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BRS YR2 > Psychosis > Flashcards

Psychosis Flashcards

1
Q

What is psychosis?

A

Difficulty perceiving and interpreting reality

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2
Q

What 3 domains are symptoms classed into?

A
  • Positive symptoms
  • Negative symptoms
  • Disorganisation
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3
Q

What is a hallucination?

A

Percepts in the absence of a stimulus

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4
Q

What is a delusion?

A

Fixed, false beliefs, out of keeping with social/cultural background

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5
Q

What are positive symptoms?

A

An aspect added onto their usual perception/experience

hallucinations and delusions

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6
Q

What are negative symptoms?

A

The loss of an aspect of their perception of day to day living
(the 4 As)

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7
Q

The 4As of negative symptoms?

A
  • Alogia
  • Anhedonia/asociality
  • Avolition/apathy
  • Affective flattening
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8
Q

What are disorganisation symptoms?

A
  • Bizarre behaviour

- Thought Disorders

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9
Q

What is the onset of psychosis?

A
  • can occur at any age
  • peak incidence in adolescence (early 20s)
  • tends to peak later in women
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10
Q

What is the course of psychosis?

A
  • Often chronic and episodic

- Very variable (person to person)

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11
Q

What is the morbidity of psychosis?

A

Substantial

  • both from the disorder and increased risk of common health problems
  • Large impact of education, employment and functioning
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12
Q

What impact does psychosis have on mortality?

A

Substantial

  • loss of 15 years from life expectancy
  • High risk of suicide in schizophrenia - 28% (in excess)
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13
Q

What to know about previous hospital admissions?

A

Whether the patient consented to the admission (were they detained by the mental health act)

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14
Q

Family history?

A
  • Mental disorder in the family
  • History of abuse, addiction, suicide
  • At home environment
  • Family relationship
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15
Q

Which drugs increase the risk of psychosis?

A
  • Skunk

- Cannabis

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16
Q

Impact of steroids on mental health?

A

Very large and significant possible impact

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17
Q

Corroborative history?

A

(Needs consent to divulge)

- Informants

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18
Q

Mental State Examination?

A
  • Appearance + Behaviour
  • Speech
  • Mood
  • Thoughts
  • Perceptions
  • Cognition
  • Insight
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19
Q

How to determine if there is pressure of speech?

A

Can you interrupt them?

If not, pressure of speech is indicated

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20
Q

What comes first in psychotic depression?

A

The extreme depression causes the psychosis

unable to be challenged

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21
Q

When should a cognition exam during a psychotic episode?

A

treat them first, then assess cognition

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22
Q

What is involved in the long term management of psychosis?

A
  • community follow up
  • managing anti-psychotic side effects
  • health promotion/education
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23
Q

What are the side effects of anti-psychotics?

A 
CNS:
- EPSEs
- Sedation
Haematological
- Agranulocytosis
- Neutropenia
Metabolic
- Increased appetite
- Weight gain 
- Diabetes
Cardiac
- Dysrhythmia
- Long QT complex
Pituitary
- increased prolactin
GI
- Constipation
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24
Q

What is Tardive dyskinesia?

A

Repeated oral/facial/buccal lingual movements

initially subtle - progesses to: tongue involvement, lip smacking

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25
Q

What increases the risk of tardive dyskinesia?

A
  • Long term antipsychotics

- Female

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26
Q

What causes ESPEs (extrapyramidal side effects)?

A

antipsychotics can cause a post-synaptic dopamine blockade in the extrapyramidal system (responsible for posture and tone)

27
Q

What are the 4 main types of ESPEs?

A
  • Parkinsonism
  • Acute Dystonia
  • Tardive Dyskinesia
  • Akathisia
28
Q

What is Parkinsonism?

A
  • Rigidity (‘cog-wheeling’)
  • Slow and shuffling gait
  • Lack of arm swing in gait (early sign)
  • ‘pill-rolling’ tremor (slow 4-6Hz movement of the thumb across the other fingers)
29
Q

What is the difference between ‘typical’ and ‘atypical’ antipsychotics?

A

‘typical’ antipsychotics tend to cause ESPEs at therapeutic doses.

30
Q

What is the management of ESPEs?

A
  • avoidance (atypical antipsychotics first line)
  • change medication
  • anticholinergic medications can help
31
Q

What is Dystonia?

A
  • increased motor tone > sustained abnormal posture
  • can occur shortly after a dopamine antagonist
  • can be: acute, frightening, painful and fatal (laryngeal dystonia)
32
Q

What is Akathisia?

