes you. Your curse that's in the red. So what type of hallucination is that? We've got The answers are up in the box at the top in those in those bolded. Which one is this? So it's a close nation in the box, right? Right. The red one. Yes. I'm asking above that. We've got the answers. I'm asking you to match it. So you mean second person? Yes. Excellent. That second person. Yeah. So I'll pop up my I'll pop up my, uh, screen. So you can. He said this one here second. Yeah. You can see you've got the arms up here, so I'm being fair. So if we've got that second person, which is this yellow one, he's been bad. He's evil. He's being followed. Third person. Brilliant. Excellent. Now, what about this one in Greene? He's walking through the park. He's sitting down. He's holding his head in his hands. Go up here. Which one of these ones that's left do we think that one is running commentary? Yes. A running commentary is a description of a person's actions as they go, uh, as they're doing them. And that is a you know, that's very schizophrenic. So psychosis that we'll talk a little bit about the different types of psychotic illnesses, but that's one that's very closely linked into longer term conditions like schizophrenia. Then we've got this one where the chap is thinking to himself what's happening with me. And then he hears happening with me. What's that one? Yeah, that's the echo. And so people who have that will have their normal thoughts. And then another voice will say part of their sentences back to them. Um, so it can be quite distressing. And then down here, we've got our last one. Cut yourself. Attack the police, Things like that. What's that? Uh, commands imperative. Imperative? Yeah, you could call it imperative. Or command hallucinations is what we we We normally, But sometimes they call imperative command hallucinations. Those are the riskiest ones, aren't they? So when you see someone who's got command hallucinations, you must always ask them if they're going to act, you know? Have they ever acted on them? How close they get to thinking about? They're going to act on them, um, and do a bit of a risk assessment with them. Okay, So a little bit here. Now, come on to our next one. It This is just a bit of thinking about when we see someone in our clinical practice. And, you know, if you work in a general hospital, you'd be pretty lucky, Uh, not to see someone with auditory hallucinations or psychosis in any given a couple of months, I would imagine so It's nice to be able to ask questions about this. So we we do want to know more about the auditory experiences. And the reasons for this are it's good at building rapport. So getting people comfortable with opening up to us, Um and, uh, it helps with us making diagnosis because not all voices are psychotic. Uh, and it helps us do a good quality risk assessment, which is really important. So let's have a think about how you might ask about things. So first off, if they if we're speaking to someone and we think they might have psychosis and we want to, um, if you want to ask them about that, whether they have any auditory hallucinations, what kind of questions could we ask them? Maybe we should ask what he see or what he here. Or maybe what happening around him. Maybe Yeah, so we can be pretty direct and kind of talk about that. How would you ask about auditory hallucinations? Specifically? Uh huh. What did you see? I don't know. So what I'd like So I'm It's good that you're saying, I don't know. That's a good place to start from because you can't get it wrong here. Let's, um let's avoid talking about seeing things because, as I said, it's not that common in psychosis. Let's focus on hearing things so we could do a bit like you suggested to say, Do you ever hear voices? Now, the reason why I don't choose that is that I say, Well, actually, people who are experiencing that might not consider them to be voices because they very real to them. They are experiencing hearing and they might have names. They might know who they are, you know, So they can say that's, you know, perfectly normal. So how can we get at whether they hear things? Uh, how can we get it? Whether they're having hallucinations, any thoughts? Maybe we should ask with hope. He talkin if it's happened, uh, in our presence. So he just speaking it corner and we asking him about what the people say. Maybe maybe it's not the human. Maybe it's some well, what I like about that is that you What you're saying is I'm going to look at the person in front of me, and I'm going to say if they if we notice that they're distracted or there may be talking to themselves, maybe they're mumbling to themselves. That does happen. Or if, whilst we're talking, you know, distracted, they often talking to some of the psychosis and they'll be kind of It's like you can see it there have something is going on and they're listening to something that's happening over here and you can't you know it's in there, you know, that's where they're hearing it from and you can see they're really distracted