Psychiatry Flashcards
What are the 5 P’s for formulation?
Problem Predisposing Precipitating Perpetuating Protective
What are the 10 areas of a MSE?
Appearance Behaviour Speech Mood Affect Thought form Thought content Perception Cognition Insight
What would you like to ask in a psychiatric history?
Setting the scene - job, relationships, age, name Presenting complaint History of presenting complaint Past psychiatric history Medications Past medical history Family history Social history Personal History Substance use Forensic history Premorbid history
What is the believed aetiology of schizophrenia?
Susceptibility due to genetics and environment that life experiences can then trigger
What are the parts of the neurodevelopmental hypothesis?
Hypoxic brain injury at birth or expose to a viral infection.
Temporal lobe epilepsy or smoked cannabis before brain was fully developed.
Changes in brain - enlarged ventricles, small amounts of grey matter loss and smaller, lighter brains.
What is the Neurotransmitter hypothesis?
excess of dopamine and overactivity of mesocorticolimbic system. Less dopamine activity in the mesocortical tracts cause negative symptoms therefore dopamine antagonists work best at treating the positive symptoms.
Increased serotonin and reduced glutamate
A patient has paranoid delusions and auditory hallucinations what form of schizophrenia are they most likely to have?
Paranoid schizophrenia
A 28 year old who first got symptoms at 18 has mood changes, unpredictable behaviour, shallow affect and fragmentary hallucinations. What is the most likely diagnosis?
Hebephrenic Schizophrenia
A patient with schizophrenia has only experienced symptoms such as avolition, anhedonia, asocial behaviour and alogia. What are these symptoms and what is the most likely diagnosis?
Negative symptoms
Simple schizophrenia
A patient with schizophrenia has problems with posturing, rigidity and stupor. What is the most likely form?
Catatonic schizophrenia
A patient with schizophrenia has suffered from both positive and negative symptoms however recently the positive symptoms have appeared to have stopped. What form is this most likely to be?
Residual schizophrenia
What are the 4 risk factors in pregnancy/birth for schizophrenia?
Malnutrition
Viral infection
Pre-eclampsia
Emergency caesarean section
What are the 9 positive symptoms in schizophrenia?
Thought echo Thought insertion or withdrawal Thought broadcasting 3rd Person auditory hallucinations delusional perception passivity odd behaviour thought disorder lack of insight
What are the 7 negative symptoms of schizophrenia?
Avolition - lack of motivation Asocial behaviour Anhedonia Alogia - poverty of speech Blunted affect Cognitive deficits poor self control
You suspect a patient had schizophrenia what investigations would you want to do and why?
Investigations to rule out other pathology.
Baseline bloods
Urine culture - UTI
Urine drug screen
HIV/Syphilis
Serum lipids (before starting antipsychotics)
What are the 2 criteria for schizophrenia diagnosis in ICD-10?
- 1 first rank symptom or persistent delusions for at least a month.
- No other cause for psychosis
What is the action of typical anti-psychotics?
Generalised D2 receptor antagonists
Name 3 typical antipsychotics?
Haloperidol Chlorpromazine Flupentixol Decanoate (depot)
What are the side effects of typical anti-psychotics and how do they differ to atypical anti-psychotics?
Extrapyramidal Hyperprolactinemia Metabolic Anticholinergic Neurological - atypical have reduced extrapyramidal and hyperprolactinemia
What is the action of atypical anti-psychotics?
Selective D2 receptor antagonists and block serotonin 5-HT3 receptors.
Name 5 examples of atypical anti-psychotics?
Olanzapine Clozapine Risperidone Amisulpride Quetiapine
What is the action of aripiprazole?
Partial dopamine agonist - even less likely to cause extrapyramidal side effects
Why must patients on clozapine have monthly blood tests?>
Risk of agranulocytosis
- neutropenia
What is the positive of clozapine for the patient?
No sexual dysfunction
also very effective
How well does olanzapine tend to be received?
Well - only symptom tends to be weight gain which should trail off after a few months.
What psychological treatments are available for patients with schizophrenia?
CBT
Family Therapy
What are schneider’s first rank symptoms of schizophrenia? (6)
Thought echo Thought insertion/withdrawal Thought broadcasting 3rd person auditory hallucinations Delusional perception Somatic passivity
What are the negative symptoms of schizophrenia?
Alogia (poverty of speech) Avolition (lack of motivation) Anhedonia Asocial behaviour Affect - blunted cognitive deficits
What are the 2 factors for diagnosis of schizophrenia?
Must have a first rank symptom or persistent delusion for at least a month.
Must not be accountable to anything else. (drugs, alcohol, brain disease - dementia, depression or mania)
