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BRS Psychiatry > 1b// Psychosis > Flashcards

1b// Psychosis Flashcards

1
Q

What is psychosis?

A

difficulty perceiving and interpreting reality (I.e., failure of reality testing)

A clinical syndrome that can be caused by many disorders- focus in research is often schizophrenia

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2
Q

What are some psychotic disorders? (7)

A

Bipolar I
Schizoaffective disorder
Schizophrenia
Depression with psychotic symptoms
Delusional disorder
Drug Induced
Due to other medical conditions

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3
Q

Is psychosis a diagnosis?

A

No, it is a clinical term- something leads to psychosis, loss of touch w/ reality

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4
Q

What is hallucination?

A

appreciation of a sensory input without there being any sensory input (i.e., hearing, seeing, smelling, etc.) has to be very realistic (symptom of psychosis)

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5
Q

What is thought disorder?

A

(symptom of psychosis)
Thought disorder is a disorganized way of thinking that leads to unusual speech and writing. People with thought disorder have trouble communicating with others and may have trouble recognizing that they have an issue.

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6
Q

What is delusion?

A

Fixed, false belief not in keeping with social/cultural norms. Delusions have a theme/flavour;

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7
Q

What are the symptom domains in psychosis?

A

Positive symptoms= gains a functions
negative symptom= loss of function
disorganisation= everything else

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8
Q

What are the 2 types of positive symptoms?

A

Hallucinations
Delusions (disorder of thought content)

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9
Q

What are the types of positive symptoms of hallucinations?

A

Perception in absence of a stimulus

Can occur in any sensory modality:
1. Auditory
- 1st (thought echo), 2nd, 3rd person
- Running commentary
- Command hallucinations
2. Visual (consider organic cause)
3. Somatic/tactile/formication
4. Olfactory
5. Gustatory

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10
Q

What are the types of positive symptoms of delusions?

A

Persecutory/Paranoid Reference Grandiosity
Religious
Pathological jealously
Nihilistic/Guilt
Somatic
Erotomanic (believe people are in love w/ u)

passivity experiences:
- 1st rank symptoms
Thought broadcasting
Thought insertion
Thought withdrawal

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11
Q

What is thought broadcasting?

A

believe that people can read your mind

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12
Q

What is thought insertion?

A

believe people are putting thoughts into your mind

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13
Q

What is thought withdrawal?

A

their thoughts just stop, it might show as them stop talking midway through a sentence

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14
Q

What hallucination is a red flag for organic hallucination?

A

visual e.g., drug induced

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15
Q

What are the negative symptoms of of delusions?

A

Alogia
Anhedonia/ asociality
Avolition/ apathy
Affective flattening

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16
Q

What is alogia?

A

paucity/ poverty of speech (little content)

slow to respond to questioning

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17
Q

What is anhedonia/ asociality?

A

few close friends
few hobbies/ interests
impaired social functioning

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18
Q

What is avolition/ apathy?

A

poor self-care
lack of drive/ persistence at work/ education
lack of motivation

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19
Q

What is affective flattening?

A
  • Unchanging facial expressions
  • Few expressive gestures
  • Poor eye contact
  • Lack of vocal intonations
  • Limited emotional range
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20
Q

What are the negative symptoms of delusions often misdiagnosed for?

A

depression

but for these people their mood is fine

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21
Q

What are the disorganisation symptoms of delusion?

A

Bizarre behaviour

Formal thought disorder (disorder of thought form)

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22
Q

What is bizarre behaviour?

A
  • Inappropriate social behaviour
  • Bizarre clothing/appearance
  • Aggression/agitation
  • Repetitive/stereotyped behaviours
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23
Q

What is formal thought disorder?

A

lack of logical connection between thoughts

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24
Q

How would you describe the increasing severity of formal thought disorder?

A

(going down is increasing severity)

o Circumstantial thought
o Tangential thought
o Flight of ideas
o Derailment/loosening of association
o Word salad

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25
Q

What is the epidemiology of psychosis? (onset)

A

can occur at any age

peak incidence in adolescence/ early 20s

peak later in women

26
Q

What is the epidemiology of psychosis? (course)

A

often chronic and episodic

variable and prognosis

27
Q

What is the epidemiology of psychosis? (morbidity)

A

Substantial, both from disorder itself and increased risk of common health problems e.g. heart disease

Significant impact on education, employment and functioning

28
Q

What is the epidemiology of psychosis? (mortality)

A

All-cause mortality 2.5x higher, ~15 years life expectancy lost

High risk of suicide in schizophrenia - 28% of excess mortality

29
Q

What is an MSE exam and what is involved in it?

