1b Psychosis Flashcards
What is psychosis?
difficulty perceiving and interpreting reality (i.e. failure of reality testing)
What are some examples of psychotic disorders?
Bipolar
Schizoaffective disorder
depression
delusional disorder
Schizophrenia
Depression with psychotic symptoms
Drug induced
What are the three symptom domains in psychosis?
Positive symptoms
Negative symptoms
disorganisation
What are the positive symptoms of psychosis?
Hallucinations
Delusions
What is a delusion?
A fixed, false belief not in keeping with social/cultural norms
What are the negative symptoms of psychosis?
Alogia
Anhedonia
Affective flattening
Avolution/apathy
What is alogia?
Paucity/poverty of speech, little content
Slow to respond
What is affective flattening?
Unchanging facial expressions
Few expressive gestures
Poor eye contact
Lack of vocal intonations
Limited emotional range
What is avolution?
Poor self-care
Lack of drive/persistence at work/education
Lack of motivation
What are the types of disorganisation symptoms?
Bizarre behaviour
Formal thought disorder
What is formal thought disorder?
Lack of logical connection between thoughts
What is the structure of a mental state examination?
Appearance and behaviour
Speech
Mood and Affect
Thoughts
Perceptions
Cognition
Insight
What are the environmental risk factors for psychosis?
Drug use, especially cannabis
Prenatal/birth complications
Maternal infections
Migrant status
Socioeconomic deprivation
Childhood trauma
What are some genetic risk factors for psychosis?
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
What things might you look for in someone with psychosis?
Bizarre or inappropriate clothing
Psychomotor retardation/agitation
Abnormal movements (medication related)
Self-neglect
Self-harm injuries
Echophenomena (echopraxia, echolalia)
Stupor and mutism (catatonia)
What are some thought disorders?
Circumstatial (longwinded)
Tangential
Flights of ideas (train of thought loosely connected)
Derailment
Word salad (complete breakdown)
What is used to measure cognition?
Addenbrooke’s Cognitive Examination (ACE III) - A 100 item cognitive assessment that looks at multiple areas of cognition. Administration takes 20-25 mins
What is biopsychosocial management for psychosis?
Pharcological
Psychological
Social support
What neurotransmitter is most implicated in antipsychotic medication?
Dopamine
What causes the positive symptoms of psychosis?
Increased dopamine activity in mesolimbic dopamine system implicated in causing positive symptoms of psychosis
Which drug actions on dopamine receptors would be most likely to improve psychotic symptoms?
Most antipsychotics are dopamine antagonists. Newer agents (e.g. aripiprazole) are partial agonists
What makes something a ‘typical’ versus an ‘atypical’ antipsychotic?
Typical antipsychotics are older agents and have an increased risk of causing EPSE
What is EPSE?
Extra pyramidal side effects
What causes EPSEs?
Caused by dopamine blockade in the nigrostriatal (extrapyramidal) dopamine system (parts of the brain that enable us to maintain posture and tone)
