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MB3 Psychiatry > Psychosis > Flashcards

Psychosis Flashcards

1
Q

define psychosis

A

thoughts, affective respomse, ability to recognise reality and comunication and impaired to interfere with dealing with reality

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2
Q

organic causes psychosis?

A

delirium
dementia
brain injury
stroke

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3
Q

substance use and psychosis cause?

A

acute drug intoxication
drug withdrawal
delirium tremens

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4
Q

mechanism of action of hallucination

A

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

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5
Q

types of hallucination

A 
visual 
auditory 
gustatory 
olfactory  
tactile 
haptic
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6
Q

what is an idea of reference

A

innocuous or coincidental events described as having meaning
can be self-referential

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7
Q

what is a primary delusion

A

delusion that is formed in consciousness without need for explanation

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8
Q

what is a secondary delusion

A

delusion formed in attempt to explain another psychiatric experience

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9
Q

types of delusion

A 
persecutory 
paranoid 
grandiose 
religious 
misidentification 
guilt 
sin
poverty
nihilistic 
erotomanic 
jealousy 
reference
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10
Q

what is fregoli syndrome and what type of delusion is it

A

same person masquerades as multiple

misidentification

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11
Q

what is capgrass syndrome and what type of delusion is it

A

people you know are replaced by imposters

misidentification

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12
Q

what is de clerambault syndrome and what type of delusion is it

A

erotomanic

celebrity or public figure is in love with you

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13
Q

what is orthello syndrome and what type of delusion is it

A

close partner in love with someone else
can be a homicide risk
jealousy

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14
Q

forms of formal thought disorder and what it is?

A 
thought observed from speech pattern 
knights move thinking 
clanging/punning 
loosening of association 
neologism
word salad/verbigeration
circumferentiality/tangentiality
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15
Q

forms of thought interference or passivity phenomena?

A

thought insertion/withdrawal/blocking/broadcasting

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16
Q

risk of schizophrenia if both parents have it

A

45%

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17
Q

risk of schizophrenia if 1st degree relative has it

A

12%

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18
Q

risk factors for schizophrenia

A

2nd trimester viral illness
pre-eclampsia, foetal hypoxia, emergency C section
childhood CNS viral infection
amphetamines, cocaine, cannabis

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19
Q

specific schizophrenia features on the brain

A

enlarged lateral ventricles
reduced frontotemporal volume
reduced activation of prefrontal areas on specific tasks

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20
Q

what is the most important dopamine receptor for treating psychosis

A

D2

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21
Q

features of children developing schizophrenia

A

impaired behaviour, motor and intellectual development

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22
Q

what is delirium

A

acute and transient disturbance from normal cognitive function

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23
Q

causes of delirium

A 
infection 
sepsis 
organ failure 
hypoglycaemia 
hypoxia 
encephalitis 
drugs 
drug withdrawal
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24
Q

drugs/drug withdrawal leading to delirium

A 
digoxin
diuretics 
steroids 
anticholinergics 
Withdrawal - benzodiazepines
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25
Q

features of delirium

A 
clouded consciousness - flux and worse at night 
impaired concentration and memory 
visual hallucination 
persecutory delusions 
psychomotor disturbance 
agitation and psychomotor retardation 
irritability 
insomnia
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26
Q

what is depressive psychosis

A

mood congruent syndrome
delusion of worthlessness/guilt/hypochondriasis/poverty/sin/nihilism
cotards syndrome
hallucination of accusing, insulting or threatening 2nd person auditory hallucination

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27
Q

what is mania with psychosis

A

mood congruent syndrome
delusions of grandeur/special ability/persecution/religion
2nd person auditory hallucination
flight of ideas

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28
Q

first rank symptoms of schizophrenia

A

delusion
auditory hallucination
thought interference
passivity phenomena

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29
Q

positive symptoms schizophrenia

A

hallucination
delusion
disorder of form of thought
passivity phenomena

30
Q

negative symptoms of schizophrenia

A 
reduced speech 
blunted affect 
reduced social interaction 
reduced interest and pleasure 
reduced motivation and drive
31
Q

diagnosis of schizophrenia?

A

> 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

32
Q

what is catatonic schizophrenia

A

movement disorder ranging from stupor to hyperkinesis

automatic obedience, posturing and waxy flexibility

33
Q

what is hebephrenic schizophrenia

A

prominent affective changes
fleeting and fragmentary delusion/hallucination
irresponsible/unpredictable behaviour
shallow and inappropriate mood
incongruent speech
tendency to social isolation and -ve symptoms

34
Q

what is persistent delusional disorder

A

only feature of the condition is a systematic, fixed delusion

35
Q

what is schizotypal disorder and what are its features

A 
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
36
Q

what is acute and transient psychotic disorder

A

schizophrenia symptoms lasting <1m

37
Q

what is schizoaffective disorder

A

affective and schizophrenic symptoms are prominent but do not justify dx of depressive, manic or schizophrenic episode

38
Q

names of first gen antipsychotics?

