Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Mental Health > Psychosis > Flashcards

Psychosis Flashcards

1
Q

Define PSYCHOSIS.

A

Psychosis refers to a state in which an individual is unable to differentiate between reality and false perception.

Psychosis has FOUR key features:

  1. hallucinations
  2. delusions
  3. thought disorder
  4. abdominal / disorganised behaviour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Outline / describe the hierarchy of diagnosis according to ICD-10.

A
  1. organic conditions (e.g. TBI, encephalopathy, delirium, dementia, epilepsy)
  2. intoxication / withdrawal (e.g. alcohol, benzodiazepines, methamphetamines)
  3. schizophrenia (e.g. schizoaffective disorder, psychotic depression)
  4. affective disorders (e.g. uni polar or bi polar depression)
  5. anxiety / stress related conditions
  6. personality disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define “HALLUCINATION.”

A

Hallucination describes an abnormal sensory experience that occurs in the absence of an appropriate stimuli.

Types of hallucinations include:

  • visual
  • auditory
  • tactile
  • olfactory
  • gustatory
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Define “DELUSION.”

A

Delusions are false and fixed beliefs that (1). require no proof or evidence (2). are held with conviction and resistant to change, despite contradictory evidence (3). create a false reality for the patient.

Types of delusions include:

  • paranoid / persecutory delusions
  • grandiose delusions
  • somatic delusions
  • nihilistic delusions
  • reference delusions
  • passivity phenomenon
  • thought control
  • delusional jealousy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Define PARANOID DELUSION.

A

A false and fixed idea that the individual is being followed, tracked, deceived etc.

Typically begins with neighbours “spying on them…”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Define PERSECUTORY DELUSION.

A

A false and fixed belief that the individual, or their loved ones, are being conspired against.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Define GRANDIOSE DELUSION.

A

A false and fixed belief that the individual is of greater importance / has special talents etc.

For example, individual believes that they are God.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Define NIHLISTIC DELUSION.

A

A false and fixed belief that a component of the person is non-existent / dying… or that the world is non-existent.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Define GUILT DELUSION.

A

A false and fixed belief that the individual is responsible for a crime or act that they did not commit.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Define REFERENCE DELUSION.

A

A false and fixed belief that causal events are linked to individuals.

For example, newsreaders / television / radio are speaking or communicating with the person.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Define PASSIVITY PHENOMENON.

A

Passivity phenomenon describes a phenomenon in which the individual believes that their thoughts, actions or bodily habits are controlled by others.

Passivity phenomenon can be described in terms of:

  • passivity of affect
  • passivity of volition
  • somatic passivity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Identify the four components of THOUGHT CONTROL.

A
  1. thought insertion
  2. thought withdrawal
  3. thought blocking
  4. thought broadcasting

These components of thought disorder are considered part of the FIRST RANK Symptoms of Schizophrenia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Define DELUSIONAL JEALOUSY.

A

A fixed and false belief regarding the infidelity of one’s partner.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Define THOUGHT DISORDER.

A

Formal thought disorder can relate to either the form or stream of one’s thoughts.

Thought disorder may relate to:

  • circumstantial thoughts
  • tangential thoughts
  • flight of ideas
  • loosening of association
  • neoglisms
  • thought blocking, insertion, withdrawal and broadcasting
  • echolalia
  • alogia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Outline the DOPAMINE HYPOTHESIS in regard to pathogenesis of psychosis.

A

Dopamine is a neurotransmitter synthesised from the amino acid tyrosine.

There are four major pathways that dopamine acts on in the brain:

  1. mesolimbic pathway
  2. mesocortical pathway
  3. nigrostriatal pathway
  4. tuberohypophyseal pathway

According to the DOPAMINE HYPOTHESIS, the symptoms of schizophrenia are due to both (a). reduced dopamine acting at D1 receptors (excitatory) within the mesocortical pathway, leading to the NEGATIVE SYMPTOMS (b). increased dopamine acting at D2 receptors (inhibitory) within the mesolimbic pathway, leading to POSITIVE SYMPTOMS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Outline the role of GLUTAMATE in the pathogenesis of psychosis.

A

Glutamate is a neurotransmitter that acts at NMDA receptors throughout the brain. NMDA receptors are excitatory receptors that activate Ca++ channels, causing depolarisation.

Glutamate is also believed to act at dopamine receptors, causing hypo / hyper activity in the mesocortical and mesolimbic pathway respectively.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

DSM-V Criteria: SCHIZOPHRENIA

A

A. At least TWO of the following symptoms present consistently for >1 month duration (at least ONE of the symptoms must either be hallucinations or delusions)

  • delusions
  • hallucinations
  • thought disorder
  • grossly disorganised or catatonic behaviour
  • negative symptoms

B. Since the onset of symptoms, level of functioning in at least ONE of the following areas has been reduced:

  • work
  • social life / inter-personal relationships
  • education

C. Continuous signs of disturbance for > 6 months

D. Psychotic depression (uni polar or bi polar) and schizoaffective disorder have been excluded

E. Symptoms are not due to organic cause or physiological effects of a drug / substance

Specifiers:

  • first episode psychosis
  • +/- catatonia
  • level of severity (e.g. acute, partial remission, full remission)
18
Q

DSM-V Criteria: BRIEF PSYCHOTIC EPISODE

A

A brief psychotic episode fulfils criteria A + D + E for SCHIZOPHRENIA, however, symptoms resolve within one month and patient returns to pre-morbid baseline.

