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Psychiatry > Psychoses > Flashcards

Psychoses Flashcards

1
Q

What is the definition of a delusion?

A

A belief, unshakeably held, which is outside of the individual’s usual social and cultural belief system

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2
Q

What is ‘psychosis’?

A

Psychosis is a mental illness that prevents people from being able from being able to distinguish between the real world and the imaginary world.

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3
Q

What is the difference between loosening of thought and flight of ideas?

A

Both involve jumping between one topic to another, but in ‘flight of ideas’ there is a discernible link between the ideas (it might be a cue or a rhyme etc.) while in ‘loosening of thought’ there is no link between the topics

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4
Q

What is the difference between an illusion and a hallucination?

A

Illusions are disturbances of perception based on an external stimulus, while hallucinations have no external stimulus

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5
Q

What types of hallucinations can a person get?

A 
Auditory (most common type in psychiatry)
Visual
Olfactory
Gustatory
Somatic - Tactile, kinestetic, visceral
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6
Q

What are the two types of disturbance of perception?

A

Illusion

Hallucination

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7
Q

What is a hallucination?

A

A disturbance of perception which is not based on an external stimulus.

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8
Q

Give 2 positive symptoms of schizophrenia

A

Hallucinations

Delusions

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9
Q

What is an ‘overvalued idea’?

A

A type of disturbance of thought connect, where a person has a thought which is culturally reasonable but they take it to the boundaries of acceptability. The tenacity of the thought is usually less than a delusion (i.e. they have some insight into the thought being unreasonable)

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10
Q

Give 2 types of disturbances of thought content

A

Overvalued ideas

Delusions

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11
Q

What is the difference between a primary and secondary delusion?

A

Primary - Comes out of the blue e.g. ‘MI5 is following me’
Secondary - The person experiences a hallucination and attributes the delusions to this e.g. ‘I can hear voices talking about me and I therefore know that MI5 is following me’

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12
Q

What is a grandiose delusion?

A

The person believes they are of great importance, have supernatural powers, enormous wealth etc.

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13
Q

What is a persecutory delusion?

A

Belief that a person or organisation is conspiring to harm / follow / kill the person e.g. ‘MI5 are following me’

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14
Q

What is a delusion of reference?

A

Belief that a person / event / object which is unrelated to the person has a personal significance to them. They may believe that something in the media is specifically directed at them, or that the media is trying to convey a message directly to them. This may involve TV personalities, stories, etc.

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15
Q

What is Beck’s cognitive triad?

A

Negative thoughts of the self, the world and the future

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16
Q

What are the two types of ‘misidentification’ delusions?

A

Capgras syndrome - The belief that someone known to them is an identically looking imposter
Fregoli’s syndrome - Belief that a stranger is actually familiar to them but in disguise

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17
Q

What is a delusion of control?

A

Belief that someone outside their body is controlling their behaviour

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18
Q

What is neologism?

A

Where a person will make up words which make sense to them but have no sense in reality

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19
Q

What is ‘talking past the point’?

A

Where the person will come very close to talking about the subject matter but never quite get there

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20
Q

What is perseveration?

A 
Where the person keeps returning to the same topic of thought over and over, repeating themselves. Example:
Dr: What is the capital of Italy?
P: Rome
Dr: What is the name of this object? 
P: Rome
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21
Q

What is the difference between a second and third person auditory hallucination?

A

Hearing voices:
Second person - The voices are talking directly to the patient
Third person - The voices are talking to each other about the patient

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22
Q

List some organic causes of psychosis

A 
Delirium
Epilepsy
Dementia
Drugs e.g. steroids, dopamine agonists
Substance misuse e.g. LDS, cocaine, ecstasy
Space occupying lesion
HIV
etc.
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23
Q

What is the difference in prevalence of schizophrenia between men and women?

A

There is no difference in prevalence, but men tend to be affected earlier and more severely than women

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24
Q

What is the lifetime risk of schizophrenia?

A

1%

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25
Q

What are the 5 first rank symptoms of schizophrenia?

A
  • Auditory hallucinations (3rd person auditory, running commentary, or ‘echo de la pensee’ i.e. their own thoughts being spoken aloud)
  • Thought withdrawal, insertion, broadcast
  • Somatic delusions
  • Delusional perception
  • Delusions of control
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26
Q

What are the 3 neurochemical changes thought to relate to the development of schizophrenia?

A 
Increased dopamine
Decreased glutamate
Increased serotonin (5-HT)
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27
Q

What is the prognosis in schizophrenia?

A
  • About 25% of those with first psychotic episode will experience no relapse
  • 65% are susceptible to relapses or continue to have symptoms
  • 10% cannot function outside of hospital
  • Increased risk of suicide and higher mortality rate than general population
28
Q

What must you warn the patient about how long it takes for antipsychotic medication to work?

A

It is not an immediate effect - it may take 2-4 weeks to have a clinical effect on the symptoms

29
Q

What is the mainstay of treatment for schizophrenia?

A

Dopamine antagonists (primarily acting on post synaptic D2 receptors)

30
Q

Give an example of a low potency typical antipsychotic

A

Chlorpromazine

31
Q

Give an example of a high potency typical antipsychotic

A

Haloperidol

32
Q

Which causes less extra-pyramidal side effects: Low potency or high potency typical antipsychotics?

A

Low potency

33
Q

What are some extra-pyramidal side effects?

A

Dystonia
Parkinsonism
Akathisia
Tardive dyskinesia

34
Q

Give the name of an antimuscarinic drug which can be given in acute episodes of dystonia caused by antipsychotic medication

A

Procyclidine (given IV or IM in these situations)

35
Q

What is dystonia?

A

Typical EPSE resulting from antipsychotic use. Characterised by maximum contraction of muscle groups which are involuntary and sustained.