A 
chlorpromazine 
haloperidol 
flupentixol 
trifluperazine 
prochlorperazine
39
Q

names of 2nd gen antipsychotics

A 
clozapine 
olanzapine 
quetiapine 
risperidone 
paliperidone 
lurasidone
40
Q

what antipsychotic may be termed 3rd gen and when is it given

A

aripiprazole

given when weight gain/metabolic syndrome concern is present as a side effect

41
Q

dopamine pathways in the brain?

A 
mesocortical 
mesolimbic 
tubuloinfundibular 
nigrostriatal 
hypothalamospinal
42
Q

what dopamine pathway is responsible for +ve symptoms

A

mesolimbic

43
Q

what dopamine pathway is responsible for -ve symptoms

A

mesocortical

44
Q

describe an acute dystonic reaction

A 
onset minutes 
increased muscle tone 
energetic 
torticollis 
oculogyric crisis 
tongue protrusion
45
Q

what dopamine pathway leads to EPSE

A

nigrostriatal

46
Q

describe the EPSE of parkinsonism

A 
shuffling gait 
resting tremor 
cogwheel rigidity 
dead pan facial expressiob 
bradykinesia
47
Q

describe tardive dyskinesia

A

long term and often permanent side effect
involuntary repetitive oro-facial movements
blinking, grimacing, pouting, lip smacking

48
Q

management of EPSE?

A

anticholinergics
procyclidine, trihexyphenidyl
consider changing antipsychotic or clozapine

49
Q

what is neuroleptic malignant syndrome?

A

rare and gradual condition over days
gradually increasing muscle tone, autonomic instablility and pyrexia
leads to rhabdomyolysis, AKI, death

50
Q

management of neuroleptic malignant syndrome?

A

stop antipsychotic
renal support and cooling
dantrolene to relax muscles
bromocriptine to act as dopamine agonist

51
Q

what dopamine pathway causes Neuroleptic malignant syndrome

A

hypothalamic

52
Q

what dopamine pathway leads to hyperprolactinaemia

A

tubuloinfundibular

53
Q

features of hyperprolactinaemia side effects in men?

A

gynaecomastia

erectile dysfunction, oligospermia, low libido

54
Q

features of hyperprolactinaemia side effects in women?

A

galactorrhoea
reduced libido, arousal, anorgasmia
amenorrhoea and anovulation

55
Q

eatures of hyperprolactinaemia side effects in men and women?

A

decreased bone mineralisation

decreased bone density and osteoporosis

56
Q

whart is akathesia or restless legs syndrome

A 
days-weeks post tx 
pacing 
cannot sit still
poor sleep 
increased suicide risk
57
Q

management of akathesia

A

1st line propranolol

2nd line benzodiazepine

58
Q

anticholinergic side effects of antipsychotics?

A

dry mouth
blurred vision
constipation

59
Q

5-HT2 side effects of antipsychotics?

A

diabetes

weight gain

60
Q

antiadrenergic side effects of antipsychotics?

A

postural hypotension

61
Q

other side effects of antipsychotics?

A

hepatotoxicity
prolongation of QTc
photosensitivity

62
Q

__ generation antipsychotics are worse for causing EPSE

A

1st

63
Q

___ generation antipsychotics are worse for causing sedation and weight gain

A

2nd

64
Q

what is clozapine good for

A

-ve side effects, tx resistance and anti-suicide

65
Q

side effects of clozapine

A 
agranulocytosis - weekly WBC for 6m then fortnight 6m then monthly
myocarditis - ECG
constipation 
weight gain 
sedation 
sialorrhoea
66
Q

describe the recommended prescribing for antipsychotic

A

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

67
Q

causes of mortality in schizophrenia

A 
suicide 
HIV, AIDS, hepatitis, TB
T2DM
cancers 
cardiac risk 
osteoporosis
68
Q

factors leading to poorer illness and prognosis

A 
poverty 
poor diet 
lack of support 
poor transport 
comorbidity 
less motivation and reduced exercise 
poor concentration 
high smoking rates 
comorbid drug use
69
Q

treatment factors leading to poor social outcomes

A 
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
70
Q

true/false - smoking whilst on clozapine is a concern

A

true - can lead to variation in concentration due to cyp450 effects
always discuss with doctor before changing smoking habits

MB3 Psychiatry (16 decks)

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