A
  • Inner restlessness
  • Feel compelled to move, but little/no relief
  • can lead to overt, relentless movement
  • most often affects legs
33
Q

What causes reality distortion in psychosis?

A

Increased dopamine activity

elevated presynaptic dopamine in the striatum

34
Q

What are most antipsychotics classed as?

A

Dopamine antagonists

occasionally partial agonists

35
Q

What drugs can cause psychotic symptoms?

A

Dopamine agonists used to manage Parkinsons disease

36
Q

What are the main 3 forms of treatment?

A
  • Pharmacological
  • Psychological
  • Social support
37
Q

What does psychological support of psychosis involve?

A
  • CBT for psychoanalysis

- newer therapies (like avatar therapy)

38
Q

What does social support involve after a psychotic break?

A
  • supportive environments, structures and routines
  • housing, benefits
  • financial support
39
Q

What is Insight?

A
  • awareness and recognition that the presenting phenomena is abnormal
  • Acceptance that the abnormal phenomena is caused by mental illness
  • awareness that treatment is required and different treatment recommendations
40
Q

What is cognition?

A
  • Consciousness
  • Orientation
    (can they get to an appointment?)
  • Memory
  • Attention
  • Language functioning
41
Q

What is the syndrome associated with visual hallucinations?

A

Charles Bonnet Syndrome

42
Q

What is a pseudohallucination?

A
  • When the mode of the hallucination does not mimic the real and locial action of the real mode of sensory input (eg: hearing)
43
Q

What is involved in the Thoughts part of a mental exam?

A
  • flight of ideas, association loss
  • Morbid thoughts, suicidal thoughts
  • primary and secondary delusions
  • obsessional thoughts and compulsions
44
Q

What is the difference between primary and secondary delusions?

A

Primary: occurs suddenly
Secondary: arises from previous abnormal idea/experience

45
Q

What is the term used to describe a shared delusion?

A

folie à deux

46
Q

Thoughts to flag?

A
  • paranoia
  • grandiose/expansive
  • jealousy
  • obsessive control
  • possession of thought (insertion, withdrawal or broadcasting)
47
Q

What are obsessional thoughts commonly associated with?

A
  • dirt/contamination
  • orderliness
  • sex
  • religion
48
Q

What do compulsions normally involve?

A
  • checking
  • cleaning
  • counting
  • dressing rituals
49
Q

Flags in mood?

A
  • Emotional lability/incontinence
  • Reduced reactivity/blunting/flattening
  • Increased irritability
  • Congruity (happy when describing sad events?)
50
Q

Flags in Speech?

A 
Quantity
- less/more/mutism
Rate
Latency
Volume
51
Q

Flags in appearance?

A
  • neglect
  • weight loss
  • posture
  • facial expressions
  • movements
  • social behaviour
52
Q

What does neglect indicate?

A
  • alcoholism
  • addiction
  • dementia
  • depression
  • schizophrenia
53
Q

What does weight loss often indicate?

A
  • anorexia nervosa
  • depression
  • cancer
  • hyperthyroidism
  • financial distress
54
Q

What does overactive/restless movements suggest?

A

mania/manic episode

55
Q

What does inactive/slow movements suggest?

A

depression

56
Q

What is involves in a past medical history?

A
  • any regular medications?
  • compliance/adherence?
  • over the counter?
  • interactions?
57
Q

What is involved in a personal history?

A
  • birth difficulties?
  • early development, childhood trauma?
  • education and job history?
  • intimate relationships?
58
Q

What is in a past psychiatric history?

A
  • any known diagnosis?
  • any treatment?
  • known to a community team?
  • previous hospital admissions
59
Q

What is Alogia?

A
  • paucity of speech

- slow responses

60
Q

What is Anhedonia/Asociality?

A
  • few close friends
  • few hobbies and interests
  • impaired social function
61
Q

What is Avolution/Apathy?

A
  • poor self-care
  • lack of persistence at work/education
  • lack of motivation
62
Q

What is Affective Flattening?

A
  • Unchanging facial expressions
  • Few expressive gestures
  • Poor eye contact
  • lack of vocal intonation
63
Q

What is bizarre behaviour?

A
  • bizarre social behaviour
  • odd clothing/appearance
  • aggression/aggitation
  • repetitive/stereotypes behaviour
64
Q

What is thought disorder?

A
  • derailment
  • circumstantial speech
  • pressured speech
  • distractibility
  • incoherent/illogical speech

BRS YR2 (70 decks)

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