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Y3 - Psych > Psychosis > Flashcards

Psychosis Flashcards

1
Q

What is psychosis?

A

A collection of symptoms in which a patient experiences a significant alteration in perceptions, thoughts, mood and behaviour, involving an inability to distinguish between subjective experience and objective reality and characterised by a lack of insight

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2
Q

What are the main symptoms psychosis?

A 
Hallucinations
Delusions
Thought disorder
Loss of insight
Self-referential experiences
Ideas of reference
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3
Q

What is a hallucination?

A

A perception which occurs in the absence of an external stimulus
A misrepresentation of inner experience as having external origin

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4
Q

What is a delusion?

A

A fixed, falsely held belief held with unshakeable conviction

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5
Q

What is the difference between primary and secondary delusions?

A

Primary - arrive fully formed without need for explanation

Secondary - attempts to explain anomalous experiences

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6
Q

Which is more common - primary or secondary delusions?

A

Secondary

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7
Q

What are thought disorders?

A

Any disturbance in cognition that adversely affects language and thought content, and thereby communication

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8
Q

What are examples of thought disorder?

A 
Passivity phenomenon
Thought interference
Loosening of associations
Knight's move thinking
Neologisms
Circumstantiality 
Tengentiality
Verbigeration
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9
Q

What is passivity phenomenon?

A

The feeling that the patient’s actions, feelings, urges aren’t their own

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10
Q

What is thought interference?

A

The feeling that the patient’s thoughts not their own, being withdrawn, broadcast, blocked

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11
Q

What is loosening of associations?

A

Speech is muddled, illogical, difficult to follow and cannot be clarified

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12
Q

What is Knight’s move thinking?

A

Jumps from topic to topic with no logical connection between them

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13
Q

What are neologisms?

A

An abnormality of speech in which the patient makes up a new word or phrase or uses existing words or phrases in bizarre ways which have no generally accepted meaning but which have idiosyncratic meaning to the patient

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14
Q

What is circumstantiality?

A

When the patient talks around the point but gets there eventually

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15
Q

What is tangentiality?

A

When the patient talks around the point and never actually gets to it

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16
Q

What is verbigeration?

A

Individual words don’t connect and sentences make no sense whatsoever

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17
Q

What are self-referential experiences (paranoia)?

A

The belief that external events are related to oneself

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18
Q

How are persecutory thoughts different to paranoia?

A

Paranoia is when you think unrelated things are related to you
Persecutory is only when you think someone is out to get you/others

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19
Q

What are ideas of reference?

A

Innocuous or coincidental events are ascribed significant meaning

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20
Q

What are psychiatric causes of psychosis?

A

Schizophrenia
Scizoaffective disorder
Mania
Depression

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21
Q

What are organic causes of psychosis?

A 
Dementia
Delirium
Huntington's
SLE
Syphilis
Hyperthyroidism
Hypoglycaemia
Parkinson's
HIV/AIDS
Syphilis
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22
Q

What cause of psychosis do auditory hallucinations make more likely?

A

Schizophrenia

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23
Q

What cause of psychosis do visual hallucinations make more likely?

A

Drugs

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24
Q

What cause of psychosis do tactile hallucinations make more likely?

A

Delirium

Alcohol withdrawal

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25
Q

What drugs can cause psychosis?

A 
Cannabis
Amphetamine
Levodopa
Steroids
Antimalarials
Anticonvulsants
Antipsychotics
Antidepressants
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26
Q

The withdrawal of which substances can cause psychosis?

A

Alcohol

Benzodiazepines

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27
Q

What is the treatment for drug-induced psychosis?

A

Cessation of use of the causative drug - usually takes about 4 weeks

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28
Q

When are psychosis symptoms mood congruent?

A

In mood disorders

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29
Q

What are features of psychosis in depression?

A

Delusions of worthlessness, guilt, nihilism
Auditory hallucinations that are derogatory, insulting or threatening
Cottard’s syndrome - belief that the body has already died
Typically second person
Affirming their perception of themself

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30
Q

What are features of psychosis in mania?

A

Delusion of grandeur, special ability, persecution, religiosity
Hallucination tend to be second person and auditory
Flight of ideas

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31
Q

What is schizoaffective disorder?

A

The diagnosis that bridges the gap between bipolar and schizophrenia
When psychosis and mood symptoms are present in equal measure

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32
Q

Who is schizophrenia most common in?

A

Men
Lower socioeconomic class
Onset in young adulthood

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33
Q

What is the aetiology of schizophrenia?

A

Multi-factorial neurodevelopment disorder
Genetics (80% inherited)
Environmental factors (obstetric complications, childhood CNS infection, early cannabis use)
Psychological factors (stress, adverse life events, psychoactive drug use)

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34
Q

What biological changes happen in schizophrenia?

