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Phase 3a > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What is the cardinal feature of schizophrenia and related psychotic illness?

A

The presence of psychotic symptoms: hallucinations and/or delusions

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2
Q

What is meant by ‘positive symptoms’ of schizophrenia?

A

An excess or a distortion of normal functioning

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3
Q

What is meant by ‘negative symptoms’ of schizophrenia?

A

A decrease or loss of functioning

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4
Q

What are the positive symptoms of schizophrenia?

A

1) Delusions
2) Hallucinations
3) Formal thought disorder

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5
Q

What are the negative symptoms of schizophrenia?

A

1) Impairment or loss of volition, motivation, and spontaneous behaviour
2) Loss of awareness of socially appropriate behaviour and social withdrawal
3) Flattening of mood, blunting of affect, and anhedonia
4) Poverty of thought and speech

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6
Q

DSM-5: what are the criteria required for a diagnosis of schizophrenia?

A

1) Characteristic symptoms
2) Social/occupational dysfunction
3) Duration (disturbance for 6 months + 1 month of symptoms meeting criteria)
4) Exclusions (rule other things out)

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7
Q

DSM-5: what are the ‘characteristic symptoms’ needed for a diagnosis of schizophrenia?

A

2+ of the following needed (at least one must be 1, 2, or 3)

1) Delusions
2) Hallucinations
3) Disorganised speech
4) Grossly disorganised or catatonic behaviour
5) Negative symptoms

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8
Q

DSM-5: what must be excluded in order to make a diagnosis of schizophrenia?

A

1) Schizoaffective disorder + depressive/bipolar disorder with psychotic features
2) Physiological effects of a substance (abuse or medication)
3) If history of ASD or communication disorder of childhood onset –> special considerations must be made

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9
Q

What are the three main theories for the cause of schizophrenia?

A

1) Neurochemical Abnormality Hypotheses
2) The Neurodevelopmental Hypothesis
3) The Disconnection Hypothesis

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10
Q

What are the neurotransmitter abnormalities proposed to cause schizophrenia?

A

1) Dopaminergic overactivity
2) Glutaminergic hypoactivity
3) Serotonergic (5-HT) overactivity
4) Alpha-adrenergic overactivity
5) GABA hypoactivity

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11
Q

What are the three distinct phases regarding the management of schizophrenia and related psychoses?

A

1) Prodromal phase
2) Acute psychotic episode
3) The maintenance phase

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12
Q

What is the prodromal phase of schizophrenia/psychosis

A

A period of disturbed behaviour and partial psychotic symptoms that suggest that schizophrenia is imminent and inevitable (in the presence of other RFs)

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13
Q

What is the typical presentation of the prodromal phase of schizophrenia?

A

Non-specific or negative symptoms. followed by attenuated, mild, positive symptoms

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14
Q

Do antipsychotics help prevent psychosis in the prodromal phase?

A

No (won’t decrease risk or prevent)

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15
Q

How long should someone in the prodromal phase of psychosis be monitored/followed-up for?

A

3 years

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16
Q

When does a first schizophrenic episode tend to occur?

A

In adolescence or early adult life

17
Q

Schizophrenic relapses tend to relate to what three things?

A

1) medication non-compliance
2) Drug or alcohol misuse
3) Life stresses
(or a combination of these)

18
Q

What are the options of management for initial treatment of acute psychosis?

A

Option 1:

  • 2nd generation antipsychotic (olanzapine, amisulpride, risperidone, quetiapine)
  • Use long-acting BDZ (e.g. diazepam) to control non-acute anxiety/behavioural disturbance

Option 2:
- low-potency 1st generation antipsychotic (e.g. chlorpromazine)

19
Q

How can the extra-pyramidal side effects (EPSEs) of antipsychotics be managed?

A

1) Give anticholinergic (procyclidine)
2) Give amantadine
3) Reducing antipsychotic dose
4) Switch to lower-potency/SGA agents

20
Q

What generation of antipsychotic is more likely to cause EPSEs?

