Psychoses: Flashcards
(43 cards)
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.
