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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
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 ```
26
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
27
what is mania with psychosis
mood congruent syndrome delusions of grandeur/special ability/persecution/religion 2nd person auditory hallucination flight of ideas
28
first rank symptoms of schizophrenia
delusion auditory hallucination thought interference passivity phenomena
29
positive symptoms schizophrenia
hallucination delusion disorder of form of thought passivity phenomena
30
negative symptoms of schizophrenia
``` reduced speech blunted affect reduced social interaction reduced interest and pleasure reduced motivation and drive ```
31
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
32
what is catatonic schizophrenia
movement disorder ranging from stupor to hyperkinesis | automatic obedience, posturing and waxy flexibility
33
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
34
what is persistent delusional disorder
only feature of the condition is a systematic, fixed delusion
35
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 ```
36
what is acute and transient psychotic disorder
schizophrenia symptoms lasting <1m
37
what is schizoaffective disorder
affective and schizophrenic symptoms are prominent but do not justify dx of depressive, manic or schizophrenic episode
38
names of first gen antipsychotics?
``` chlorpromazine haloperidol flupentixol trifluperazine prochlorperazine ```
39
names of 2nd gen antipsychotics
``` clozapine olanzapine quetiapine risperidone paliperidone lurasidone ```
40
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
41
dopamine pathways in the brain?
``` mesocortical mesolimbic tubuloinfundibular nigrostriatal hypothalamospinal ```
42
what dopamine pathway is responsible for +ve symptoms
mesolimbic
43
what dopamine pathway is responsible for -ve symptoms
mesocortical
44
describe an acute dystonic reaction
``` onset minutes increased muscle tone energetic torticollis oculogyric crisis tongue protrusion ```
45
what dopamine pathway leads to EPSE
nigrostriatal
46
describe the EPSE of parkinsonism
``` shuffling gait resting tremor cogwheel rigidity dead pan facial expressiob bradykinesia ```
47
describe tardive dyskinesia
long term and often permanent side effect involuntary repetitive oro-facial movements blinking, grimacing, pouting, lip smacking
48
management of EPSE?
anticholinergics procyclidine, trihexyphenidyl consider changing antipsychotic or clozapine
49
what is neuroleptic malignant syndrome?
rare and gradual condition over days gradually increasing muscle tone, autonomic instablility and pyrexia leads to rhabdomyolysis, AKI, death
50
management of neuroleptic malignant syndrome?
stop antipsychotic renal support and cooling dantrolene to relax muscles bromocriptine to act as dopamine agonist
51
what dopamine pathway causes Neuroleptic malignant syndrome
hypothalamic
52
what dopamine pathway leads to hyperprolactinaemia
tubuloinfundibular
53
features of hyperprolactinaemia side effects in men?
gynaecomastia | erectile dysfunction, oligospermia, low libido
54
features of hyperprolactinaemia side effects in women?
galactorrhoea reduced libido, arousal, anorgasmia amenorrhoea and anovulation
55
eatures of hyperprolactinaemia side effects in men and women?
decreased bone mineralisation | decreased bone density and osteoporosis
56
whart is akathesia or restless legs syndrome
``` days-weeks post tx pacing cannot sit still poor sleep increased suicide risk ```
57
management of akathesia
1st line propranolol | 2nd line benzodiazepine
58
anticholinergic side effects of antipsychotics?
dry mouth blurred vision constipation
59
5-HT2 side effects of antipsychotics?
diabetes | weight gain
60
antiadrenergic side effects of antipsychotics?
postural hypotension
61
other side effects of antipsychotics?
hepatotoxicity prolongation of QTc photosensitivity
62
__ generation antipsychotics are worse for causing EPSE
1st
63
___ generation antipsychotics are worse for causing sedation and weight gain
2nd
64
what is clozapine good for
-ve side effects, tx resistance and anti-suicide
65
side effects of clozapine
``` agranulocytosis - weekly WBC for 6m then fortnight 6m then monthly myocarditis - ECG constipation weight gain sedation sialorrhoea ```
66
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
67
causes of mortality in schizophrenia
``` suicide HIV, AIDS, hepatitis, TB T2DM cancers cardiac risk osteoporosis ```
68
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 ```
69
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 ```
70
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

MB3 Psychiatry (16 decks)

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