Psychosis Flashcards
What is psychosis?
The inability to differentiate between subjective experience and objective reality.
What are the characteristic features of psychosis?
Hallucinations
Delusions
Thought formation disorders
What is schizoaffective disorder?
An overlap between bipolar disorder and schizophrenia.
Can psychosis be of organic aetiology?
Yes
What are halucinations?
A disconnect between perception of a stimulus and memory - a perception without an external stimulus.
It can affect any sensory modality.
What sensory modalities are most commonly affected by hallucinations?
Visual
Auditory
What are ideas of reference?
When innocuous/coincidental events are ascribed a significant meaning by the patient.
Associated with aberrant dopamine signalling.
What is paranoia?
A sense that external events are related to oneself in some way.
What are delusions?
Fixed, falsely held beliefs.
Held with unshakeable conviction.
What is passivity?
The disconnect between an action/urge.
What are the 4 forms of thought interference?
Insertion
Withdrawal
Broadcasting
Blocking
What is insight?
The capacity to realise their mental experience is not real.
If retained, a good prognostic factor.
What are possible causes for psychosis?
Organic cause
Substance misuse
Paranoid psychoses
Mood disorders
What form of hallucinations are highly suggestive of schizophrenia?
Third person auditory hallucinations.
What are the 2 stages of diagnosing a psychiatric disorder?
History
Mental state examination
What is delirium?
An acute, transient disturbance from normal cognitive function. It is due to an insult to the brain (e.g. infection).
What are features of delirium?
Worse at night Impaired concentration Hallucinations (usually visual) Agitation Psychomotor retardation Insomnia
What drugs are commonly associated with drug-induced psychosis?
Legal highs
What are the ‘positive’ symptoms of schizophrenia?
Hallucinations
Delusions
Passivity phenomena
Thought formation disorder
What are ‘negative’ symptoms of schizophrenia?
Reduced speech Reduced motivation Reduced interest Reduced social interaction Blunted affect
Is psychosis a symptom or condition?
It is a symptom - appears in many conditions.
What are the 5 dopamine pathways within the brain?
Mesolimbic pathway Mesocortical pathway Nigrostriatal pathway Tuberoinfundibular pathway Hypothalamospinal pathway
What are the receptors targeted in schizophrenic patients?
D2 receptors of the mesolimbic pathway.
What are potential side-effects of dopamine therapy?
Extra-pyramidal symptoms
Hyperprolactinaemia
Akathesia/restless leg syndrome
Neuroleptic malignant syndrome
What is neuroleptic malignant syndrome?
A slowly evolving dystonia with hyperpyrexia and autonomic instability.
Has a CK>1000 and swinging BP too.
Transfer to ITU - highly fatal.
What is affected if dopamine is blocked in the tuberoinfundibular pathway?
Prolactin
Can produce osteopenia.
What are common side-effects of anticholinergics?
Dry mouth
Blurred vision
Constipation
What is thought to be the best anti-psychotic?
Clozapine
Risk of agranulocytosis, therefore last-line treatment.
Does schizophrenia affect life expectancy?
Yes, associated with 10-20 years less.
What is the gold standard assessment for delirium?
4AT
How is delirium treated?
Treat underlying cause.
When is schizophrenia most commonly diagnosed?
Adulthood
How long do the symptoms of delirium typically last?
Hours to weeks.
Is there any physiological differences seen in those with schizophrenia?
Ventricles are enlarged in the brain - this is non-progressive.
What is schizophrenia?
A disease of dopamine pathway overactivity.
Organic cause hallucinations are typically of what sense?
Visual
How is delirium diagnosed?
Physical examination - trying to find the underlying cause.