Specifiers:

  • acute stressors
  • post partum
  • catatonia
  • severity
19
Q

DSM-V Criteria: SCHIZOPHRENIFORM DISORDER

A

Schizphreniform disorder fulfils criteria A + D + E for SCHIZOPHRENIA, however, symptoms are present for between one to six months duration and patient returns to pre-morbid baseline.

20
Q

DSM-V Criteria: SCHIZOAFFECTIVE DISORDER

A

A. Concurrent mood disorder (bipolar or unipolar depression) + Criteria A for SCHIZOPHRENIA

B. Delusions +/- hallucinations occur in the absence of mood symptoms for at least two weeks over the duration of the illness

C. Symptoms of major mood disorder are present for the majority of the illness lifetime

D. Symptoms are NOT attributed to organic pathology or the physiological effects of a substance / drugs

N.B Bipolar subtype is more common in young people; unipolar subtype is more common in older adults

21
Q

DSM-V Criteria: DELUSIONAL DISORDER

A

A. Presence of one or more delusions for > 1 month duration

B. Criteria A for schizophrenia has never been met

C. Functioning is NOT impaired

D. If depressive symptoms occur, there are brief compared to the delusional disorder

E. Symptoms are not attributed to physiological effects of a drug or an organic pathology

22
Q

Identify the POSITIVE and NEGATIVE symptoms of schozprenia.

A

POSITIVE SYMPTOMS

  • hallucinations
  • delusions
  • thought disorder
  • disorganised or catatonic behaviour

NEGATIVE SYMPTOMS

  • anhedonia (lack of motivation)
  • affective flattening (blunt affect)
  • alogia (reduced speech)
  • avolition / apathy
  • attentional impairment
23
Q

Outline some factors that are more suggestive of a positive prognosis.

A 
✔️ acute onset
✔️ known precipitant
✔️ older age at onset
✔️ no family history of psychosis or mood disorders
✔️ adherence to medication
✔️ no drug / alcohol / substance use
✔️ mainly positive symptoms
✔️ good insight into condition
24
Q

Outline the principles of management for schizophrenia.

A
  • early identification and treatment of first episode of psychosis (within 12 months)
  • optimisation of therapeutic relationship
  • engagement with family and support networks as appropriate
  • tailor the therapy to account for individual age, gender, symptoms, severity, goals etc.
  • psychotherapy should be undertaken along with pharmacotherapy
  • patients should be commenced on pharmacotherapy with the lowest possible dose to obtain symptom control
  • monitoring for side effects

Pharmacotherapy should include:
✔️ antipsychotics (SGA preferred over FGA)
✔️ antidepressants for management of mood symptoms
✔️ benzodiazepines (acutely) for management of agitation / aggression
✔️ cessation of drug and alcohol

25
Q

Explain the mechanism of action for EXTRA PYRAMIDAL SIDE EFFECTS (EPSEs).

A

EPSEs are more commonly associated with FGA (e.g. haloperidol). These drugs bind non-selectively to D2 receptors throughout the brain, including within the nigrostriatal pathway.

The nigrostriatal pathway is particularly involved in regulation of movement. Thus, inhibition of D2 receptors can induced “Parkinsonism.”

26
Q

Identify EPSEs (in the order the most commonly occur).

A
  1. akathisia –> a feeling of restlessness, psychomotor agitation or aggression
  2. dystonia –> sudden and painful spasm of muscle groups
  3. Parkinsonism –> rigidity (Cogwheel or Lead Pipe), bradykinesia, hyperreflexia, postural hypotension, pin-rolling tremour
  4. tardive dyskinesia –> lip smacking, tongue clicking etc.
27
Q

Outline the management of EPSEs.

A

EPSEs are dose-dependent. Thus, if identified, the first step in management is to reduce the dose of antipsychotic.

If possible, the patient should be changed to an antipsychotic with a lower risk of EPSEs (e.g. SGA).

Anti-cholinergic agents can be used to reduce the severity (e.g. benztropine).

EPSEs should be screened for every 6 months.

28
Q

Explain the mechanism of HYPERPROLACTINEMIA.

A

Dopamine and prolactin have an inverse relationship; increased dopamine levels is associated with suppression of prolactin secretion.

Hyperprolactinemia is due to inhibition of D2 receptors within the tuberohypophyseal pathway within the brain.

29
Q

Identify symptoms of hyperprolactinemia.

