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Psychiatry Y4 > 5. Psychosis > Flashcards

5. Psychosis Flashcards

1
Q

Psychosis

A

Abnormal condition of the mind that results in difficulties determining what is real and what is not.

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2
Q

Two domains of psychosis:

A

• Perception. • Cognition

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3
Q

Hallucinations division

A

Physiological, Physical, Psychiatric

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4
Q

Delusion:

A

Disorder of thought content. Usually, false belief that is out of keeping with patient’s social and cultural background.

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5
Q

Primary delusions

A

Not understandable, not occurring in response to psychopathology

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6
Q

Primary delusions entail:

A

Delusional perception and Wahnstimmung/delusional mood

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7
Q

Delusional perception

A

true perception to which a patient attributes a false meaning; eg. Traffic light turning red interpreted as martians are about to land

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8
Q

Wahnstimmung

A

change of mood preceding a delusion, patient senses an mysterious change in the environment

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9
Q

Autochthonous delusion

A

morbid origin, not a transformation of real perception (ghosts), suggestive of schizophrenia

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10
Q

Secondary delusions and systematization

A

Where brain formulates and establishes delusions secondary to another psychopathological state, delusions induced by morbid psychopathology

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11
Q

Capgras syndrome:

A

Believe a close acquittance has been replaced by a pretender/imposter

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12
Q

Fregoli syndrome:

A

Two or more people are the same person changing disguises in order to mislead

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13
Q

Othello syndrome:

A

One believes their partner is being unfaithful

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14
Q

Cotard syndrome:

A

Nihilistic delusion (severe depression) you believe your body is rotting away/ you are dead

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15
Q

Couvade syndrome:

A

Pregnant women’s partner experiences symptoms mimicking pregnancy.

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16
Q

De Clerembault’s syndrome or erotomania:

A

Excessive sexual desire, often believing a VIP is in love with them

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17
Q

Ekbom’s syndrome:

A

Belief that one is infested with parasites

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18
Q

Factitious disorder/Munchausen:

A

Consciously pretending to have a medical illness as they have satisfaction in taking a sick role

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19
Q

VS. Hypochondriasis:

A

Unconsciously pretending they have a medical illness

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20
Q

Folie a deux:

A

Shared delusions, hallucinations between people

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21
Q

Formal Thought Disorder

A

Illogical or muddled thinking, experiences of struggling to think clearly.

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22
Q

Three features of healthy thinking (Schneider):

A
  • Constancy
  • Organization
  • Continuity
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23
Q

Tangentiality:

A

Wandering from a topic without returning to it

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24
Q

Entgleisen

A

Jumping between topics that are not connected

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25
Q

Word salad:

A

Completely incoherent speech where real words are strung together into nonsense sentences

26
Q

The Kraepelinian continuum

A

Affective disorder – schizoaffective disorder – schizophrenia/psychotic disorder

27
Q

First Rank Symptoms

A

Used to distinguish affective psychosis from schizophrenia and related ‘purely psychotic’ disorders.

28
Q

First rank formula

A

n = 11 = (3x3+2)
3 auditory hallucinations, 3 passivity phenomena, 3 thought phenomena +2 (delusional perception and somatic hallucinations)

29
Q

Positive symptoms of schizophrenia

A

Caused by excess of dopamine in mesolimbic pathway, symptoms include hallucinations and delusion – decreasing dopamine in the pathway would be therapeutic

30
Q

Negative and cognitive symptoms in schizophrenia

A

shortage of dopamine in mesocortical pathway - increasing dopamine in this pathway would be therapeutic

31
Q

Mesocortical pathway

A

Cognition and executive function

32
Q

Mesocortical, hypodopaminergic symptoms:

A

Alogia, affective flattening, avolition

33
Q

Mesolimbic pathway

A

Regulation of emotional behaviour

34
Q

Mesolimbic, hyperdopaminergic symptoms:

