Psychosis Flashcards
define psychosis
thoughts, affective respomse, ability to recognise reality and comunication and impaired to interfere with dealing with reality
organic causes psychosis?
delirium
dementia
brain injury
stroke
substance use and psychosis cause?
acute drug intoxication
drug withdrawal
delirium tremens
mechanism of action of hallucination
usually stimulus interacts wth sensory organ, processed by brain and memory and leads to perception
in hallucination there is aberrant brain processing leading to perception in absence of stimuli
types of hallucination
visual auditory gustatory olfactory tactile haptic
what is an idea of reference
innocuous or coincidental events described as having meaning
can be self-referential
what is a primary delusion
delusion that is formed in consciousness without need for explanation
what is a secondary delusion
delusion formed in attempt to explain another psychiatric experience
types of delusion
persecutory paranoid grandiose religious misidentification guilt sin poverty nihilistic erotomanic jealousy reference
what is fregoli syndrome and what type of delusion is it
same person masquerades as multiple
misidentification
what is capgrass syndrome and what type of delusion is it
people you know are replaced by imposters
misidentification
what is de clerambault syndrome and what type of delusion is it
erotomanic
celebrity or public figure is in love with you
what is orthello syndrome and what type of delusion is it
close partner in love with someone else
can be a homicide risk
jealousy
forms of formal thought disorder and what it is?
thought observed from speech pattern knights move thinking clanging/punning loosening of association neologism word salad/verbigeration circumferentiality/tangentiality
forms of thought interference or passivity phenomena?
thought insertion/withdrawal/blocking/broadcasting
risk of schizophrenia if both parents have it
45%
risk of schizophrenia if 1st degree relative has it
12%
risk factors for schizophrenia
2nd trimester viral illness
pre-eclampsia, foetal hypoxia, emergency C section
childhood CNS viral infection
amphetamines, cocaine, cannabis
specific schizophrenia features on the brain
enlarged lateral ventricles
reduced frontotemporal volume
reduced activation of prefrontal areas on specific tasks
what is the most important dopamine receptor for treating psychosis
D2
features of children developing schizophrenia
impaired behaviour, motor and intellectual development
what is delirium
acute and transient disturbance from normal cognitive function
causes of delirium
infection sepsis organ failure hypoglycaemia hypoxia encephalitis drugs drug withdrawal
drugs/drug withdrawal leading to delirium
digoxin diuretics steroids anticholinergics Withdrawal - benzodiazepines
features of delirium
clouded consciousness - flux and worse at night impaired concentration and memory visual hallucination persecutory delusions psychomotor disturbance agitation and psychomotor retardation irritability insomnia
what is depressive psychosis
mood congruent syndrome
delusion of worthlessness/guilt/hypochondriasis/poverty/sin/nihilism
cotards syndrome
hallucination of accusing, insulting or threatening 2nd person auditory hallucination
what is mania with psychosis
mood congruent syndrome
delusions of grandeur/special ability/persecution/religion
2nd person auditory hallucination
flight of ideas
first rank symptoms of schizophrenia
delusion
auditory hallucination
thought interference
passivity phenomena
positive symptoms schizophrenia
hallucination
delusion
disorder of form of thought
passivity phenomena
negative symptoms of schizophrenia
reduced speech blunted affect reduced social interaction reduced interest and pleasure reduced motivation and drive
diagnosis of schizophrenia?
> 1 1st rank for >1m
OR >2 for >1m
hallucinations of any modality every day
neologism, break or interruption in train of thought
catatonic behaviour
negative symptoms
what is catatonic schizophrenia
movement disorder ranging from stupor to hyperkinesis
automatic obedience, posturing and waxy flexibility
what is hebephrenic schizophrenia
prominent affective changes
fleeting and fragmentary delusion/hallucination
irresponsible/unpredictable behaviour
shallow and inappropriate mood
incongruent speech
tendency to social isolation and -ve symptoms
what is persistent delusional disorder
only feature of the condition is a systematic, fixed delusion
what is schizotypal disorder and what are its features
eccentric behaviour and anomalies of thinking and affect resembling schizophrenia cold affect anhedonia eccentric behaviour social withdrawal paranoid/bizarre ideas but not a full delusion obsessive rumination thought disorder transient quasi-psychotic episode auditory/other hallucination
what is acute and transient psychotic disorder
schizophrenia symptoms lasting <1m
what is schizoaffective disorder
affective and schizophrenic symptoms are prominent but do not justify dx of depressive, manic or schizophrenic episode
names of first gen antipsychotics?
