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PSYCHIATRY phase 1b > 1b Psychosis > Flashcards

1b Psychosis Flashcards

1
Q

What is psychosis?

A

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

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2
Q

What are some examples of psychotic disorders?

A

Bipolar
Schizoaffective disorder
depression
delusional disorder
Schizophrenia
Depression with psychotic symptoms
Drug induced

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3
Q

What are the three symptom domains in psychosis?

A

Positive symptoms
Negative symptoms
disorganisation

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4
Q

What are the positive symptoms of psychosis?

A

Hallucinations
Delusions

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5
Q

What is a delusion?

A

A fixed, false belief not in keeping with social/cultural norms

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6
Q

What are the negative symptoms of psychosis?

A

Alogia
Anhedonia
Affective flattening
Avolution/apathy

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7
Q

What is alogia?

A

Paucity/poverty of speech, little content
Slow to respond

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8
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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9
Q

What is avolution?

A

Poor self-care
Lack of drive/persistence at work/education
Lack of motivation

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10
Q

What are the types of disorganisation symptoms?

A

Bizarre behaviour
Formal thought disorder

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11
Q

What is formal thought disorder?

A

Lack of logical connection between thoughts

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12
Q

What is the structure of a mental state examination?

A

Appearance and behaviour
Speech
Mood and Affect
Thoughts
Perceptions
Cognition
Insight

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13
Q

What are the environmental risk factors for psychosis?

A

Drug use, especially cannabis
Prenatal/birth complications
Maternal infections
Migrant status
Socioeconomic deprivation
Childhood trauma

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14
Q

What are some genetic risk factors for psychosis?

A

Schizophrenia is highly heritable ~46% concordance in MZ twins
Highly polygenic - lots of genes of small effect sizes, but ones found so far account for ~20% of known genetic risk

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15
Q

What things might you look for in someone with psychosis?

A

Bizarre or inappropriate clothing
Psychomotor retardation/agitation
Abnormal movements (medication related)
Self-neglect
Self-harm injuries
Echophenomena (echopraxia, echolalia)
Stupor and mutism (catatonia)

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16
Q

What are some thought disorders?

A

Circumstatial (longwinded)
Tangential
Flights of ideas (train of thought loosely connected)
Derailment
Word salad (complete breakdown)

17
Q

What is used to measure cognition?

A

Addenbrooke’s Cognitive Examination (ACE III) - A 100 item cognitive assessment that looks at multiple areas of cognition. Administration takes 20-25 mins

18
Q

What is biopsychosocial management for psychosis?

A

Pharcological
Psychological
Social support

19
Q

What neurotransmitter is most implicated in antipsychotic medication?

A

Dopamine

20
Q

What causes the positive symptoms of psychosis?

A

Increased dopamine activity in mesolimbic dopamine system implicated in causing positive symptoms of psychosis

21
Q

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

A

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

22
Q

What makes something a ‘typical’ versus an ‘atypical’ antipsychotic?

A

Typical antipsychotics are older agents and have an increased risk of causing EPSE

23
Q

What is EPSE?

A

Extra pyramidal side effects

24
Q

What causes EPSEs?

A

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

25
Q

What are parkinsonism symptoms?

A

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

26
Q

What are some EPSE?

A

Parkinsonism
Acute dystonic reactions
Tardive dyskinesia
Akathisia

27
Q

What is Akathisia?

A

Inability to bw still

28
Q

What are the side effects of antipsychotics?

A

Agranulocytosis
neutropenia
Increased appetite
Weight gain
Constipation
Increased prolactin as release suppressed by dopamine

29
Q

What are some management principles for ESPEs?

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)

PSYCHIATRY phase 1b (7 decks)

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