A

Delusions, hallucinations, disorganised speech, behaviour, thought

35
Q

Nigrostriatal pathway

A

Motor control

36
Q

Tuberoinfundibular pathway

A

Regulation of prolactin secretion

37
Q

Schizophrenia pathophysiology

A

Dopamine increased in mesolimbic pathway (Causes positive symptoms) and dopamine levels in mesocortical pathway decreased (causing negative and cognitive symptoms)

38
Q

Schizophrenia treated with Dopamine 2 antagonist

A

Reduces dopamine signalling in mesolimbic pathway – reduce positive symptoms, Negative symptoms are not addressed

39
Q

Schizophrenia treated with atypical dopamine 2 partial agonist

A

Reduced excess dopamine in mesolimbic pathway, and enhances dopamine signalling in mesocortical pathway (improving both positive and negative symptoms)

40
Q

Schizophrenia definition

A

Severe mental illness characterised by disintegration of the thinking process, of contact with reality, and of emotional responsiveness (hallucinations and delusions)

41
Q

Schizophrenia diagnosis (Schneiders 1st rank)

A

At least 1 for >1 month

  • Delusions (false and fixed beliefs)
  • Passivity (delusions of control)
  • Thought disorders (thought insertion, withdrawal, broadcasting)
  • Auditory hallucinations (thought echo, 3rd person voice, running commentary)
42
Q

Schizophrenia diagnosis

A

> =2 of the following for >=1 month
• Paranoid: persistent hallucinations in any modality
• Hebephrenic: incoherent or irrelevant speech (neologisms)
• Catatonic: excitement, posturing, waxy flexibility, negativism, negativism, mutism, stupor
• Simple Schizophrenia: negative symptoms – apathy

43
Q

Residual schizophrenia:

A

previous schizophrenia -> now just negative signs and symptoms

44
Q

1st line treatment for Schizophrenia

A

Low dose Aripiprazole/ Quetiapine or high dose Olamzapine/Risperidone

45
Q

Aripiprazole side effects

A

Initial akathisia

46
Q

Quetiapine side effects

A

Sedation and weight gain

47
Q

Olanzapine side effects

A

Weight gain

48
Q

Risperidone

A

Hyperprolactinaemia, EPSEs, sedation

49
Q

Augmentation

A

Diazepam or lithium

50
Q

Non compliance 1st line treatment for schizophrenia

A

1x monthly IM depot injection, Clopixol

51
Q

2nd line treatment for Schizophrenia

A

6 weeks, typical antipsychotics

52
Q

3rd line treatment for Schizophrenia/resistance

A

Clozapine

53
Q

Clozapine side effects

A

Neutropenia or agranulocytosis

54
Q

Mood congruent

A

‘in agreement’: manic person believes they are a powerful god

55
Q

Mood incongruent

A

‘conflicting’: laughing when your dog dies

56
Q

Schizoaffective disorder

A

A group of disorders in which both affective and schizophrenic (psychotic) symptoms are prominent equally but do not justify a full diagnosis of either of those.

57
Q

Manic type schizoaffective disorder

A

Both schizophrenic and manic symptoms prominent, develop at the same time; Single episode or recurrent disorder (majority manic episodes)

58
Q

Depressive Type schizoaffective disorder

A

Both schizophrenic and depressive symptoms prominent, develop at the same time; Single episode, or recurrent disorder (majority depressive episodes)

59
Q

Schizoaffective disorder diagnosing criteria

A

Psychotic (schizophrenic) states to persist for >=2 weeks without concurrent affective symptoms
Requires 2 episodes of psychosis:
• 1 episode lasting >2 weeks without mood disorder symptoms
• 1 episode requires obvious overlap of mood and psychotic symptoms

60
Q

Schizoaffective disorder treatment

A

As per schizophrenia

61
Q

BPAD treatment (mania+depression)

A

1st line: Fluoxetine (SSRI) + Olanzapine (antipsychotic)

2nd line: Lamotrigine

Psychiatry Y4 (26 decks)

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