by that. What you would do is go. You might say, I'm noticed. You seem really distracted. I'm wondering. Is there something going on? Maybe that I'm not able to hear. Um, you know, something like that and that's a really good way to pick up on those things. And picking up on those cues makes you a really good practitioner. Now, the way that I approach this with auditory hallucinations. As I normally say, Do you ever hear sounds or voices when there's no one else around when you're on your own? Because if people are here having auditory hallucinations, they might think that other people can hear what it is that's happening and that gets passed that. And so if I say if you hear them when you're on your own, then it's clearly it's an auditory hallucination. So that's one way that I do it. Other people might say, Do you ever hear voices? Do you hear things other people can't seem to hear? Do you ever hear anything that you can't explain? Um, I've got my way of asking. You just need to find your way of asking. So then it's good to have a couple of questions, general questions which are useful for diagnosis, putting a bit of rapport. So that's thinking about how we can get the content of their speech of of what the voices are saying so really open question sick. Can you tell me a bit about what it is that you hear? What? What What are the voices that you hear? Are they people? Um, you know Sometimes there are other things. Sometimes it just sounds, um what do they say to you? Health. Didn't you hear them? Do you ever get any, uh, time where they're not there? Um and where does it sound like they're coming from? So we've all got our own internal voice, haven't we? That's really normal. And we can hear it inside our head. But most of us, I don't think we hear it outside ahead. So whereas if they're hearing things from outside the head, that really indicates that it's a proper, good going auditory hallucination, it sounds like it's coming from out here. If people are being sound voices that sound like they're in their head, then that can be a lot of different things. It can be, uh, you know, internal thoughts, which they don't really want to consider their own. There's all kinds of things. So we then want to establish the level of insight. So we might say, you know, we could ask them whether they think the voices are real. Um, or what I probably would do is ask, you know, say, Has anyone else been helped to hear these? They probably you know, they're going to say no and I'll say, Why is it that you think that people don't hear them? And then I would then follow that up with is Do you think it's possible that the reason why other people can't hear them is that they're specific to you? Maybe that it could be a symptom of a mental illness, and normally they'll say, No, that's not possible, but you're testing their insight and seeing where they are. Um, if we're thinking about assessing risk, what kind of questions we want to ask to assess risk for people who hear voices, maybe whether those voices are giving commands. Uh, and if they are threatening the patient? Yeah, that's a really important one. Uh, did I give you commands? And so for one of my you know, I've got a patient and she she hears these awful voice is, um and they tell her they're going to do terrible things. They're gonna, uh, torture her. They're gonna put spiders in her hair and she ends up, and then she cuts off her hair, shaved her head because she thinks they're gonna put spiders in her hair. They said she was going to um they're going to throw HIV infected needles into a flat. Um, and so she left the flat and went to go and live on the streets. So the risks aren't just her telling you to go and do something. Um, you know, horrible. Not just command hallucinations. There's lots of other risk that could be there as well, But it is important to check that they ever tell you to do things now for her. They tell her to leave money around the city. So she then she has problems with her finances because she's been putting money into holes in walls and things like that. Um, any other questions you might ask to assess risk around voices? Mhm to ask. What? What does the voice want from you or something like this? Yeah, we could absolutely. Do you get the sense the voices want anything from you? Are they, you know, and do they want you to do anything for that? Yep. I'd probably also ask how this was impacting on them. I want to know whether they make them. It gets so bad that they feel suicidal. They think about hurting themselves because it's really distressing. I've got. You know, people get very tormented by their voices. Um become very can become very suicidal about that. And then the clues of the patient denies hearing voices. But actually, we think they might be, because sometimes they do. People do cover that up because they recognize that other people would think that it is unusual that they hear voices and they don't want to end up being brought into treatment or put into hospital. So do they look distracted? Are they