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Phase 3A Medicine > Psychiatry - Psychosis > Flashcards

Psychiatry - Psychosis Flashcards

1
Q

What is psychosis?

A

People lose touch with reality, experiencing hallucinations and delusions

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2
Q

What is a hallucination?

A

A perception in the absence of a stimulus ie. hearing, seeing, smelling touching or tasting something that isn’t there.

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3
Q

What is a delusion?

A

A fixed false belief held despite rational argument or evidence to the contrary. It cannot be explained by the patient’s cultural, religious or educational background.

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4
Q

What is the lifetime risk of developing schizophrenia?

A

1%

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5
Q

What is the typical age of onset of schizophrenia in men and women?

A

Men 20-30

Women 50-60

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6
Q

Which gender is effected more by schizophrenia?

A

Both equal

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7
Q

Age of onset of schizophrenia generally?

A

Second to third decade

But another peak in fourth-fifth

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8
Q

Lifetime risk of developing schizophrenia in first degree relatives of people with schizophrenia?

A

10%

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9
Q

Aetiology of schizophrenia? (Give 5)

A
  1. Genetics
  2. Obstetric complications e.g. pre-eclampsia, low birth weight, emergency C section, pre-natal malnutrition
  3. Substance misuse
  4. Social disadvantage
  5. Urban life and death
  6. Migration
  7. Ethnicity - Black Carribbean and African
  8. Expressed emotion - highly critical or overly involved relatives
  9. Premorbid personality - schizotypal disorder
  10. Adverse life experience- sexual or physical abuse
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10
Q

Give 4 examples of illicit substances that can cause psychotic symptoms

A
  1. Cannabis
  2. Amphetamines
  3. Cocaine
  4. LSD
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11
Q

Why does the risk that smoking cannabis has on developing schizophrenia vary from person to person?

A

`COMT (catechol-O-methyl transferase) breaks down dopamine.
COMT is coded for by 2 alleles Val and Met
The Val allele increases the risk of schizophrenia in cannabis users. So those who are Val-Val are at highest risk.

Also the type of cannabis smoked contains different concentrations of tetrahydrocannabinol - e.g. skunk is dangerous

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12
Q

What are the main three theories surrounding the development of schizophrenia?

A
  1. Neurodevelopmental
  2. Neurotransmitter
  3. Psychological
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13
Q

What is the evidence for the neurotransmitter theory of schizophrenia? (The dopamine hypothesis - that positive symptoms occur as a result of dopamine overactivity in the mesolimbic tracts and negative symptoms occur due to underactivity of dopamine in the mesocortical tracts)

A
  1. All known antipsychotics are dopamine antagonists (receptor blockers)
  2. Antipsychotics work better against positive rather than negative symptoms
  3. Dopaminergic agents e.g. amphetamine, cocaine can all induce psychosis.
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14
Q

What are antipsychotics?

A

Dopamine antagonists

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15
Q

What are the three clinical phases of schizophrenia?

A
  1. At risk mental state (ARM)
  2. Acute phase - positive symptoms
  3. Chronic phase - negative symptoms
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16
Q

Generally, how much shorter life-span does a person with schizophrenia have, when compared to the general population?

A

25 years

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17
Q

On what receptor do antipsychotics work?

A

Dopamine (D2) receptor

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18
Q

What are Schneider’s first rank symptoms?

A
  1. Delusional perception
  2. Passivity phenomena
  3. Third person auditory hallucinations
  4. Thought alienation (interference)
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19
Q

How many first rank and secondary symptoms are required to diagnose schizophrenia?

A

First rank = More than one

Secondary = 2 or more

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20
Q

Give 6 secondary symptoms of schizophrenia?

A
  1. Delusions
  2. 2nd person auditory hallucinations
  3. Hallucinations in any other modality
  4. Thought disorder
  5. Catatonic behaviour
  6. Negative symptoms
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21
Q

Give 3 examples of negative symptoms

A
  1. Blunting of affect
  2. Amotivation (Avolition)
  3. Poverty of Speech
  4. Poverty of Thought
  5. Self-neglect
  6. Lack of insight
  7. Poor non-verbal communication
  8. Deterioration in functioning
  9. Loss of interest (anhedonia)
22
Q

Give 5 types of delusion

A
  1. Thought interference (alienation)
  2. Grandiose
  3. Passivity
  4. Delusional perception
  5. Delusions of reference
  6. Nihilistic
  7. Persecutory
23
Q

What are the three forms of thought interference?

