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Psychiatry > Psychosis > Flashcards

Psychosis Flashcards

1
Q

How common is schizoprenia?

A

1% of the population

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2
Q

Define psychosis

A

A mental disorder in which someone loses contact with reality

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3
Q

Define hallucination and illusion

A

Hallucination: an abnormal perception in the absence of a stimulus
Illusion: an abnormal perception of a stimulus

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4
Q

What are the characteristics of psychosis?

A

Delusions and/or perceptions

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5
Q

What are some causes of psychosis or differential diagnoses?

A

Causes:

  • Schizoprenia
  • Severe depression or mania
  • Drug-induced psychosis
  • Acute and transient psychotic episode
  • Steroid-induced psychosis
  • Schizoaffective disorder

DDx: drug use or withdrawal, delirium, dementia, PD, hypercalcaemia, porphyrias, etc

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6
Q

What is schizophrenia?

A

A chronic psychotic illness lasting for >6 months in the absence of organic pathology

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7
Q

What are the types of schizoprenia?

A
  • Paranoid
  • Catatonic
  • Residual (chronic, negative symptoms)
  • Hebephrenic/disorganised: child-like behaviour, mood
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8
Q

How is schizophrenia diagnosed?

A

Diagnosis should be made in secondary care
DSM: at least 1 month of 2 active symptoms with at least 6 months of functional impairment
ICD-10: more focus on first-rank symptoms, lasting at least 1 month with effects over 6 months

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9
Q

Define a delusion

A

A fixed and firmly held belief that cannot be shaken by evidence to the contrary, and out of keeping with the cultural context

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10
Q

Describe the features of catatonia

A
  • Stupor
  • Rigid, motionless
  • Automatic obedience
  • Waxy flexibility
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11
Q

What are the first rank symptoms of schizoprenia?

A
  • Auditory hallucinations: usually third person, commentary, echo
  • Delusional perceptions
  • Passivity
  • Thought interference: insertion, withdrawal, broadcasting
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12
Q

What are some features of schizoprenia?

A
  • Delusions
  • Hallucinations
  • Thought disorder
  • Negative symptoms: alogia, avolition, anhedonia, affective flattening
  • Disturbed behaviour: withdrawal, antisocial
  • Depressive features
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13
Q

What are the negative symptoms of schizoprenia?

A

Alogia: poverty of speech
Avolition: lack of motivation
Anhedonia: lack of pleasure
Affective flattening: lack of expression

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14
Q

In which demographics is schizoprenia more common?

A

Young males (18-25)

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15
Q

Name some risk factors for schizoprenia

A
  • Young, male
  • Family Hx
  • Low socioeconomic status
  • Substance misuse: specifically cannabis
  • History of abuse, neglect, violence
  • Perinatal trauma
  • Migrants, ethnic minorities
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16
Q

Describe the dopamine hypothesis of schizoprenia

A

Symptoms of schizoprenia are due to abnormalities of dopamine in certain brain areas:

  • Excess DA in the mesolimbic system: positive symptoms
  • Lack of DA in the mesocortical system: negative symptoms
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17
Q

Describe the clinical course of schizophrenia

A
  • Prodrome/at-risk mental state: social withdrawal, loss of interest in normal activities
  • Acute phase: positive symptoms dominate
  • Chronic phase: negative symptoms dominate. Also known as residual schizoprenia
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18
Q

What is the prognosis of schizoprenia?

A

1/3 improve and have complete recovery
1/3 have some improvement but can have occasional relapse
1/3 no improvement
**The earlier the intervention or the shorter the duration of untreated psychosis (DUP), the better the prognosis. Specifically <3 months

19
Q

What type of formal thought disorder might you see in a patient with schizoprenia?

A
  • Loosening of associations/knight’s move thinking
  • Word salad
  • Alogia
20
Q

How would you investigate a patient presenting with psychotic symptoms?

A
  • History and collateral history
  • Physical examination and observations
  • Urine drug screen
  • ECG
  • Bloods: FBC, CRP, U+Es, LFTs, TFTs, cortisol, glucose
  • CT/MRI as indicated, especially if visual hallucinations
21
Q

What are the important components of a risk assessment in someone with schizoprenia? What is important to know when assessing risk to others?

A

Risk to self: self-harm and suicide, neglect, debts
Risk from others: scams/fraud
Risk to others: paranoia, voices -> violence
-Consider history of substance misuse, previous violence or forensic history, access to weapons, threats

22
Q

Who is eligible for early intervention services?

A

Everyone (all ages) with first episode or first presentation of psychosis
Also anyone with at-risk mental state and risk of psychosis in the future

23
Q

You see a young man in the GP clinic who reports hallucinations and delusions. What would you do next?

