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4C - Psychiatry > Assessment of Psychosis > Flashcards

Assessment of Psychosis Flashcards

1
Q

how does psychosis present

A

hallucinations
psychomotor
thought disorder
delusions
negative symptoms

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2
Q

Assessment of Psychosis

A

history
MSE
risk assessment
Physical exam

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3
Q

organic causes of psychosis
(there’s a lot)

A

Delirium, dementia, malignancy, epilepsy, head trauma, CVA, HIV/AIDS encephalitis, CJD, syphilis, metabolic (thyroid, Ca, Na, glucose), vitamin deficiencies (B1, B3, B12, folate), medications, substances

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4
Q

what classification is a delusional disorder

A

ICD-11

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5
Q

what is included in the ICD-11

A
  • Presence of a delusion or set of related delusions
  • Persists for at least 3 months
  • Absence of a depressive, manic, or mixed episode
  • Content varies across individuals, but stable within individuals - can evolve in time
  • Common forms of delusion: persecutory, somatic, grandiose, jealousy, erotomania
  • Absence of hallucinations, FTD, experiences of influence/passivity/control, or negative symptoms suggestive or schizophrenia. In some cases, there may be specific hallucinations related to the delusionary content
  • Apart from actions/attitudes directly related to the delusional system, affect, speech and behaviour typically unaffected
  • Symptoms not due to another medical condition, substances, medications, withdrawal. Not better explained by another mental disorder
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6
Q

what is capgras syndrome

A

Belief that a person closely related to the patient has been replaced by a double

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7
Q

what is fregoli syndrome

A

Identifies familiar people in strangers

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8
Q

what conditions does capgras or fregoli syndrome occur

A

schizophrenia, traumatic brain injury, affective psychosis, Alzheimer’s disease

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9
Q

what is erotomania

A

Believe that somebody of a higher social class is in love with them

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10
Q

who is more at risk of erotomania

A

F>M

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11
Q

what is othello syndrome

A

morbid jealousy
Delusional belief that partner is having an affair without any evidence

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12
Q

when is Othello syndrome more common

A

alcoholism, organic states, affective psychosis

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13
Q

what is cotard’s syndrome

A

False belief that part of the body is dead, dying, or doesn’t exist

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14
Q

when is cotards syndrome typically seen

A

psychotic depression

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15
Q

what is ekbom syndrome

A

Delusional parasitosis, describes the delusion of infestation

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16
Q

what is ekbom syndrome associated with

A

tactile hallucination (formication) in cocaine misuse, dementia, and alcohol withdrawal

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17
Q

in what conditions does ekbom syndrome occur

A

affective psychosis, delusional disorder, paranoid schizophrenia, organic brain syndromes

18
Q

what is Foli-à-deux

A

madness of 2
Delusion disorder that occurs at the same time in two people who have a strong emotional or situational link

19
Q

What’s the diagnosis?

A patient believed that an electronic device was jamming his mind. He claimed that this started 5 years ago when he picked up his telephone and heard an unusual clicking noise.

A

delusional perception

20
Q

What’s the diagnosis?

A patient on the ward believes that he has special powers and hears the voice of God telling him how to help others

A

grandiose delusion

21
Q

What’s the diagnosis?

A patient believes that her neighbour could change his appearance and even sex at will to spy on her.

A

fregoli syndrome

22
Q

What’s the diagnosis?

A patient suffering from severe depression believes that she is very wicked and about to be imprisoned for life.

A

delusion of guilt

23
Q

Whats the diagnsois

A woman believes that her husband has been replaced by an exact double

A

capras syndrome

24
Q

what’s the diagnosis

A man believes he is being tormented, followed, tricked, spied on ridiculed

A

persecutory delusion

25
Q

whats the diagnosis

A woman believes that the Prime Minister is in love with her. She has never met him and writes him regularly

A

erotomania
(De Clerambaults syndrome)

26
Q

whats the diagnosis

A man normally mildly jealous suffering from alcohol dependence becomes convinced that wife is having an affair

A

Othello syndrome

27
Q

whats the diagnosis

A patient believes that certain comments, newspapers and song lyrics are specifically directed at her

A

delusions of reference

28
Q

what substances can cause psychosis

A

Alcohol
cannabis, “legal highs
amphetamine
cocaine
hallucinogens,
inhalants/solvents
prescribed medications (antiparkinsonian drugs, corticosteroids, anticholinergics)

29
Q

what is puerperal psychosis

A

Considered a type of BPAD in DSM-V. Positive psychotic symptoms, depressive/manic symptoms also typically present.

30
Q

what cause lewy body dementia

A

alpha-synuclein cytoplasmic inclusions (Lewy bodies) in the substantia nigra, paralimbic, and neocortical areas

31
Q

what are the key features of lewy body dementia

A

Progressive cognitive impairment
Parkinsonism
Visual hallucinations
Fluctuating cognition
Repeated falls, syncope
Neuroleptic sensitivity – parkinsonism

32
Q

what are the 2 main drugs given for lewy body dementia

A

Donepezil or rivastigmine

33
Q

whats the difference between delirium and dementia

A

delirium is abrupt, lasts hours to weeks, sleep impaired, hallucinates, delusional

dementia is slow, sleep normal, no hallucinations

34
Q

what are non-pharmaceutical management of delirium

A

Calm environment, consistent caregivers
visit from friends/family
good eyesight - glasses
good hearing - hearing aids

35
Q

what pharmacological management can be done for delirium

A

haloperidol - 1st choice
quetiapine

36
Q

what must you avoid in delirium

A

Benzos!!

37
Q

What’s the psychopathology?

A 45 year old man believes his wife is having an affair as she has been frequently coming home late from work and he thinks he saw her kissing another man. He is upset and has been trying to get evidence to confront her. He has quit his job in order to follow her and taken out a loan to buy cameras to place in her car, workplace, and handbag.

A

obsession

38
Q

What is the most likely diagnosis?

An 18 year old man is brought to A&E by his flatmates because for the last fortnight he has been complaining the neighbours are talking about him and tonight stated “enough was enough” and picked up his cricket bat to go and confront them. His friends cannot hear the neighbours. The man has smoked cannabis every day for the last 6 months and has recently been experimenting with “legal highs”.

A

Psychosis secondary to psychoactive substance use

39
Q

What is the most likely diagnosis?

An 80 year old lady with macular degeneration is brought to her GP by her daughter who is concerned that her mother has been asking her to move non-existent dogs and cats off her couch. Her mother is otherwise alert, orientated, and in good health.

A

Charles Bonnet syndrome

40
Q

what is Charles bonnet syndrome

A

people who have lost some or all of their sight to see things that aren’t there. (hallucinations)

4C - Psychiatry (15 decks)

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