Psychosis Flashcards
prevelance of psychotic disorders?
3.5%
what diseases can cause psychosis?
schizoaffective disorder depression with psychotic features substance related bipolar schizophrenia delusional disorder
what are the domains is psychosis ?
positive symptoms
negative symptoms
disorganisation
2 types of positive symptoms?
hallucinations, delusions
hallucinations type?
Percepts in absence of a stimulus
Auditory
Voices commenting on you
Voices talking to each other
Visual
Somatic/tactile
Olfactory (rare)
What are delusions? and types
fixed belief out of cultural background
Persecutory
Control
Reference
Mind reading
Grandiosity
Religious
Guilt/sin
Somatic
sexual/ amorous
hypochondriaal
Thought broadcasting
Thought insertion
Thought withdraw
what are negative symptoms?
Alogia -> Paucity of speech, little content
Slow to respond
Anhedonia ->Few close friends
Few hobbies/interests
Impaired social functioning
Avolition/apathy->Poor self-care
Lack of persistence at work/education
Lack of motivation
Affective flattening ->Unchanging facial expressions Few expressive gestures Poor eye contact Lack of vocal intonations Inappropriate affect
what are the disorganisation symptoms?
bizarre behaviour
thought disorder -> derailment, circumstantial speech, pressure speech, distractibility, illogical speech
what is prodrome?
the start of negative symptoms, which are subtle and change over years, eg less social, less studying, then early 20s start show positive symptoms and is diagnosed
Onset of psychosis?
any age
peak in adolescence
peak later in women
what is the course like?
chronic or episodic
Morbidity in psychosis?
substantial, both from disorder and from health risks such as CVD
impact on employment and functioning
Mortality in psychosis?
all cause is 2.5x higher
15 years of life lost
high risk of suicide in schizophrenia 28% of excess mortality
what does the psychiatric history include?
HoPC
past psych history
background history -> mothers pregnancy and birth. alcohol illicit drug use, forensic history, migrant status
past medical history and medicines -> interaction, compliance
corroborative history -> need consent
what does the mental health examination include?
Appearance and Behaviour Speech Mood Thoughts Perceptions Cognition Insight
what should be looked at under appearance and behaviour?
General appearance -> weight loss, neglect
Facial expression -> anxious, wooden parkisonian
Posture -> hunched depressed, upright anxious
Movements -> overreactive
Social behaviour -> disinhibited, overfamiliar
what falls under speech?
quantity
rate -> ketogenic schizophrenia speak slowly
spontaneity -> derailment-> speech that tends to fall off track
volume
what falls under mood?
Subjective -> how it seems to them
Objective -> how it seems to you, how do you leave the room, happy or sad?
Predominant mood
Constancy
Congruity -> cheerful while describing sad events
what is under thoughts?
Stream -> pressure, blocking
Form -> loosening of associations, flight of ideas
Content
Preoccupations
Morbid thoughts, suicidality
Delusions, overvalued ideas -> primary - occurs suddenly, or secondary arises from previous abnormal idea or experience
delusional mood/ perception/ memory which is shared -> folie a deux
Obsessional symptoms
what falls under perceptions?
illusions= misperception of a real external stimulus
hallucinations = perception in the absence of external stimulus true perception + 2) coming from outside the headpseudohallucination = 1) OR 2) -> first person hallucinations coming from your head
distortions
what is charles bonnet syndrome?
hallucinations which are caused by severe vision loss-> not have to do with mental health
what falls under cognitions?
Consciousness
Orientation
Attention and concentration
Memory
Language functioning
Visuospatial functioning
what is insight?
awareness of condition and that these things are abnormal
acceptance that these are caused by mental illness
awareness that treatment is required and accepting treatment
always wait before diagnosing schizophrenia
Treatment for psyshosis?
antipsychotic medication
CBT, avatar therapies
supportive environment, structure and routines, housing benefits
what do antipsychotic drugs act on and what do they do?
mostly dopamine, but can act on serotonin, acetylcholine, histamine
-> we know increased dopamine activity causing distortion in reality in psychosis
most are antagonists, but some such as ARIPIPRAZOLE are partial agonists
What extrapyramidal side effects can antipsychotics cause?
can cause post synaptic dopamine blockade
Parkisonism -> rigid, slow and shuffling gait, lack of arm swing and pin rolling tremor
Tardive dyskinesia- > repeated facial, buccal and lingual movements initial subtle and then can be more prominent, increase risk in females
Akathisia- > feel compelled to move, relentless movement, legs more commonly affected
what makes something typical vs atypical antipsychotics?
typical -> cause parkinsonism
atypical -> less likely to cause them eg olanzapine
how to manage typical antipsychotics?
avoid them in first place
change medication
anticholinergic medication can help eg procyclidine
side effects of antipsychotics?
EPSEs sedation agranulocytosis neutropenia increased appetite weight loss diabetes constipation more prolactin dysrhythmia Long QTc