A

Risk assessment

Refer urgently to the early intervention service

24
Q

Describe the overall management approach in people with psychosis

A

Biopsychosocial!! MDT!

  • Bio: check for any organic causes. Give antipsychotics
  • Psycho: CBT and/or family intervention, arts therapy
  • Social: support with housing, education, employment, finances. Peer support.
25
Q

Describe the management of someone with first episode psychosis presenting to secondary care

A

Risk assessment and capacity!! Consider need for admission
Biopsychosocial approach with EIS MDT
-Bio: start antipsychotic eg. olanzapine
-Psych: start CBT and/or family intervention

26
Q

How long should someone take antipsychotic medication for after an acute episode?

A

Typically recommended that they take medication for 1-2 years, as the risk of relapse is high if they stop during this period
*But obv, no one can be forced to take it so capacity must be assessed

27
Q

If a person with known schizoprenia presents to GP with suspected relapse, what is the appropriate action? What should happen then?

A

Refer to crisis team in secondary care for assessment
Secondary care should assess symptoms, risk and capacity and consider any need for admission/home treatment, medication changes etc

28
Q

Who is on the MDT in EIS?

A

Main point of contact is the care coordinator (usually specialist nurse, social worker). Psychiatrist, psychologist, specialist mental health nurses, social worker, etc also involved

29
Q

What is rehabilitation for psychosis?

A

Program for people with treatment resistant symptoms or other comorbid mental health conditions eg. substance misuse, neurodevelopmental problems
Involves daily living skills, social skills training, substance misuse counselling etc

30
Q

What are some different antipsychotic medications?

A

Typical (1st gen): haloperidol, chlorpromazine

Atypical (2nd gen): olanzapine, risperidone, aripiprazole, clozapine

31
Q

What is the mechanism of action of antipsychotics?

A

Most are D2-R antagonists

  • Typicals have higher action
  • Atypicals are also 5HT2-R antagonists
32
Q

What are the side effects of typical antipsychotics?

A 
Extra-pyramidal side effects 
-Tardive dyskinesia
-Acute dystonia
-Akathisia
-Parkinsonism 
Cardiac side effects eg. QTc prolongation 
Hyperprolactinaemia
33
Q

What are the side effects of atypical antipsychotics?

A 
Weight gain
Metabolic syndrome: T2DM, hyperlipidaemia
Sedation 
Anticholinergic effects 
Hyperprolactinaemia
Neuroleptic malignant syndrome
34
Q

What is tardive dyskinesia? What is the management?

A

A complication of long-term antipsychotic use. Syndrome characterised by choreoathetoid movements
Mx: avoid anticholinergics. Decrease antipsychotic dose/stop.

35
Q

What is akathisia? What is the management?

A

A subjective feeling of restlessness leading to fidgeting, pacing, etc
Mx: reduce antipsychotic/change. Benzos.

36
Q

What is dystonia? What is the management?

A

Abnormal muscle tone resulting in spasm/abnormal posture.
Presents as torticollis or oculogyric crisis
Mx: anticholinergics eg procyclidine. Reduce antipsychotics

37
Q

What should be done before starting antipsychotic medication? How should they be monitored?

A 
Measure:
-Weight
-Blood pressure and pulse
-HbA1c, lipids, prolactin
-ECG
Monitoring: monitor for symptom improvement and complications. Measure BP, HbA1c, lipids at 12 weeks, 1 year, then anually. Weight weekly for 6 weeks -12 weeks-1 year.
38
Q

Describe the signs and symptoms of neuroleptic malignant syndrome

A
  • Muscle stiffness and rigidity
  • Altered consciousness
  • Hyperthermia
  • Autonomic instability: ^ HR, sweating
39
Q

What is the management of neuroleptic malignant syndrome?

A
  • Stop antipsychotics immediately
  • Admission for IV fluids
  • May need ITU, dialysis, muscle relaxant
40
Q

What are the complications of NMS?

A
  • Rhabdomyolysis
  • AKI
  • Metabolic acidosis
41
Q

Which antipsychotics have extra monitoring in addition to normal?

A

Risperidone: prolactin
Clozapine: FBC weekly

42
Q

What is treatment resistant schizoprenia? What is the management?

A

Schizoprenia unresponsive to trial of 2 different antipsychotic drugs at sufficient dosage for 6 weeks
Mx: clozapine

43
Q

What are the consequences/side effects of clozapine?

A

Agranulocytosis
Constipation
Seizures
Cardiac effects

Psychiatry (10 decks)

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