looking around the room? Are they talking to themselves? Do they do little responses like I was describing there? You know, that's what we we want to, uh to do. And just important to remember that hearing voices is very common throughout the general population, and not all of that is psychotic in nature. About 5 to 8% of the general population will have a psychotic like experience throughout their life, but only 1% of people will be diagnosed with a psychotic illness, So lots of people will have periods in which they might hear voices, but they won't be psychotic. Voices will be more like what I was describing about hearing things within within their head. Maybe those, um uh, thoughts which are very difficult to to manage being taking on slightly different sounds. Okay, so that's really auditory hallucinations. And how I want you guys to be able to gather that information. Now, we'll move on now and talk about delusions so that these are these fixed, false beliefs and we'll go through them one by one. I'll share my screen again so that you can see, uh, which ones I'm talking about. So we'll go back and fill in this bit about which delusions most commonly associated with. Let's start with this one. We got someone here looking out the window, and he's saying they're following me to kill me. What type of a delusion do we think that is Some kind of paranoia. Good. So you paranoia, and we've got a slightly different word we normally use for this. You can use paranoid, but we've got another one persecutor delusions, maybe persecutory. Yeah, absolutely. Now you could call that paranoid delusion, but, uh, more technical term is persecutory. Very good. I've got one here. Ok, This woman here is saying army satellites beam electric shocks into my stomach and they make my feet kick up. What is this? Uh, I'm not sure about English terminology, but from Ukrainian, it translates to something like delusions or influence. Um, that she's influenced by something. Yeah, you could. I'm I'm perfectly happy with that. It's a passivity. Phenomena is how you would describe this, but a delusion of influence sounds very reasonable to me. And in this, this is made thoughts, feelings or actions. And so what that means is that they have a sense that the things that they do are under the control of someone or something else. So in this case, it's army satellites that are causing, uh, this person to kick their feet up. Now, they might have tactile hallucinations as well from electric shocks in their stomach. But the kicking their feet up is a passivity, phenomena or a delusion of control. Delusion of influence. That would work as well. Very good. Okay, then we've got delusional perceptions. I've just said it out loud. Sorry. I read the wrong spit. The lights change to green. That means Boris Johnson has give been given the green light to kill me. I said it out loud. So I just tell you what it is a delusional perception. And that is where you take a normal thing. The light traffic light changing color. Perfectly normal. But you give it a delusional interpretation. So here it goes to green. And that means, uh, the green light has been given to kill them. All right, go over to this one here. Um, this is, uh, someone who's who's watching the TV, And I say all this cause it's all about me, the TV, the radio, the papers, the stuff that they're they're seeing or reading is about them. What type of delusion is this? Okay, so this one is, uh this one is a delusion of reference. That's how I would describe this so or a referential delusion. So this is where they'll you know, It's like it says, you know, they're listening to radio, and I think it relates to them, uh, in particular. Right. Then we've got the thought alienation categories. Okay, so, uh, these all are slightly similar. Bit different. So here we go. The first one on the left doctor sends suicidal thoughts directly into my brain. What's that? And his horse? Not really. Okay, so that's something called thought insertion. Okay, so that is that's feeling that thoughts are being directly inserted into their brain the next one along. You can probably guess this, this person says. Suddenly my mind goes blank. They suck my thoughts away. All right, Well, that one is thought withdrawal. So they're removing thoughts in their brain. Broke the thoughts, go blank. That might look like thought block that we covered a little bit earlier. And then then the last one, the right they No, I they know. I think they're stupid. My brain leaked and they absorbed it all. Now that's thought broadcasting and they're your experience is that you think you believe that everyone can read your thoughts Now? Some of us have a bit of that. When we get a bit of social phobia we go on to about asked me, Oh, God, everyone's looking at me And maybe that you know, it's not unusual that people human beings can go. Oh, you know, people who might question or you know what if people read my thoughts, but we can reality test and go hang on a minute. Is that possible? That's not possible. So, um, you