A

Changes in dopamine signalling pathways in the brain
Lack of gliosis (reactive change of glial cells in response to damage to the central nervous system)
Ventricular enlargement and alteration fo CSF flow
Decrease in white matter volume

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35
Q

What are the ‘first rank’ symptoms of schizophrenia?

A

3rd person auditory hallucinations
Thought insertion, broadcast or removal
Passivity phenomenon
Delusions

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36
Q

Describe the hallucinations of schizophrenia?

A

3rd person auditory hallucinations that give a running commentary or discussion of the patient

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37
Q

Describe the delusions of schizophrenia?

A

Persistent

Culturally inappropriate or completely impossible

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38
Q

What are the additional symptoms of schizophrenia? (other than first rank ones)

A 
Other types of hallucinations
Incoherent or irrelevant speech
Neologisms
Breaks or interruptions in train of thought
Catatonic behaviour
Negative symptoms
39
Q

What symptoms of schizophrenia are ‘positive’ symptoms?

A

Delusions
Hallucinations
Thought disorder
Passivity phenomena

40
Q

What symptoms of schizophrenia are ‘negative’ symptoms?

A 
Apathy
Social withdrawal
Self neglect
Poverty of thought
Reduced social performance
Blunted and incongruent affect
Reduced motivation
41
Q

What is a ‘blunted’ affect?

A

Reduced outward display of emotions

42
Q

What is an ‘incongruent’ affect?

A

React inappropriately to social circumstance

43
Q

What are the prodromal symptoms of schizophrenia?

A 
Gradual onset
Non-specific symptoms
Odd ideas and experiences
Eccentricity
Altered affect
44
Q

What is the diagnostic criteria for schizophrenia?

A

At least 1 first rank
Or at least 2 additional symptoms
Present for at least 1 month
Not explained by another cause

45
Q

When is schizophrenia diagnosed if the patient also meets the criteria for a manic or depressive episode?

A

If the schizophrenic symptoms were present before the disturbance of mood developed

46
Q

What are the subtypes of schizophrenia?

A 
Paranoid
Disorganised/hebephrenic
Catatonic
Simple
Undifferentiated
Residual
47
Q

What is pathetic most common subtype of schizophrenia?

A

Paranoid schizophrenia

48
Q

What is paranoid schizophrenia?

A

3rd person auditory hallucinations and delusional beliefs about self, with these often being persecutory

49
Q

What is disorganised/hebephrenic schizophrenia?

A

Affective changes are prominent
Delusions and hallucinations are fleeting
Behaviour irresponsible and unpredictable
The mood is shallow and inappropriate, thought is disorganised, speech is incoherent
A tendency to social isolation and negative symptoms

50
Q

What is catatonic schizophrenia?

A 
Movement disorder predominates - characterised by unusual, limited and sudden movements
Mutism, stupor
Posturing
Negativism
Command automatism
51
Q

What is posturing?

A

Maintenance of odd postures

52
Q

What is negativism?

A

Resistance to command or attempts to be moved

53
Q

What is command automatism?

A

The patient will do whatever you ask them to

54
Q

What is simple schizophrenia?

A

Negative symptoms are most predominant early and worsen
Positive symptoms are rarely experienced
Rare

55
Q

What is undifferentiated schizophrenia?

A

Some signs of paranoid, hebephrenic or catatonic but not obviously fitting into one type alone

56
Q

What is residual schizophrenia?

A

When there is a history of psychosis but the patient currently only experiences the negative symptoms

57
Q

What are good prognostic indicators for schizophrenia?

A

Female
Older age of onset
Family history of mood disorder
Marked mood disturbance, especially elation

58
Q

What are bad prognostic indicators for schizophrenia?

A 
Male
Early age of onset childhood, adolescence)
Insidious onset
Prolonged duration of undiagnosed psychosis
Poor premorbid adjustment in life
Co-morbid substance misuse
Social isolation
Cognitive impairment
Disorganised subtype
Multiple first rank symptoms
59
Q

What is the mainstay of treatment for schizophrenia?

A

Antipsychotics (typical or atypical)

60
Q

What are examples of typical antipsychotics?

A

Haloperidol

Chlorpromazine

61
Q

What is the mechanism of typical antipsychotics?

A

Block dopamine D2 receptors - they are dopamine antagonists
Results in inhibition of the mesolimbic and nigrostriatal pathways - where delusions, hallucinations, thought disorders arise
Reduce symptoms and prevent relapse

62
Q

What are the side effects of antipsychotics?

