Psychosis

Question 1

prevelance of psychotic disorders?

Answer 1

3.5%

Question 2

what diseases can cause psychosis?

Answer 2

schizoaffective disorder
depression with psychotic features 
substance related 
bipolar
 schizophrenia 
delusional disorder

Question 3

what are the domains is psychosis ?

Answer 3

positive symptoms
negative symptoms
disorganisation

Question 4

2 types of positive symptoms?

Answer 4

hallucinations, delusions

Question 5

hallucinations type?

Answer 5

Percepts in absence of a stimulus​

Auditory​

Voices commenting on you​

Voices talking to each other​

Visual​

Somatic/tactile​

Olfactory (rare)

Question 6

What are delusions? and types

Answer 6

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

Question 7

what are negative symptoms?

Answer 7

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

Question 8

what are the disorganisation symptoms?

Answer 8

bizarre behaviour

thought disorder -> derailment, circumstantial speech, pressure speech, distractibility, illogical speech

Question 9

what is prodrome?

Answer 9

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

Question 10

Onset of psychosis?

Answer 10

any age
peak in adolescence
peak later in women

Question 11

what is the course like?

Answer 11

chronic or episodic

Question 12

Morbidity in psychosis?

Answer 12

substantial, both from disorder and from health risks such as CVD
impact on employment and functioning

Question 13

Mortality in psychosis?

Answer 13

all cause is 2.5x higher
15 years of life lost
high risk of suicide in schizophrenia 28% of excess mortality

Question 14

what does the psychiatric history include?

Answer 14

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

Question 15

what does the mental health examination include?

Answer 15

Appearance and Behaviour​
Speech​
Mood​
Thoughts​
Perceptions​
Cognition​
Insight

Question 16

what should be looked at under appearance and behaviour?

Answer 16

General appearance​ -> weight loss, neglect

Facial expression​ -> anxious, wooden parkisonian

Posture ​-> hunched depressed, upright anxious

Movements ​-> overreactive

Social behaviour -> disinhibited, overfamiliar

Question 17

what falls under speech?

Answer 17

quantity
rate -> ketogenic schizophrenia speak slowly
spontaneity -> derailment-> speech that tends to fall off track
volume

Question 18

what falls under mood?

Answer 18

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

Question 19

what is under thoughts?

Answer 19

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

Question 20

what falls under perceptions?

Answer 20

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

Question 21

what is charles bonnet syndrome?

Answer 21

hallucinations which are caused by severe vision loss-> not have to do with mental health

Question 22

what falls under cognitions?

Answer 22

Consciousness ​

Orientation​

Attention and concentration​

Memory​

Language functioning​

Visuospatial functioning

Question 23

what is insight?

Answer 23

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

Question 24

Treatment for psyshosis?

Answer 24

antipsychotic medication
CBT, avatar therapies
supportive environment, structure and routines, housing benefits

Question 25

what do antipsychotic drugs act on and what do they do?

Answer 25

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

Question 26

What extrapyramidal side effects can antipsychotics cause?

Answer 26

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

Question 27

what makes something typical vs atypical antipsychotics?

Answer 27

typical -> cause parkinsonism

atypical -> less likely to cause them eg olanzapine

Question 28

how to manage typical antipsychotics?

Answer 28

avoid them in first place
change medication
anticholinergic medication can help eg procyclidine

Question 29

side effects of antipsychotics?

Answer 29

EPSEs
sedation 
agranulocytosis 
neutropenia 
increased appetite
weight loss 
diabetes 
constipation 
more prolactin 
dysrhythmia 
Long QTc