Psychiatry Flashcards
Schizophrenia
the most common form of psychosis, generally a lifelong condition that can take a chronic or relapsing & remitting form with episodes of acute illness
Schizophrenia epidemiology
usually presents in adolescences & early 20s
generally females have a later age of occurrence
responsible for 25% of all psychiatric hospitalisations of 10-18 year olds
Risk factors for schizophrenia
family history* cannabis use obstetric/perinatal complications ACEs psychological stress migrant status
Presentation of schizophrenia
deterioration in functioning over the preceding months
4 symptomatic domains
Positive symptoms:
hallucinations (usually auditory), delusions, thought disorders (e.g. broadcasting, withdrawal, insertion), speech disorder, derealisation
Negative symptoms:
asocial behaviour, affective blunting, anhedonia, alogia (↓ speech), abolition (↓ motivation), social withdrawal, self neglect
Catatonia:
extreme loss or malignant excess of motor activity
catatonic stupor/rigidity/negativism/excitement
cognitive deficits/affctive symptoms/physical symptoms:
problems with language/memory/attention/excutive function, depression, elation, motor coordination deficits, left-right disorientation, sensory integration deficit
Positive symptoms of schizophrenia
hallucinations (usually auditory) delusions thought disorders (e.g. broadcasting, withdrawal, insertion) speech disorder derealisation
Negative symptoms of schizophrenia
asocial behaviour affective blunting anhedonia alogia (↓ speech) abolition (↓ motivation) social withdrawal self neglect
Catatonic symptoms fo schizophrenia
extreme loss or malignant excess of motor activity
catatonic stupor/rigidity/negativism/excitement
cognitive deficits/affective symptoms/physical symptoms of schizophrenia
problems with language/memory/attention/excutive function depression elation motor coordination deficits left-right disorientation sensory integration deficit
DSM-5 criteria for schizophrenia
Schizophrenia can be diagnosed if the following conditions are met.
Two or more of the following symptoms are present: delusions, hallucinations, disorganised speech, disorganised/catatonic behaviour, or negative symptoms. At least one of the symptoms must be a positive symptom.
Symptoms occur for a period of at least 1 month (less, if treated) and are associated with at least a 6-month period of functional decline
Symptoms do not occur concomitantly with substance use or with a mood disorder episode.
ICD-11 criteria for schizophrenia
Criteria for schizophrenia require a combination of at least one first-rank psychotic symptom or at least two other symptoms, including other positive psychotic symptoms, disorganised thinking or speech, negative symptoms, or catatonia.
First-rank psychotic symptoms include thought echo, thought insertion or withdrawal and thought broadcasting, delusions of control, influence or passivity, delusional perception, other strange delusions, and auditory hallucination commenting on the patient’s behaviour or talking about the patient in the third person.
Investigating schizophrenia
clinical diagnosis
consider FBC & LFTs, urine drug screen
Management of schizophrenia
1st line: PO atypical antipsychotic e.g. risperidone/olanzapine
NB clozapine = antipsychotic of choice for treatment resistant schizophrenia
Cognitive behavioural therapy (CBT) electroconvulsive therapy (ECT) - if resistant to pharmacological treatment
Monitoring of treatment for schizophrenia
- extrapyramidal effects/metabolic syndrome/excessive prolactin
- cardiac abnormalities (baseline ECG, motor for QT prolongation)
- postural hypotension
poor prognostic factors for schizophrenia
↑ duration of untreated psychosis early/insidious/gradual onset of schizophrenia male sex negative symptoms FHx continued substance misuse
Bipolar disorder
Also known as bipolar affective disorder
chronic episodic mental illness associated with behavioural disturbances which is characterised by episodes of mania (or hypomania) and depression
Types of bipolar disorder
Type I: presents with manic episodes interspersed by major depressive episodes (most common type)
Type II: pt do not meet criteria for full mania & are described as hypomanic, has ↓ associated dysfunction
NB: rapid cycling - defined as four or more cycles of depression and mania a year, with no intervening asymptomatic episodes
Bipolar disorder epidemiology
usually develops in late teen years
usually seen <25 y/o
Risk factors for bipolar disorder
family history (50-10x ↑ risk) onset of mood disorder <20y/o stressful life events ACEs history of depression history of substance misuse presence of anxiety disorder
Presentation of bipolar disorder
Manic phase:
elevated mood, ↑quantity&speed of physical/mental activity, grandiose ideas, pressure of speech, ↑energy, racing thoughts/flight of ideas, overactivity, ↑appetite, sexual disinhibition, ↓need for sleep, hallucinations, delusions, lack of isnight
Hypomanic phase:
persistent mild elevation in modd
↑ activity/energy levels
NO psychotic symptoms
Depressive phase: low mood (worse in mornings), ↓energy levels, unkempt, anhedonia, ↓self-esteem, despair, guilt, ↓appetite, weight loss, loss of libido, altered sleep pattern, self neglect
Psychological functioning:
difficulties in relationships & at work
Manic symptoms of bipolar disorder
elevated mood ↑quantity&speed of physical/mental activity grandiose ideas pressure of speech ↑energy racing thoughts/flight of ideas overactivity ↑appetite sexual disinhibition ↓need for sleep hallucinations delusions lack of insight
Depressive symptoms of bipolar disorder
low mood (worse in mornings) ↓energy levels unkempt, anhedonia ↓self-esteem despair, guilt ↓appetite weight loss loss of libido altered sleep pattern self neglect
Differentiating hypomania and mania
NO psychotic symptoms in hypomania
Hypomania does not impair functional ability significantly
hypomania is shorter lasting than mania
ICD-10 criteria for bipolar disorder
≥2 episodes of a persons mood & activity levels being significantly disturbed (at least one of which is mania/hypomania)
3 of the following confirm mania
-grandiosity/inflated self esteem, pressured speech, ↓need for sleep, flight of ideas, distractibility, psychomotor agitation, excessive involvement in pleasurable activity without thought for consequence
±psychotic symptoms e.g. hallucinations/delusions
frequency & duration of episodes are variable and may even vary day to day/within a day between mania/depression/hypomania
Management for bipolar disorder
self help/support groups
CBT/interpersonal therapy
Mood stabilisers
1st line: lithium (valproate/olanzapine if lithium not tolerated)
2nd line: add valproate if lithium alone ineffective
For acute mania:
give antipsychotic e.g. haloperidol/olanzapine/risperidone
consider IM sedation e.g. bentos
For acute depression:
offer fluoxetine ± olanzapine/quetiapine