know, it's That's one of those things where it is psychotic in nature. Okay, now, if we went back to the top delusions most commonly associated with what type of psychotic condition we've got all these delusions thought alienation. What condition are these most commonly associated with schizophrenia. And I would say also, schizophrenia form conditions. So not not not just that's not just schizophrenia, but that is, uh, conditions of the psychotic illnesses that are like schizophrenia. So that can all this stuff can happen in things like first episode psychosis as well. And then we've, uh, done the Snyders first rank symptoms. We've covered these already, actually. And these are ones which we don't use Snyder's first rank symptoms as diagnostically anymore. But these are helpful because if you see these things, then, uh, it indicates that the longer term diagnosis might be schizophrenia. And if a person doesn't have is psychotic but doesn't have these ones, then you think they're prognosis is like, probably gonna be a bit better. So that includes. So these first rank symptoms are in delusions. It's delusional perception, passivity, phenomena and thought, alienation. And in hallucinations, it'll be third, Uh, it'll be third person auditory hallucinations, running commentary and thought echo. So those are more likely to lead into that longer term schizophrenic illness, but not 100% definite. Right? Let's move on. We've got these delusions here, and we've got two of them, but they're the same delusion. So in the first one, someone says I'm Jesus, and then the other one, they think that their air to Rothschild fortune. But as you can see, uh, in reality, they're, um they're homeless. What? How do we describe this delusion? Maybe, uh, grandiose delusions. That's it. Grandiose delusions. And what condition do enormous see grandiose delusions in maybe some manic episodes? Absolutely. Yeah. Manic episodes, usually as part of a bipolar illness, Absolutely so grandiose. Delusions. They're good. Now we move on to our last set of delusions. So you've got on this side. We've got, uh, someone who's saying I'm bank, who's thinking I'm bankrupt. I'm rotting inside. I'm dead. And so all my family. Now, none of that is true. So that's the context of this. But that's their belief. What type of a delusion is this like we can move onto the next one. We'll come back to this one if we need to. So the other one is someone's thinking that are far in the school. In 19. Oh two. I did it. My family will suffer for it. Clearly, they can't have done that before they were born. What kind of a delusion do we think this is? Okay, well, look, I'll give you the answers in a minute. But before we even come to the answers to those questions, what what condition do you think these most most likely to occur in? I know the first type of delusion. It's, um, can be found in a condition called Qatar Syndrome. Yes, so parts of this are Qatar's. And actually it's the rotting inside or I'm and I'm dead. That is a Cotard syndrome. Yeah, absolutely. And what what condition does that occur in mhm, Maybe some organic diseases. I'm not so much. Actually. People are normally fit and well with this. So this normally happens in psychotic depression. So you've got the I'm bankrupt. I'm rotting inside. It's a nihilistic delusion. And the one on the right, The fire, that school. That's a delusion of guilt. So these are consistent. He's a mood congruent with someone who is depressed and these normally grow out of feelings of guilt. Um, and then preoccupation around physical health sometimes, right? So, uh, guys, that's I'm gonna what I'm gonna do, I'm gonna bring that session to close, because what I'd like to do is give a little bit of time for questions. And also, uh, the next bit is we're going to do a little bit of discussion around some cases, and I want to save that for the session on the eighth of, uh, sixth of December. I think it is, um, and talk about how we can determine which psychotic illness are patient is suffering from, and we'll go through the potential different diagnoses. And we'll follow that up with thinking about what treatments we use for psychosis. And in the new year, we'll have time to go and do a bit of a bit more material and some other, uh, stuff related to the psychosis. But before, uh, we do that any, uh, questions that people want to ask around psychosis, schizophrenia or associated conditions? Okay, I'm going to take that as a no, and I'll let you guys go a little bit for the end. I'll I'm happy to hang around. If anyone's got any particular questions, they want to ask. But otherwise thank you for joining me today. Uh, I hope you enjoy the rest of your afternoon. Um, thank you very much, Doctor Fan. I just like to remind everyone to please do the feedback. Um, in the chat. It's very important for us if you could take two minutes to do that and then right at the end. Um, we'll person certificate for you. Thank you very much. Ok, thank you. Thank you for this lecture and they for think for the winning.