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Yr2 Lily BRS Psych > psychosis > Flashcards

psychosis Flashcards

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1
Q

what is psychosis?

A

descriptive term:
difficulty perceiving and interpreting reality
can be caused by many disorders
eg. schizophrenia, bipolar, substance related, schizoaffective disorder, depression with psychotic features

prevalence is around 3.5%

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2
Q

what are the symptom domains in psychosis?

A

positive symptoms
negative symptoms
disorganisation

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3
Q

what are the positive symptoms of psychosis?

A 
hallucinations:
auditory (voices may be talking to you -2nd person, may be talking to each other -3rd person)
visual
tactile
olfactory (rare)
delusions:
(fixed false beliefs, out of keeping with societal/cultural background)
persecutory
control
reference
sexual
jealousy
paranoid
hypochondriacal
mindreading
grandiosity
religious
guilt
thought broadcasting
thought insertion
thought withdrawal
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4
Q

what are the negative symptoms of psychosis?

A

Alogia:
paucity of speech
little content
slow to respond

avolition/apathy:
poor self care
lack of persistence in work/education
lack of motivation

anhedonia/asociality:
few close friends
few hobbies/interests
impaired social functioning

affective flattening:
unchanging facial expressions
few expressive gestures
poor eye contact
lack of vocal intonations
inappropriate affect
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5
Q

what are the disorganisation symptoms of psychosis?

A 
bizarre behaviour:
odd social behaviour
odd clothing/appearance
aggression/agitation
repetitive/stereotyped behaviours
thought disorder:
derailment
circumstantial speech
pressured speech
distractibility
incoherent/illogical speech
loosening of associations
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6
Q

what is the epidemiology of psychosis?

A

onset:
can be at any age
peaks in adolescence/early 20s
peak is later in women

course:
often chronic and episodic
vary variable

morbidity:
substantial
from disorder itself and increase risk of common health problems
significant effects on education, employment and functioning

mortality:
substantial
all cause mortality 2.5x higher
15 years loss of life expectancy
high risk of suicide (28%) of excess mortality
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7
Q

what are the components of a psychiatric history?

A 
history of presenting concern
past psychiatric history 
background history (fam, personal, social)
past medical history and medicines
corroborative history
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8
Q

what does the HPC entail?

A

patients description pf presenting problem

nature, severity, onset, course, worsening factors, treatment received
circumstances leading to arrival at hospital (why now?)

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9
Q

what does past psychiatric history entail?

A

any known diagnoses
any treatment
known to a community team?
any previous admissions to hospital

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10
Q

what does the background history entail?

A

family:
age of parents, siblings, relationships with them
atmosphere at home
mental disorder in the family, alcohol/drug (esp weed and skunk) misuse, suicide, abuse!

personal:
mothers pregnancy and birth
early development, separation, childhood illness
education and occupational history
intimate relationships
social:
living arrangements
financial issues
alcohol and illicit drug use!
forensic history!
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11
Q

what does past medical history and medicines entail?

A

medical problems = a cause/consequence of mental disorder or psychiatric treatment

regular medications?
compliance?
over the counter?
interactions?

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12
Q

what does the corroborative history entail?

A

need for consent!

informants:
relatives, friends, authority

confidentiality

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13
Q

what does a mental state examination test (MSE)?

A 
appearance and behaviour
speech
mood 
thoughts
perceptions
cognition
insight
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14
Q

what is being looked for in the appearance and behaviour part of the MSE?

A

general appearance:
neglect (alcoholism, drugs, dementia, depression, schizo), weight loss (anorexia nervosa, depression, cancer, financial issues, hyperthyroidism)

facial expression:
depressive, anxious, “wooden” parkinsonian

posture:
hunched shoulders, downcast head and eyes - depressive
upright, head erect, hands gripping the chair - anxious

movements:
overactive, restless - manic
inactive, slow - depressive
immobile, mute - stupor
tremors, tics, dystonia, mannerisms, stereotypes

social behaviour:
disinhibited, overfamiliar, withdrawn, preoccupied, signs of impending violence

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15
Q

what is being looked for in the speech section of the MSE?