A 
Males: 
✔️ gynacomastia
✔️ erectile dysfunction
✔️ galactorrhea 
✔️ infertility

Females:
✔️ amenorrhea
✔️ galactorrhea
✔️ infertility

Signs and symptoms of hyperprolactinemia should be screen for every 12 months.

30
Q

Explain the mechanism of METABOLIC EFFECTS associated with antipsychotics.

A

For unknown reasons, SGA have a high risk of adverse metabolic effects.

SGAs (particularly olanzapine and clozapine) are associated with metabolic syndrome, which is characterised by:

  • insulin resistance
  • hypertension
  • dyslipidemia
  • increased BMI
  • high blood glucose levels

Insulin resistance is also linked to PCOS, obesity and T2DM.

If patients have cardiovascular risk, they should be placed on an antipsychotic with a lower risk of adverse metabolic effects (e.g. risperidone).

31
Q 
Identify the intervals at which the following parameters should be monitored in patients on antipsychotic medications: 
✔️ blood pressure
✔️ blood glucose levels
✔️ lipid levels
✔️ BMI / waist circumference
✔️ ECG
✔️ EPSEs
✔️ menstural dysfunction, gynacomastia 
✔️sedation + anticholinergic effects
✔️smoking + alcohol
A

✔️ blood pressure –> every 12 months (6 months in olanzapine)
✔️ blood glucose levels –> every 12 months (6 months in olanzapine)
✔️lipid levels –> every 12 months (6 months in olanzapine)
✔️ BMI / waist circumference –> annually
✔️ ECG –> annually
✔️ EPSEs –> every 6 months
✔️ menstural dysfunction, gynacomastia –> annually
✔️sedation + anticholinergic effects –> every visit
✔️smoking + alcohol –> every visit

32
Q

Define DRUG-RESISTANT SCHIZOPHRENIA.

A

DEFINITION - continued positive symptoms despite trialling of at least TWO antipsychotic medications for > 6 weeks

33
Q

Outline the current recommendations for the management of drug-resistant schizophrenia.

A

✔️ early identification (diagnosis within 6 to 12 months)
✔️ a trial of clozapine in those who are eligible
✔️ clozapine monitoring must be followed vigerously
✔️ metabolic monitoring and interventions should occur
✔️ where clozapine is ineffective, the drug may be augmented with adjuvant therapies (e.g. fish oil, ECT)

34
Q

Identify side effects / risks of CLOZAPINE.

A
  • neutropenia / agranulocytosis (occurs within first 18 weeks)
  • myocarditis / cardiomyopathy (occurs within first 4 to 6 weeks)
  • weight gain
  • insulin resistance
  • hypotension
  • hypertension
  • hyper-salivation
  • sedation

Clozapine has anti-cholinergic effects. Whilst this means that risk of EPSEs is less, the drug is associated with greater risk of sedation.

35
Q

Outline the monitoring protocol for CLOZAPINE.

A

Prior to commencing clozapine therapy, patients should have baseline tests including: ECG, FBC, WCC, UECs, BGL, lipids.

Weekly blood tests for the first 18 weeks of therapy + monthly blood tests thereafter.

36
Q

Identify side effects / risks of RISPERIDONE.

A

Risperidone is a SGA used mainly for management of first episode of psychosis.

Risperidone has the greatest risk of EPSEs amongst all SGAs. It also has a high risk of hyperprolactinemia. Its metabolic profile is not as adverse as olanzapine or clozapine.

37
Q

Identify side effects / risks of OLANZAPINE.

A

Olanzapine is an SGA used mainly for maintenance therapy of schizophrenia. It is not recommended for used in FEP due to adverse metabolic profile.

Side effects include: 
✔️ significant weight gain
✔️ insulin resistance 
✔️ metabolic syndrome
✔️ sedation
✔️ sexual dysfunction secondary to hyperprolactinemia
38
Q

Identity the FIVE negative symptoms of schizophrenia.

A
  1. anhedonia - reduced interest in activities
  2. asociality - reduced interest in social interactions
  3. alogia- poverty of speech
  4. affect reduced
  5. apathy - reduced emotions
39
Q

Outline side effects of CLOZAPINE and how to monitor for these.

A

✔️ agranulocytosis / neutropenia –> FBC + WCC
✔️ myocarditis / cardiomyopathy –> ECG
✔️ QTc prolongation –> ECG
✔️ seizures
✔️ hyperglycaemia / insulin resistance –> blood glucose levels / HbA1c
✔️ dyslipidemia –> fasting lipids
✔️ weight gain
✔️ sedation
✔️ anticholinergic side effects (e.g. urinary incontinence, constipation, blurred vision)

40
Q

Pharmacological treatment for first episode psychosis (FEP)?

A

Benzodiazepines can be used to treat acute aggression (e.g. lorazepam, clorazepam).

Commence RISPERIDONE (second generation antipsychotic) –> may take 2 to 4 weeks to show a positive effect.

If no response, switch to OLANZAPINE.

Consider mood stabilisers in the case of bipolar depression or antidepressants in the case of unipolar depression.

Mental Health (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions