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Psychiatry > 2: (E): Psychosis and Schizophrenia > Flashcards

2: (E): Psychosis and Schizophrenia Flashcards

1
Q

Define psychosis

A

Acute mental status, where individual experiences delusions and hallucinations

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2
Q

Define delusion

A

Fixed, stage or irrational belief that if firmly held and not in-keeping with individuals culture background

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3
Q

Define hallucination

A

Sensory perception (auditory, tactile or visual) with no external stimulus

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4
Q

Define an illusion

A

Perceptual abnormality that results in misinterpretation of external stimuli

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5
Q

What age is psychosis more common

A

16-30 years-old

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6
Q

Which gender is psychosis more common

A

Males

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7
Q

How can the causes of psychosis be divided

A
  • Schizophrenia
  • Depressive Disorders
  • Drug-induced
  • Neurological
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8
Q

What depressive disorder can psychosis occur in

A

Both unipolar and bipolar depressive disorder

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9
Q

What delusions are more common in bipolar depressive disorder

A
  • Grandiosity
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10
Q

What delusions are more common in schizophrenia

A
  • Persecutory
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11
Q

What three drugs can cause psychosis

A

Amphetamines
Cannabis
Steroids

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12
Q

What psychosis do steroid produce

A

Psychosis similar to schizophrenia = persecutory delusions

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13
Q

Give 5 neurological (organic) causes of psychosis

A
  • Temporal lobe seizures
  • Head Injury
  • Dementia
  • Vitamin B12 deficiency
  • Hypoglycaemia
  • Cushing’s disease
  • Thyrotoxicosis
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14
Q

Explain delusions in head injury

A

In head injury individual often has auditory delusions that they can talk to, this is rare for psychiatric illness

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15
Q

Define a bizarre delusion and give an example

A

Delusion that cannot be true and are not in keeping with social or culture norms (eg. I can fly)

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16
Q

What is a non-bizarre delusion

A

Delusions that could be true or are in-keeping with social norms (eg. I won the lottery)

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17
Q

What are grandiosity delusions

A

Delusions of importance: the traffic light turned green, therefore, I must be god

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18
Q

In which condition do grandiosity delusions occur

A

Bipolar depressive disorder

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19
Q

What are ideas of reference delusion

A

There are special meanings in news or on TV for that person

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20
Q

What are paranoid delusions

A

Distrust of others

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21
Q

What are persecutory delusions

A

Person believes they are being cheated on or harassed

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22
Q

In which condition is persecutory delusions more common

A

Schizophrenia

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23
Q

What is erotomania

A

Person believes someone else is in love with them

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24
Q

What is morbid jealousy

A

Believes partner is cheating on them with no justficiation

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25
Q

What is somatic

A

Experiencing body function, when it is not happening

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26
Q

How are delusions assesed

A
  • Psychiatric assessment
  • Risk assessment
  • Medication-review
  • Physical health
  • work-up for organic causes
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27
Q

Explain prevention of psychosis

A

If someone has any of the following they should be assessed by a specialist mental health service and may receive CBT:

  • Previous psychosis
  • First-degree relative with psychosis
  • Other indicate behaviour
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28
Q

How is psychosis first managed

A

Oral antipsychotic
CBT
Family Intervention

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29
Q

If someone has recurrent episodes of psychosis how is it managed

A

Organise follow-up with crisis resolution and home treatment team (CRHT) to manage in the community. CBT, Family Intervention and Antipsychotic

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30
Q

Define schizophrenia

A

Severe psychiatric disorder characterised by chronic or recurrent delusions

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31
Q

What are the four points ICD-10 states must be present to make a diagnosis of schizophrenia

A
  1. > 1-months
  2. One of:
    - Thought Disorder
    - Auditory hallucinations - third person
    - Delusions of control
  3. Or, two of:
    - Any Hallucination
    - Catatonic
    - Negative symptoms
    - Incoherent or irrelevant speech
  4. Disorder not due to substance mis-use or organic brain disorder
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32
Q

When is the peak onset of schizophrenia in men

A

18-25

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33
Q

What is the peak onset of schizophrenia in women

A

25-35

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34
Q

In which gender is schizophrenia more common

A

Female

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35
Q

What ethnicity is schizophrenia more common

A

Afro-Carribean

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36
Q

What are the 3 hypothesis of schizophrenia

A
  • Neurochemical
  • Neurodevelopment
  • Disconnection
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37
Q

Explain neurodevelopment hypothesis

A

Those with obstetric complications have a higher risk of schizophrenia. Motor deficits often seen in individuals with schizophrenia when younger

38
Q

What is concordance in monozygotic twins

A

50%

39
Q

What is chance of schizophrenia if parent affected

A

15%

40
Q

What is chance of schizophrenia if sibling affected

A

10%

41
Q

What is the greatest RF for schizophrenia

A

Afro-Carribean

42
Q

What is a mnemonic to remember risk factors of schizophrenia

A

COAL FAME

43
Q

What are the risk factors of schizophrenia

A

Cannabis use
Obstetric complications
Afro-carribean
Low IQ

FH
Abuse
Migrant
Enviroment-Urban-Urban

44
Q

How are symptoms of schizophrenia divided

A
  1. Positive
  2. Negative
  3. Cognitive
45
Q

What are the 5 broad categories for positive symptoms

A 
Hallucinations 
Delusions 
Thought Disorder 
Speech Disorder 
Other
46
Q

What are primary delusions

A

Hallucinations start with disorder

47
Q

What are secondary delusions

A

Hallucinations start after primary disorder

48
Q

What are delusions of passivity

A

Synonymous with delusion of control. Individual believes their actions, feelings or impulses aren’t their own