A

quantity:
less, more, mutism

rate:
slow, fast, pressure of speech (can you get a word in)

spontaneity:
latency

volume:
quiet, loud

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16
Q

what is being looked for in the mood section of the MSE?

A

may be subjective or objective (do they tell you about it, or to you judge it)

objective:
predominant mood

constancy - emotional lability, reduced reactivity, blunting, flattening, irritability

congruity- cheerful while describing sad events

17
Q

what is being looked at in the thoughts section of the MSE?

A

stream:
pressure, poverty, blocking

form:
flight of ideas, loosening associations, perseveration

content:
preoccupations
morbid thoughts/ suicidality!!!
delusions, overvalued ideas
obsessional symptoms (dirt, contamination, aggressive actions, disease, sex, religion)(checking, cleaning, counting, dressing rituals)
18
Q

what is being looked at in the perceptions section of the MSE?

A

illusions:
misperception of a real external stimulus

hallucinations:
perception in the absence of external stimulation
1) true perception
2) coming from outside the head

distortions:
changes in size and shapes of objects

19
Q

what is being looked at in the cognition section of the MSE?

A 
consciousness
orientation
attention and concentration 
memory
language functioning
visuospatial functioning
20
Q

what is being looked at in the insight section of the MSE?

A

Awareness of oneself as presenting phenomena that other people consider abnormal

recognising that this is abnormal
accepting this is caused by mental illness
awareness that treatment is required
acceptance of treatment recommendations

21
Q

what is the prodrome of psychosis?

A

psychosis is often preceded by prodromal symptoms:

changes in social behaviour
impairments in functioning

(people at high risk of developing psychosis often have/had another mental disorder like affective disorders earlier in life)

22
Q

what are the risk factors for psychosis?

A

genetics:
schizophrenia is highly heritable (46% concordance inMZ twins)
highly polygenic

environmental:
drug use (esp cannabis and skunk)
prenatal/birth complications
maternal infections
migrant status
socioeconomic deprivation
childhood trauma
23
Q

what are possible differentials for someone presenting with psychotic symptoms?

A

Drugs(cocaine, cannabis)
metabolic
endocrine (thyroid, cushings, addisons)
infections (encephalitis, syph)

schizophrenia
delirium
mania
depression 
schizoaffective disorder
personality disorder
dementia
huntingtons

encephalopathy, acquired brain injury, stroke

24
Q

what are the categories of treatment options for psychosis?

A

pharmacological - antipsychotics

psychological - CBT

social support - supportive environments, structures and routines
housing benefits
support with budgeting/employment

25
Q

how do most antipsychotics work?

A

they mainly act on dopamine

increased dopamine activity is implicated in causing reality distortion in psychosis

so most antipsychotics are DOPAMINE ANTAGONISTS

(dopamine agonists, like those used in parkinsons, can cause psychotic symptoms)

26
Q

what are the extrapyramidal side effects of antipsychotics?

A

extrapyramidal side effects:
parkinsonism (rigidity, slow and shuffling gait, lack of arm swing, pill rolling tremor)
acute dystonia
tardive dyskinesia
akathisia
(due to post synaptic dopamine blockade in the parts of the brain that maintain posture and tone)

27
Q

what is the difference between typical and atypical antipsychotics?

A

typical:
commonly cause extrapyramidal side effects at therapeutic doses

atypical:
dont

(so atypical used as first line, also anticholinergic medications help)

28
Q

what are the (other) side effects of antipsychotics?

A

extrapyramidal side effects
sedation

agranulocytosis
neutropenia

increased appetite
weight gain
diabetes

constipation

hyperprolactinaemia (due to increased dopamine)

dysrhythmia
long QTc

Yr2 Lily BRS Psych (3 decks)

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