chlorpromazine haloperidol flupentixol trifluperazine prochlorperazine
names of 2nd gen antipsychotics
clozapine olanzapine quetiapine risperidone paliperidone lurasidone
what antipsychotic may be termed 3rd gen and when is it given
aripiprazole
given when weight gain/metabolic syndrome concern is present as a side effect
dopamine pathways in the brain?
mesocortical mesolimbic tubuloinfundibular nigrostriatal hypothalamospinal
what dopamine pathway is responsible for +ve symptoms
mesolimbic
what dopamine pathway is responsible for -ve symptoms
mesocortical
describe an acute dystonic reaction
onset minutes increased muscle tone energetic torticollis oculogyric crisis tongue protrusion
what dopamine pathway leads to EPSE
nigrostriatal
describe the EPSE of parkinsonism
shuffling gait resting tremor cogwheel rigidity dead pan facial expressiob bradykinesia
describe tardive dyskinesia
long term and often permanent side effect
involuntary repetitive oro-facial movements
blinking, grimacing, pouting, lip smacking
management of EPSE?
anticholinergics
procyclidine, trihexyphenidyl
consider changing antipsychotic or clozapine
what is neuroleptic malignant syndrome?
rare and gradual condition over days
gradually increasing muscle tone, autonomic instablility and pyrexia
leads to rhabdomyolysis, AKI, death
management of neuroleptic malignant syndrome?
stop antipsychotic
renal support and cooling
dantrolene to relax muscles
bromocriptine to act as dopamine agonist
what dopamine pathway causes Neuroleptic malignant syndrome
hypothalamic
what dopamine pathway leads to hyperprolactinaemia
tubuloinfundibular
features of hyperprolactinaemia side effects in men?
gynaecomastia
erectile dysfunction, oligospermia, low libido
features of hyperprolactinaemia side effects in women?
galactorrhoea
reduced libido, arousal, anorgasmia
amenorrhoea and anovulation
eatures of hyperprolactinaemia side effects in men and women?
decreased bone mineralisation
decreased bone density and osteoporosis
whart is akathesia or restless legs syndrome
days-weeks post tx pacing cannot sit still poor sleep increased suicide risk
management of akathesia
1st line propranolol
2nd line benzodiazepine
anticholinergic side effects of antipsychotics?
dry mouth
blurred vision
constipation
5-HT2 side effects of antipsychotics?
diabetes
weight gain
antiadrenergic side effects of antipsychotics?
postural hypotension
other side effects of antipsychotics?
hepatotoxicity
prolongation of QTc
photosensitivity
__ generation antipsychotics are worse for causing EPSE
1st
___ generation antipsychotics are worse for causing sedation and weight gain
2nd
what is clozapine good for
-ve side effects, tx resistance and anti-suicide
side effects of clozapine
agranulocytosis - weekly WBC for 6m then fortnight 6m then monthly myocarditis - ECG constipation weight gain sedation sialorrhoea
describe the recommended prescribing for antipsychotic
start 2nd gen for 6-8 weeks then assess
if no good then go 1st or 2nd gen for 6-8 weeks
if no good check dx, optimise support and check compliance
consider depot
consider clozapine, or high dose antipsychotic monotherapy or two antipsychotics
causes of mortality in schizophrenia
suicide HIV, AIDS, hepatitis, TB T2DM cancers cardiac risk osteoporosis
factors leading to poorer illness and prognosis
poverty poor diet lack of support poor transport comorbidity less motivation and reduced exercise poor concentration high smoking rates comorbid drug use
treatment factors leading to poor social outcomes
medication induced weight gain falls due to EPSE sedation and immobility osteoporosis due to prolactin -ve symptoms so poor activity/exercise cognitive effects from drugs
true/false - smoking whilst on clozapine is a concern
true - can lead to variation in concentration due to cyp450 effects
always discuss with doctor before changing smoking habits