A

First generation

21
Q

What are some extra-pyramidal symptoms?

A

Parkinsonism (think classic Parkinson’s symptoms), dystonia, akathisia

22
Q

What psychological therapy can be given to schizophrenic patients?

A

1) Family therapy + psychoeducation
2) Individualised CBT approaches
3) Compliance therapy
3) Art therapies

23
Q

Give some examples of first generation antipsychotics:

A

1) Chlorpromazine
2) Pericyazine
3) Trifluoperazine
4) Flupentixol
5) Haloperidol
6) Pimozide
7) Sulpiride

24
Q

What are some anti-adrenergic side effects?

A

Sedation, orthostatic hypotension, dry mouth, N+V, sexual dysfunction

25
Q

What are some anti-muscarinic side effects?

A

Dry mouth, dilation of pupils (blurred vision), constipation, dry skin, urinary retention, bradycardia

26
Q

What are some antihistaminic side effects?

A

Sedation, weight gain

27
Q

Give examples of some second generation antipsychotics:

A

1) Olanzapine
2) Risperidone
3) Paliperidone
4) Quetiapine
5) Clozapine
6) Amisulpride
7) Aripiprazole
8) Lurasidone

28
Q

What drug is commonly given for treatment-resistant schizophrenia?

A

Clozapine

29
Q

What is treatment-resistant schizophrenia?

A

Failure to respond to 2+ antipsychotic medications given in therapeutic doses for 6 weeks or more

30
Q

When should clozapine be offered to people?

A

When their schizophrenia has not adequately responded to treatment despite the sequential use of adequate doses of at least two different antipsychotic drugs (at least one of which was a non-clozapine SGA)

31
Q

Why must clozapine use be closely monitored, and how is it monitored?

A

Risk of fatal agranulocytosis

Regular FBC checks to monitor for neutropenia

32
Q

What are the common side effects of clozapine?

A

Anticholinergic: constipation, dry mouth, blurred vision, difficulty passing urine

Antiadrenergic: hypotension, sexual dysfunction

Other: sedation, weight gain, N+V, ECG changes, headache, fatigue, tachycardia, hypertension, drowsiness, dizziness

33
Q

What are antipsychotic depot drugs?

A

A long acting injection giving into large muscle, allowing for a sustained release over 1-4 weeks

34
Q

What are the indications for antipsychotic depot injection?

A

1) Poor compliance with oral treatment
2) Failure to respond to oral medication
3) Memory problems/other factors interfering with ability to take medication regularly
4) Clinical need to ensure patient compliance (detained under MHA)

35
Q

What criteria must be fulfilled for a diagnosis of depression?

A

1) Symptoms must be present for at least 2 weeks and represent a change from normal
2) Are not secondary to the effects of drug/alcohol misuse, medication, a medical disorder, or bereavement
3) May cause significant distress and/or impairment of social, occupational, or general functioning

36
Q

What are the core symptoms of depression?

A

1) Depressed mood
2) Anhedonia
3) Weight change
4) Disturbed sleep
5) Psychomotor agitation/retardation
6) Fatigue or loss of energy
7) Reduced libido
8) Feelings of worthlessness or excessive or inappropriate guilt
9) Diminished ability to think or concentrate or indecisiveness
10) Recurrent thoughts of death or suicide

37
Q

What are the somatic symptoms of depression?

A

1) Loss of emotional reactivity
2) Diurnal mood variation
3) Anhedonia
4) EMW
5) Psychomotor agitation or retardation
6) Loss of appetite and weight
7) Loss of libido

38
Q

What is the minimum criteria for a clinically significant depressive episode? (DSM-5 and ICD-10)

A

ICD-10: 2 typical symptoms (depressed mood, anhedonia, fatigue) + at least two other core symptoms

DSM-5: 5+ core symptoms (at least one must be depressed mood or anhedonia)

39
Q

What are the subtypes of depression?

A

1) Without somatic symptoms (irritable/hostile depression or anxious depression)
2) With somatic symptoms
3) With psychotic symptoms

Phase 3a (7 decks)

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