Psychoses: Flashcards
What is a hallucination?
A perception without an external object
What is a delusion? How does it differ from an overvalued idea?
A strong belief which is fixed and unshakable. Not explained by cultural, religious or educational beliefs.
List 6 types of delusion:
- Persecutory
- Grandiose
- Nihilistic (life is meaningless)
- Misidentification
- Hypochondriacal
- Guilt
What are two common misidentification delusions?
Capgras - that a new person is an ‘imposter’
Fregoli - a stranger is Familiar/known to them
List 5 possible causes of delusions:
- Schizophrenia
- Substance abuse psychotic disorders (e.g. alcohol and cannabis)
- Schizophrenic-like non-affective disorder (brief paranoid disorder, schizophreniform disorder)
- Medical disorder (e.g. brain tumour)
- Affective disorders (e.g. depression, bipolar)
What is an affective disorder?
Disorders relating to mood
What is schizophrenia?
Disordered thinking and perception.
List the 3 types of thought alienation:
- Thought insertion
- Thought broadcasting
- Thought withdrawal
What is passivity phenomenon (delusions of control)?
One is no longer in control of ones own body, feelings or thoughts.
What is a delusional perception?
A primary delusion of any content that is reported by the patient as having arisen following the experience of a normal perception
What are the first rank symptoms of schizophrenia?
- Thought alienation
- 3rd Person auditory hallucination
- Delusion of control (passivity phenomenon)
- Delusion of perception
What are the 2nd rank symptoms in schizophrenia?
- Delusions
- 2nd person auditory hallucinations
- Hallucinations in any other modality
- Thought disorder
- Catatonic behaviour
- Negative symptoms
List 5 negative symptoms in schizophrenia:
- Blunting of affect
- Amotivation
- Poverty of speech
- Self-neglect
- Lack of insight
What is a 3rd person auditory hallucination?
Patients hears voices talking about themselves, referring to them in the third person, for example “he is an evil person”.
What is a 2nd person auditory hallucination?
A voice appears to address the patient in the second person. For example the voice may be talking directly to the patient - “You are going to die” - or the voice may be telling the patient to do some action - “kill him”.
What is the criteria for diagnosing schizophrenia?
Symptoms must be:
- Present for at least 6 months
- Present much of the time for at least one month
- Marked impairment in work or home functioning
What investigations could be performed in those with schizophrenia?
(pretty much everything)
- Full neuro examination
- Bloods (including gamma- GT)
- EEG
- Fasting glucose
- CT brain
- MSU - culture/dip
List 5 organic causes of delusions/schizophrenic like symptoms:
- Alzheimers
- Lewy body dementia
- Infections (delirium)
- Encephalitis
- Parkingsons
- Thyroid
Many many more…
How does one differentiate between substance-induced psychosis and schizophrenia?
If there has been <4 weeks between substance abuse and start of odd ideas = more likely to be substance-induced psychosis.
Visual hallucinations more likely in substance abuse.
Signs of drug abuse on blood tests (alcohol (gamma-GT).
Drug seeking behaviour.
What can trigger schizophrenia?
Cannabis
Outline the 1st, 2nd and 3rd line management of schizophrenia:
1st - Atypical antipsychotic (e.g. risperidone or olanzapine)
2nd - try a second antipsychotic
3rd - Clozapine (SE…)
List two atypical antipsychotics:
- Risperidone
- Olanzapine
List 2 typical antipsychotics:
- Haloperidol
- Chlorpromazine
What is a major SE of clozapine?
Agranulocytosis (neutrophils, basophils, eosinophils). Presents with sore throat, fever, septicaemia, seizures.
What receptors do typical antipsychotics work on?
D2 antagonist alone = increases dopamine blockade
In what condition must you not prescribe typical antipsychotics?
Parkinsons disease
On what receptors do atypical antipsychotics work on?
- Serotonin antagonist
- D2 antagonist
What are the SE of antipsychotics?
(fat man who thinks he’s an Egyptian sat on a pyramid with boobs and a floppy willy)
- weight gain and DM
- Prolactinaemia
- Extrapyramidal side effects
Outline 4 extrapyramidal signs:
- Acute dystonic reaction (hours)
- Parkinsonism (weeks)
- Akathisia - cant stay still (months)
- Tardative dyskinesia (years)
Procyclidine for everything apart from akathisia.
Akathisia = propanolol
What is persistent delusional disorder?
(think Trump)
No evidence of persistent hallucinations, schizophrenic symptoms, or evidence of brain disease
What would your immediate management be of someone who is brought in with confusion, very high temperature and rigidity?
ABCDE
The lady who is brought in with confusion, high temperature and rigidity was recently diagnosed with schizophrenia and started on olanzapine - what is the likely diagnosis?
Neuroleptic malignant syndrome.
What would you see one investigation of someone with neuroleptic syndrome?
- Raised serum CK
- ^ WCC
- Metabolic acidosis
How would you manage someone with neuroleptic malignant syndrome?
1) Stop anti-psychotic
2) Supportive: Oxygen, IV fluids, cooling blankets
3) BZD (agitation)
4) IV Dantrolene (muscle relaxant)
What are the risk factors for postpartum psychosis?
- PMHx of depression or postpartum depression
- Lack of social support
- Single parent
How would you manage post partum psychosis?
- Admit to hospital
- ADs/APs/ECT depending on symptoms (good response to ECT)
A lady with a 1 day old infant appears low in mood - what diagnosis do you give her and what management?
- Baby blues
- Reassurance and explanation
A lady has a 4 week old infant and has expressed concerns that she wont be able to look after her son well enough. She appears to have significant anxiety. What tool may help you to guide her management?
Edinburgh postnatal depression scale.
What is the treatment for postnatal depression?
Antidepressants +/- CBT
List 3 types of schizophrenia:
- Paranoid
- Hebephrenia (Bizarre behaviour)
- Catatonic (unresponsive)
What is a schizoaffective disorder?
Disorder where symptoms of both a mood disorder and schizophrenic symptoms are prominent within the same episode of illness. (does no mean that those with psychotic symptoms in mood disorders changes it to a schizoaffective disorder)
What should be considered involving antipsychotics in post natal psychosis?
APs past through breast milk so breast feeding should be stopped.
List some endocrine disorders with psychiatric symptoms:
- Addisons
- Cushings syndrome
- Hypothyroidism
- Hyperthyroidism