A 
Extrapyramidal side effects
Sedation
Neuroepileptic malignant syndrome
Hyperprolactinaemia
Akathisia
Anti-cholinergic effects
QT prolongation
Increased appetite and weight gain
63
Q

What are the different extrapyramidal side effects?

A

Acute dystonia
Parkinsonism
Tardive dyskinesia

64
Q

What is acute dystonia?

A

Painful, sustained contractions of muscles, usually in the eyes, jaw or neck
Occurs within a few minutes-hours of starting treatment

65
Q

What is used to treat acute dystonia?

A

Procyclidine

66
Q

What are the symptoms of parkinsonism?

A 
Resting tremor
Shuffling gait
Reduced facial expressions
Cogwheel rigidity
Bradykinesia
67
Q

What is tardive dyskinesia?

A

Repetitive, uncontrollable, involuntary contraction of the muscles of the face, tongue and upper body
Typically presents as excessive blinking, lip smacking, facial grimaces
Seen with long term use and is non-reversible

68
Q

Are extrapyramidal side effects of antipsychotics seen more often with typical or atypical antipsychotics?

A

Typical

69
Q

What is neuroleptic malignant syndrome?

A

Rare serious complication of typical antipsychotics

70
Q

What is the presentation of neuroleptic malignant syndrome?

A 
Increased muscle tone and bradykinesia
Pyrexia
Changing pulse/BP swinging from increased to decreased
> Rhabdomyolysis
> Acute renal failure
> Coma
> Death
71
Q

What do blood tests show in neuroleptic malignant syndrome?

A

Raised WCC

CK in the thousands

72
Q

What is the management of neuroleptic malignant syndrome?

A

Stop antipsychotic
Rapid cooling, renal support
Skeletal muscle relaxants - e.g. dantrolene
Dopamine agonists - e.g. bromocriptine

73
Q

Why do anti-psychotics cause hyperprolactinaemia?

A

Prolactin release inhibited by dopamine so dopamine antagonists cause increased release of prolactin

74
Q

What are the symptoms of hyperprolactinaemia?

A

Women: galactorrhea, decreased libido, decreased arousal, anorgasmia, amenorrhoea, anovulation
Men: gynaecomastia, erectile dysfunction, oligospermia, decreased libido
Decreased bone mineralisation
Decreased bone density
Fractures

75
Q

What is akathisia?

A

Restlessness
Pacing and unable to stand still
Leads to poor sleep

76
Q

How is akathisia treated?

A

Beta blockers

Benzodiazepines

77
Q

What are anti-cholinergic side effects?

A

Dry mouth
Blurred vision
Constipation

78
Q

What are examples of atypical antipsychotics?

A 
Olanzapine
Quetiapine
Aripiprazole
Risperidone
Amisulpride
Clozapine
79
Q

What is the mechanism of atypical antipsychotics?

A

Block D2 dopamine receptors

And receptors for other neurotransmitters

80
Q

Which side effects are most common in atypical antipsychotics?

A 
Weight gain
Sedation
Hyperprolactinaemia
Sexual dysfunction
Increased risk of seizures
Extrapyramidal side effects
81
Q

Which is the most effective antipsychotic?

A

Clozapine

82
Q

When is clozapine used, and why?

A

Treatment resistant schizophrenia

Bad side effects

83
Q

What are the side effects of clozapine?

A 
Agranulocytosis
Myocarditis
Weight gain
Sedation
Hypersalivation
Cardiomyopathy
PE
Constipation that can lead to gastric paresis, obstruction and perforation
84
Q

What is treatment resistant schizophrenia?

A

Illness that does not respond to two adequate trials (6 weeks) of two different anti-psychotics, one of which was an atypical

85
Q

What is needed for patients on clozapine?

A

Regular blood testing because of agranulocytosis
Hyoscine hydrobromide for treatment of hypersalivation
Titration to therapeutic dose

86
Q

What type of antipsychotics are first line?

A

Atypical - but differs depending on which side effects are appropriate/inappropriate for different patients

87
Q

What antipsychotic would you give to avoid extrapyramidal side effects?

A

An atypical

88
Q

What antipsychotic would you give to avoid sedation?

A

Haloperidol

Risperidone

89
Q

What antipsychotic would you give to provide sedation?

A

Olanzapine

Chlorpromazine

90
Q

What antipsychotic would you give to avoid weight gain?

A

Haloperidol

Aripiprizole

91
Q

What antipsychotic would you give in treatment resistant schizophrenia?

A

Clozapine

92
Q

What antipsychotic would you give if compliance is an issue?

A

Depot risperidone

93
Q

Which other situations can antipsychotics be used in?

A

Anxiety - olanzapine
Bipolar as a mood stabiliser or for acute depression or mania
Rapid tranquilisation

Y3 - Psych (12 decks)

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