**_🤯Psychiatry🤯 - Psychosis Flashcards

1
Q

What is the definition of psychosis?

A

Difficulty perceiving and interpreting reality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What disorders are typically associated with “psychotic disorders”?

A

Schizoaffective disorder
Schizophrenia
Bipolar type 1
Delusional disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What 3 domains can psychotic symptoms be separated into?

A

Positive symptoms
Negative symptoms
Disorganisation symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are positive symptoms?

A

Hallucinations
Delusions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are hallucinations?

A

Perception in absence of a stimulus
Can occur in any sensory modality
Auditory (1st, 2nd, 3rd person)
Visual (consider organic cause)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How are hallucinations different to illusions?

A

An illusion is misperceiving an existing stimulus (e.g. thinking a coat on a hanger is a man when its dark)
A hallucination is when there is no stimulus at all (e.g. seeing a man even thought there is no coat on a hanger)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are delusions?

A

Fixed, false beliefs not in keeping with social/cultural norms
Persecutory/paranoid
Grandiosity, religious, nihilistic/guilt, somatic, erotomanic (leads to stalking)
Passivity experiences

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are negative symptoms?

A

Alogia - poverty of speech, slow question responses
Anhedonia/asociality - few close friends/hobbies/interests
Avolition/apathy - lack of self-care/drive/motivation
Affective flattening - lack of facial expression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are disorganisation symptoms?

A

Bizarre behaviours
Formal thought disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When can psychosis onset?

A

Can occur at any age
Peak incidence in adolescence/early 20s
Peak later in women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the course of psychosis?

A

Often chronic and episodic
Variable prognosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the morbidity of psychosis?

A

Substantial, both from disorder itself and increased risk of common health problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the mortality of psychosis?

A

15-20 life years lost
High risk of suicide in schizophrenia - 28% excess mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What signs often precede psychosis?

A

Prodromal symptoms:
6-18 months before psychosis develops
Increasing isolation
Poor self care
Social withdrawal
Declining academic performance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are some common risk factors for psychosis?

A

Environmental risk factors:
Drug use, particularly cannabis
Prenatal/birth complications
Socioeconomic deprivation/migrant status
Childhood trauma
Genetics:
Highly heritable (esp. schizophrenia)
Highly polygenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What might you look for someone with psychosis?

A

Bizarre or inappropriate clothing
Psychomotor retardation/agitation, abnormal movements (medication related)
Self-neglect, self-harm injuries
Stupor and mutism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why is assessing mood important for psychosis?

A

Some affective disorders can cause psychosis (e.g. bipolar, depression)
Depression comorbid with schizophrenia in ~30% cases)
People at high risk of psychosis often have other mental disorders

18
Q

What is meant by “thought content”?

A

Thought insertion
“I do think things that aren’t me… they’re putting thoughts in my brain”
Denied thought broadcasting or thought withdrawal (passivity phenomena)
Paranoid/persecutory delusions

19
Q

What is thought disorder?

A

Breakdown in the train of thought and logical connections between different thoughts

20
Q

What are the various forms of thought disorder, in increasing severity

A

Circumstantial - longwinded responses that eventually answer a given question
Tangential - train of thought goes off on tangents. Logical connections but question isn’t answered
Flight of ideas - Trains of thought loosely connected. May be connected by meaning semantics, sounds, rhyming or puns
Derailment - Unrelated and unconnected trains of thought
Word salad - Complete breakdown of logical connection between words and thoughts

21
Q

What is a pseudohallucination?

A

True hallucinations must be phenomenologically indistinguishable from a true perception (e.g. voices must be perceived as originating from outside, not inside, a person’s head)
Insight typically preserved in pseudohallucinosis
Example would be someone being aware that a voice is coming from their own head, maintaining insight and also being able to distinguish it from voices outside of their head

22
Q

Explain the role of cognitive impairment in schizophrenia

A

Commonly affects working memory and executive function
Poorer educational attainment (from childhood)
Cognitive impairment is stable over time and independent of psychotic symptoms
Cognitive impairments are difficult to treat and cause morbidity

23
Q

What is insight, in the context of mental health disorders as a wider subject

A

The awareness into your own mental state, symptoms and need for treatment

24
Q

What difficulties may be experienced with treating someone with poor insight into their psychosis (or any mental health disorder)?

A

Concordance with treatment
Attendance at follow-up
Willingness to be admitted to hospital
Impact on ability to have capacity to consent to treatment

25
Q

What is the next step with a first episode psychosis presentation?

A

Many people who have a first episode psychosis will not have another
Follow up for 3 years under Early Intervention in Psychosis Services

26
Q

What are the 3 types of managements options for mental health disorders?

A

Pharmacological
Psychological
Social support
BioPsychoSocial model

27
Q

What are the pharmacological management options for psychosis?

A

Antipsychotic medications
Often mainstay of treatment

28
Q

What are the psychological management options for psychosis?

A

CBT - cognitive behavioural therapy
Newer therapies, such as avatar therapy

29
Q

What are the social support management options for psychosis?

A

Supportive environments, structures, routines
Housing, benefits
Support with budheting/employment

30
Q

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

A

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

31
Q

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

A

Antagonist
Because increased dopamine activity is implicated in causing reality distortion in psychosis

32
Q

What is the primary driving factor that is implicated in causing the positive symptoms seen in psychosis?

A

Increased dopamine activity in mesolimbic dopamine system

33
Q

Why can Parkinson’s medications cause psychotic effects?

A

They are dopamine agonists
Excess dopamine - can lead to distorted reality perception

34
Q

What broad category of side effects can arise from antipsychotic medications?

A

Extrapyramidal side effects (ESPEs)

35
Q

What are ESPEs and why do they occur as a side effect of antipsychotic medications?

A

Caused due to the fact that they are dopamine antagonists
Dopamine blockade in the nigrostriatal (extrapyramidal) dopamine system - extremely similar mechanism to that of Parkinson’s
Parkinson’s = lack of dopaminergic neurons and synaptic dopamine

36
Q

Why does the amount of dopamine in a person’s brain need to be carefully managed?

A

Too little dopamine = Parkinson’s like symptoms (Parkinsonism)
Too much dopamine = Psychotic symptoms

37
Q

What are the classic features of Parkinsonism?

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:

38
Q

How can ESPEs be managed?

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)

39
Q

Outline atypical antipsychotic drugs

A

Antipsychotics divided into older typical drugs and newer atypical drugs
Also referred to as first and second generation
Atypical antipsychotics associated with a lower risk of EPSE
Less likely to cause EPSEs due to 5HT-2A antagonism (context, not required)

40
Q

Broadly outline the other side effects that antipsychotics can have

A