A
  1. Thought insertion
  2. Thought withdrawal
  3. Thought broadcasting
24
Q

Give 5 examples of positive symptoms

A
  1. Hallucinations
  2. Delusions
  3. Passivity phenomena
  4. Thought alienation
  5. Lack of insight
  6. Disturbance in mood
  7. Catatonic behaviour
25
Q

What is a delusional perception?

A

A true perception to which an individual attributes a false perception

26
Q

How long do positive symptoms have to be present before diagnosing schizophrenia?

A

1 month

Including prodrome and chronic phase - 6 months

27
Q

Give 6 different forms of psychoses

A
  1. Schizophrenia
  2. Delusional disorder
  3. Schizotypal disorder
  4. Depressive psychosis
  5. Manic psychosis
  6. Organic psychosis
28
Q

What is the drug used to treat refractory schizophrenia?

A

Clozapine

29
Q

What is the definition of refractory schizophrenia? Ie. when would you prescribe clozapine?

A

Failure to respond to 2 or more antipsychotics at least one of which is an atypical when given at the therapeutic dose for at least 6 weeks

30
Q

What is the main (serious) side effect of clozapine?

A

Agranulocytosis in 0.7%

Weekly blood tests must be conducted on patients starting on the drug as 3% become neutropenic

31
Q

Give three examples of a typical antipsychotic

A

Chlorpromazine, haloperidol, flupentixol decanoate

32
Q

Give three examples of an atypical antipsychotic

A

Olanzapine, risperidone, quetiapine, aripiprazole, clozapine

33
Q

What is the other name for first generation and second generation antipsychotics?

A

First generation - typical

Second generation - atypical

34
Q

Give the advantages and disadvantages of typical (first generation) antipsychotics

A

Advantage - cheap, effective and can be used as a depo

Disadvantage - cause EPSE’s! can increase prolactin levels

35
Q

Give the advantages and disadvantages of atypical (second generation) antipsychotics

A

Advantage - don’t cause EPSE’s, don’t increase prolactin levels
Disadvantage - can’t be used as depo, more expensive

36
Q

Which of the second generation antipsychotics can increase prolactin levels?

A

Risperidone

37
Q

How to second generation antipsychotics work?

A

Block dopamine and serotonin 5-HT2 receptors

38
Q

What type of antipsychotic is clozapine?

A

Atypical (weak dopamine antagonist)

39
Q

What are the 4 EPSE’s associated with typical antipsychotic use?

A
  1. Dystonia - sustained involuntary muscle spasm
  2. Akithisia - subjective feeling of restlessness
  3. Tardive dyskinesia - rhythmic involuntary movements of mouth, face, limbs and trunk (grimace/chew)
  4. Parkinsonism - resting tremor, rigidity, bradykinesia +/- mask like facies and shuffling gait
40
Q

How do you treat dystonia secondary to antipsychotic use?

A

Anticholinergic e.g. procyclidine

41
Q

How do you treat akithisia?

A

Decrease dose or change of antipsychotic

+/- benzo +/- propanolol

42
Q

How do you treat tardive dyskinesia?

A

Switch to atypical
AVOID anticholinergic
(Note/ this can be irreversible)

43
Q

How to treat parkinsonism?

A

Anticholinergic (procyclidine)

44
Q

Give 5 side effects of antipsychotics

A
  1. Anticholinergic side effects - tachycardia, dry mouth, blurred vision, constipation, urinary retention
  2. Seizures
  3. Arrhythmias
  4. Weight gain (olanzapine and clozapine)
  5. Hyperprolactinaemia - galactorrhoea, amenorrhoea, gynaecomastia, hypogonadism
  6. Sedation
  7. EPSEs
  8. Increased risk of diabetes
  9. Neuroleptic malignant syndrome
45
Q

Which two antipsychotics typically cause weight gain?

A

Clozapine and olanzapine

46
Q

What is often the trigger for neuroleptic malignant syndrome (NMS)?

A

New antipsychotic or increased dose

47
Q

What is neuroleptic malignant syndrome and give 3 clinical features?

A

NMS = A life threatening reaction to antipsychotic drugs that is typically related to fever, altered consciousness, muscle stiffness and rigidity, and disturbance of the autonomic nervous system (tachycardia, labile BP)

48
Q

What is the management of neuroleptic malignant syndrome?

A
  1. Stop antipsychotic

2. Get urgent medical treatment

49
Q

What investigation and results would you see in NMS?

A
  1. Increased CK

2. Increased WCC

50
Q

What is the most serious consequence of NMS?

A

Death from acute renal failure secondary to skeletal muscle breakdown

Phase 3A Medicine (12 decks)

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