36
Q

What is akathisia?

A

Restlessness, usually of the lower limbs, and the inability to sit still

37
Q

Procyclidine is useful for treating which types of extra-pyramidal side effect?

A

Dystonia

Parkinsonism

38
Q

What might be considered for ‘treatment’ of tardive dyskinesia?

A

Tetrabenzine

39
Q

Give 6 examples of atypical antipsychotics

A 
Risperidone
Olanzapine
Quetiapine
Amisulpride
Aripriazole
Clozapine
40
Q

List some important side effects of typical antipsychotic medication

A
  • Extra-pyramidal side effects
  • Drowsiness
  • Hyperprolactinaemia
  • Cardiovascular disease
  • Prolonged QT interval
  • Metabolic syndrome: Weight gain, hyperglycaemia, deranged cholesterol
  • Reduced seizure threshold
  • Postural hypotension
  • Anticholinergic side effects
  • Risk of neuroleptic malignant syndrome
41
Q

What is the drug of choice for ‘treatment resistant schizophrenia’?

A

Clozapine

42
Q

What pre-treatment tests and monitoring are required for clozapine?

A

Pre-treatment: ECG and FBC
Monitoring: BP and Pulse
FBC check weekly for 18 weeks, then fortnightly for 1 year then monthly after that

43
Q

Why is it important to check the FBC of a patient taking clozapine?

A

Can (rarely) cause neutropenia and agranulocytosis which may not happen until 8-10 weeks after treatment started.

44
Q

Why is it potentially dangerous to stop smoking whilst taking clozapine?

A

Smoking causes increased levels of clozapine, so stopping smoking without checking the levels of clozapine can cause dangerously high levels

45
Q

Give some side effects of clozapine

A 
Sore throat, fever
Hypersalivation
Constipation
Seizures
Urinary incontinence
Drowsiness / sedation
Hypotension
Tachycardia
Metabolic problems: Significant weight gain, hyperglycaemia, raised cholesterol
PE
Myocarditis
Cardiomyopathy
Neutropenia / agranulocytosis
46
Q

What might be a useful blood marker for checking a patient’s compliance with risperidone? Why?

A

Prolactin levels - Risperidone causes significantly raised prolactin so if the patient has been taking their medication, their prolactin will be raised

47
Q

Which drug causes least amount of EPSEs and so can be useful if patients are suffering with side effects?

A

Quetiapine

48
Q

What is the key side effect to remember with olanzapine?

A

Metabolic effects - Significant weight gain, dysregulation of glucose (increased risk of diabetes)

49
Q

What would be the first-line treatment for an acute episode of psychosis?

A

Atypical antipsychotic e.g. olanzapine, risperidone, quetiapine
Benzodiazepine e.g. diazepam (if agitated / aggressive for sedation)

50
Q

Give 3 types of disturbance of thought stream

A

Pressure of thoughts
Poverty of thoughts
Thought block

51
Q

What is ‘pressure of thoughts’?

A

When a person talks, usually quite quickly, about a varied number of topics and is usually quite hard to follow

52
Q

What is ‘poverty of thoughts’?

A

Few thoughts, lacking in variation, may be repetitive

53
Q

What is ‘thought block’?

A

Stream of thought suddenly becomes interrupted - the patient may report that their mind has gone blank

54
Q

What is a pseudo hallucination?

A

Voices heard by a patient which may either appear to come from within their head or from the outside world, but the patient recognises them as unreal

55
Q

What is schizophreniform disorder?

A

Often a provisional diagnosis before a true diagnosis of schizophrenia. Symptoms persist for more than 1 month but less than 6 months.

56
Q

What type of delusions are see in mood disorders?

A

Mood congruent delusions:
e.g. Mania = Grandiose
Depression = Nihilistic, persecutory, etc.

57
Q

Give 2 key risk factors for schizophrenia

A

1) Cannabis use - associated with a 2.5x higher risk, increased with earlier use
2) Family history - strong genetic involvement

58
Q

Give some poor prognostic factors for schizophrenia

A 
Male
Younger age at onset
Insidious onset
Longer duration of episode
Drug use
Social isolation
Negative symptoms
Poor compliance with treatment
Family history
59
Q

What are the negative symptoms of schizophrenia?

A 
Social withdrawal
Flat affect
Lack of pleasure from activities
Decreased speech
Lack of motivation
Poor memory
60
Q

Give 1 drug which is particularly associated with causing severe EPSEs

A

Haloperidol

61
Q

What is neuroleptic malignant syndrome?

A

Life threatening syndrome caused by antipsychotic medication which is though to be due to a profound dopamine deficient. Tends to affect patient who have recently started on antipsychotics.

62
Q

List some features of neuroleptic malignant syndrome

A 
Lead pipe rigidity
Confusion
Fluctuating BP
Tachycardia
Fever
Raised CK
63
Q

How might you treat neuroleptic malignant syndrome?

A 
Stop all antipsychotics
Monitor observations: HR, RR, Temp
May need ITU admission if rigidity affecting respiration
Bromocriptine = Dopamine agonist
Sedation using benzodiazepines
Dantrolene = Muscle relaxant
64
Q

True / False: Quetiapine causes raised prolactin

A

False - Quetiapine does not raise prolactin levels and so is useful is a patient is experiencing these effects on other medications

65
Q

List some general side effects of atypical antipsychotics

A

Increased cardiovascular and cerebrovascular event risk
Sexual dysfunction
Metabolic syndrome: Weight gain, deranged cholesterol, hyperglycaemia
Increased risk of seizures
Dizziness, postural hypotension

66
Q

Reduced seizure threshold is more of a problem in typical or atypical antipsychotics?

A

Atypical

Psychiatry (6 decks)

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