49
Q

What hallucinations are more common in schizophrenia

A

Auditory hallucinations:

- Where individual believes a third person is commentating on their actions

50
Q

What do visual or gustatory hallucinations indicate

A

Organic pathology

51
Q

What do auditory hallucinations where individual can talk to the voice indicate

A

Head trauma

52
Q

Explain the effect of treatment on hallucinations in schizophrenia

A

Voices may become:

  • Quieter
  • Disappear
  • More positive
53
Q

What are the 4-types of thought disorder

A
  • Insertion
  • Broadcasting
  • Withdrawal
  • ECHO
54
Q

What is thought insertion

A

Individual believes thoughts are being put inside their head

55
Q

What is thought withdrawal

A

Individual believes thoughts are being taken from their head

56
Q

What is thought broadcasting

A

Individual believes others can hear their thoughts

57
Q

What is thought ECHO

A

Individual hears their thoughts repeated soon after

58
Q

As part of speech disorder, what is neologism

A

Creating new words

59
Q

As part of speech disorder, what is word salad

A

Individual says words in no logical sequence

60
Q

What is flight-of-ideas

A

Rapidly moves from one idea to the next

61
Q

What is knight’s move thinking (Derailment)

A

Loosening of associations, where there is no logical connection between one word and the next

62
Q

What is circumstantiality

A

Focus of conversation drifts, will eventually come back to original point

63
Q

What is tangentiallity

A

Individual wanders during conversation, rarely returns to original point

64
Q

What is pressure of speech

A

Frantic rushing of speech

65
Q

What is clanging

A

Individual moves on in conversation using similar sounding words, opposed to logical progression through topic

66
Q

What is echolalia

A

Individuals repeats phrases said by other person

67
Q

What are the negative symptoms of schizophrenia

A

Alogia
Avolition
Psychomotor retardation

68
Q

What is alogia

A
  • Poverty of ideas. Alogia may progress to poverty of speech
69
Q

What is avolition

A

Lack of interest and motivation

70
Q

Describe purpose of Schneider’s

A

If present, increase risk of schizophrenia.

However, can be present in other disorders such as organic and affective psychoses

71
Q

What is a the method to remember schneider’s first rank symptoms

A

ABCD

72
Q

What is the A of Schneider’s first rank symptoms

A

Auditory Hallucinations

73
Q

What are two types of auditory first-rank symptoms

A
  • Commentary

- Arguing voice

74
Q

What is the B of Schneider’s first rank symptoms

A

Broadcasting thought - Thought Disorder

75
Q

What are Thought disorder symptoms

A

Broadcasting
ECHO
Insertion
Withdrawal

76
Q

What does the C of Schneider’s first rank symptoms

A

Control

77
Q

What are the 3C’s of schender’s first-rank

A

Made affect
Made impulse
Made violation

78
Q

What is made voilation

A

Individual feels their will is controlled by an external force

79
Q

What is D of Schneider’s first-rank symptoms

A

Delusion of perception

80
Q

What are delusions of perception

A

Delusion of content following experience of normal perception

81
Q

What are the main differential diagnosis of schizophrenia

A

Schizotypal diaorder

Schizoaffective disorder

82
Q

What is schizotypal disorder

A

Where eccentric behaviour and thinking anomalies are present that mirror that of schizophrenia. However, no characteristic schizophrenia anomalies occur at any stage

83
Q

What are three particular features of schizotypal disorder

A
  • Magical thinking
  • Discomfort in close relationships
  • Quasi-psychotic episodes triggered by external events
84
Q

Define schizoaffective disorder

A

Schizophrenic and affective symptoms are present but neither are sufficient to cause diagnoses of schizophrenia

85
Q

What is first-line management for schizophrenia

A

Atypical antipsychotic
CBT
Family Intervention

86
Q

What needs to be checked before starting antipsychotic

A
  • Weight
  • Waist circumference
  • HbA1c
  • Lipid Profile
  • Prolactin
  • Assessment for movement disorders
  • Assessment nutritional status
87
Q

What is second-line for schizophrenia

A

Clozapine

88
Q

When is clozapine indicated

A

If symptoms do not improve on two different antipsychotics

89
Q

What must anyone on clozapine engage with

A

Clozapine monitoring system (CPMS)

90
Q

What does clozapine monitoring system check and why

A

FBC - due to agranulocytosis

91
Q

What is given to support social factors in schizophrenia

A

Vocational support

92
Q

What are 5 poor prognostic factors

A
  • Social withdrawal in pre-morbid personality
  • FH
  • Gradual-onset
  • Low IQ
  • Negative symptoms
  • Lack precipitant

Psychiatry (13 decks)

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