A

mental state examination (MSE):

o Appearance and behaviour
o Speech
o Mood and Affect
o Thoughts
o Perceptions
o Cognition
o Insight

30
Q

When do you start psychological therapies for psychotic disorders?

A

when they are more stabilised

31
Q

What are the treatment options for psychotic disorders?

A

Pharmacological

Psychological

Social Support

32
Q

What is involved with the pharmacological treatment for psychotic disorders?

A

antipsychotic medications

often mainstay of treatment

33
Q

What is involved with the psychological treatment for psychotic disorders?

A

CBT for psychosis

newer therapies like avatar therapy

34
Q

What is involved with the social support treatment for psychotic disorders?

A

Supportive environments, structures and routines

Housing, benefits

Support with budgeting /employment

35
Q

What neurotransmitter system is most implicated in the mechanism of antipsychotics?

A

Dopamine - but antipsychotics act on many neurotransmitters including serotonin, acetylcholine, histamine

Increased dopamine activity in mesolimbic dopamine system implicated in causing positive symptoms of psychosis.
Evidence from imaging + drug models + post-mortem studies

36
Q

Which drug actions on dopamine receptors would be most likely to improve psychotic symptoms?

A

Antagonists

Most antipsychotics are dopamine antagonists. Newer agents (e.g. aripiprazole) are partial agonists

Dopamine agonists like those used in Parkinson’s disease can cause psychotic symptoms

37
Q

What does EPSEs stand for?

A

Extrapyramidal side effects

38
Q

What are extrapyramidal side effects?

A

Umbrella term for side effects outside the traditional pyramidal movement pathway

Caused by dopamine blockade in the nigrostriatal (extrapyramidal) dopamine system (parts of the brain that enable us to maintain posture and tone)

39
Q

What are examples of extrapyramidal side effects?

A

parkinsonism
acute dystonic reactions
tardive dyskinesia
akathisia (restlessness, restless legs)

40
Q

What is parkinsonism?

A
  • Bradykinesia
  • Postural instability
  • Rigidity - characteristic ‘cog-wheeling’
  • Slow and shuffling gait
  • Festination (chasing centre of gravity)
  • Lack of arm swing in gait – early sign
  • ‘pill-rolling’ tremor - slow (4-6Hz) movement of the thumb across the other fingers:
41
Q

What are the management principles of EPSEs?

A
  • Counsel about risk
  • Use lowest therapeutic dose
  • Use atypical as first line
  • Change medication to a more
    movement sparing agent
  • Anticholinergic medications can help
    (e.g. procyclidine)
42
Q

How are antipsychotics divided?

A

Antipsychotics divided into older typical drugs and newer atypical drugs:
o Also referred to as first and second generation

Atypical antipsychotics associated with a lower risk of EPSE

43
Q

Why are atypical antipsychotics less likely to cause ESPEs?

A

Less likely to cause EPSEs due to 5HT-2A antagonism

44
Q

What are other side effects of antipsychotics?

A

CNS:
- EPSEs
- sedation

Haematological:
- agranulocytosis
- neutropenia

Metabolic:
- increased appetite
- weight gain
- diabetes

Gastrointestinal:
- constipation

Pituitary;
- increased prolactin

Cardiac:
- dysrhythmia
- long QTC

45
Q

Why is increased prolactin a symptom of antipsychotics?

A

because prolactin is suppressed by dopamine

less dopamine= more prolactin

46
Q

Describe the 2 main components of a psychiatric history assessment.

A
  1. psychiatric history
  2. mental state examination
47
Q

What are the main components of the psychiatric history?

A
48
Q

What is hypnagogia?

A

transitional state of consciousness between wakefulness and sleep

49
Q

What is hypnopompic?

A

hallucinations in people with deteriorating vision

50
Q

What is Charles Bonnet syndrome?

A

hallucinations in people with deteriorating vision

51
Q

What often precedes psychosis?

A

prodromal symptoms

52
Q

Describe some risk factors for psychosis.

A
53
Q

What might you look out for in appearance and behaviour of someone with psychosis?

A
54
Q

What cognitive impairments are associated with schizophrenia?

A

Working memory impairments
Lower scores of cognitive testing (from childhood)
Poorer educational attainment (from childhood)

Cognitive impairments are stable over time and independent of psychotic symptoms

Cognitive impairments are difficult to treat and cause morbidity

55
Q

What difficulties might you have treating someone with very poor insight into their psychosis>

A

concordance with treatment

Attendance at follow-up

Would not stay in hospital

56
Q

What are the advantages and disadvantages of being given a diagnosis?

A
57
Q

What are the differentials of psychosis?

A
58
Q

What is dystonia?

A
59
Q

What is tardive dyskinesia?

A
60
Q

Do you understand this infographic of psychosis?

A

BRS Psychiatry (11 decks)

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