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Psychiatry > Psychosis > Flashcards

Psychosis Flashcards

1
Q

Define Psychosis

A

A mental state in which reality is greatly distorted

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2
Q

Name the three prevalent features of Psychosis and define them

A
  • *Delusions** (Fixed false belief held firmly despite evidence to the contrary)
  • *Hallucinations** (Perception in the absence of external stimuli)
  • *Thought Disorder** (impairment in the ability to form thoughts from logically connected ideas)
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3
Q

Describe the ICD10 class 1-8 of Psychotic Disorders

A

1 - Schizophrenia
2 - Schizotypal Disorder
3 - Persistent Delusional Disorder
4 - Acute and Transient Psychotic Disorder (<1m)
5 - Induced Delusional Disorder
6 - Schizoaffective Disorder
7 - Other non organic Psychotic
8 - Unspecified

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4
Q

most common psychotic disorder

A

schizophrenia

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5
Q

name some causes of psychosis

A

non-organic and organic

non-organic - schizophrenia, schizotypal disorder, schizoaffective disorder, acute psychotic episode

organic - iatrogenic, complex partial epilepsy, delirium, dementia, huntington’s, SLE

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6
Q

What is Schizotypal Disorder (AKA Latent Schizophrenia)?

A

Eccentric Behaviour, Suspiciousness, Unusual Speech and deviations of thinking and affect that is similar to those suffering from schizophrenia

No Hallucinations or Delusions

More common in those with a first degree relative with Schizophrenia

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7
Q

what is Mood disorders with psychosis?

A

psychosis develops secondary to depression or mania

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8
Q

What is Schizoaffective Disorder?

A

Symptoms of both Schizophrenia and Mood Disorder in the same episode, with mood disorder meeting criteria (mood disorder can be depression or mania)

mood symptoms should meet criteria for either a depressive illness or manic episode + 1 or 2 typical symptoms of schizophrenia

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9
Q

What is Persistent Delusional Disorder?

A
  • Single or set of delusions (often persecutory, grandiose, hypochondriacal) for at least 3 months in which delusions is the only or most prominent symptom
  • Other areas of thinking intact, unlike Schizophrenia
  • often responds well to antipsychotics
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10
Q

What is Folie à Deux?

A

‘Thought shared by two’

A delusional belief shared between two people.

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11
Q

Name three common types of Delusions

A

Grandiose
Persecutory
Hyperchondriacal

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12
Q

Name three ways of classifying Delusions

A

Cause: Primary vs Secondary
Mood : Congruent vs Incongruent
Plausibility: Bizarre vs Non Bizarre

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13
Q

Name four Organic Causes of Psychosis

A

Drug Induced
Iatrogenic (Steroids)
Dementia
Delirium

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14
Q

Define Schizophrenia

A

Most common form of Psychosis characterised by Hallucinations, Delusions and Thought Disorders which lead to functional impairment.

occurs in absence of organic disease, alcohol or drug-related disorders and is not secondary to elevation or depression of mood

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15
Q

Give three PREDISPOSING risk factors for Schizophrenia

A

bio = genetic, neurochemical, neurodevelopmental, age 15-35,

psychological = FHx, childhood abuse

social = substance misuse, low socioeconomic status, migrants, urban area, birth in late winter/early spring season

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16
Q

Give two PRECIPITATING risk factors for Schizophrenia

A

bio = Smoking Cannabis or psychostimulants

psych = Adverse Life Events, poor coping style

social = adverse life events

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17
Q

Give three PERPETUATING risk factors for Schizophrenia

A

bio = Substance Misuse, Poor Medication Compliance

psychological = adverse life events

social = Lack of Social Support

18
Q

What are Schneider’s First Rank Symptoms for Schizophrenia?

A

symptoms which, if 1 or more are present, are strongly suggestive of schizophrenia as alternative to ICD-10

  • Delusional Perception
  • Third Person Auditory Hallucinations
  • Thought Interference (Insertion, Withdrawal, Broadcast)
  • Passivity Phenomenon (They have no control)
19
Q

Positive symptoms are normally seen in the ‘Acute Phases’ of Schizophrenia, and can be remembered by ‘Delusions Held Firmly Think Psychosis’. What does this mnemonic stand for?

A
  • *D**elusions
  • *H**allucinations
  • *F**ormal Thought Disorder
  • *T**hought Interference
  • *P**assivity Phenomenon
20
Q

The negative symptoms are normally seen in the Chronic Phases of Schizophrenia. What are they?

A
  • Avolition - reduced motivation
  • Asocial behaviour - loss of drive for any social engagements
  • Anhedonia - lack of pleasure in activities that were previously enjoyable
  • Affect Blunted - diminished or absent capacity to express feelings
  • Alogia - Poverty of Speech
  • Attention deficits - may experience problems with attention, language, memory, executive function
21
Q

There are 7 main subtypes of Schizophrenia. Define Paranoid Schizophrenia.

A

Most common, dominated by positive symptoms

22
Q

There are 7 main subtypes of Schizophrenia. Define Post Schizophrenic Depression.

A

Depression predominates with Schizophrenic illness in the past 12 months, and some symptoms still present

23
Q

There are 7 main subtypes of Schizophrenia. Define Hebephrenic Schizophrenia.

A

Though disorganisation predominates
Illness onset is earlier (15-25)
Poorer Prognosis

24
Q

There are 7 main subtypes of Schizophrenia. Define Catatonic Schizophrenia.

A

Rare form characterised by one or more Catatonic Sx

25
Q

There are 7 main subtypes of Schizophrenia. Define Simple Schizophrenia.

A

Rare form with negative symptoms only (no psychotic)

26
Q

There are 7 main subtypes of Schizophrenia. Define Undifferentiated Schizophrenia.

A

Meets criteria for Schizophrenia but doesn’t fit in any categories

27
Q

There are 7 main subtypes of Schizophrenia. Define Residual Schizophrenia.

A

One year of chronic negative symptoms preceded by a clear cut psychotic episode

28
Q

What are the four symptoms in ICD10 Group A Criteria of Schizophrenia?

A

Thought Interference
Delusions of Control/Influence/Passivity
Running Commentary Auditory Hallucinations
Bizarre Persistent Delusions

29
Q

What are the four symptoms in ICD10 Group B Criteria of Schizophrenia?

A

Hallucinations in other modalities that are persistent
Thought Disorganisation
Catatonic Symptoms
Negative Symptoms

30
Q

What is required to diagnose Schizophrenia from ICD10 categories?

A

One clear symptom from Group A, and at least two from Group B
For at least one month

31
Q

Describe the expected Appearance, Behaviour, Speech and Thought of a Schizophrenic patient (MSE)

A

Appearance - may be normal or may have self neglect

Behaviour - Positive (Preoccupied, Restless) or Negative (Withdrawn, Poor Eye Contact)

Speech - Loosening of Associations, Thought Blocking

Thought - Delusions, Thought Interference, Formal Thought Disorder (Circumstantiality)

32
Q

Describe the expected Mood, Perception, Cognition and Insight of a Schizophrenic patient (MSE)

A

Mood - Incongruent
Perception - Hallucinations
Cognition - Orientated but attention and concentration impaired
Insight - Poor

33
Q

what bloods you would like to do for a Schizophrenic Patient

A
  • FBC - anaemia and infection
  • TFTs - thyroid dysfunction can present with psychosis
  • Glucose/HbA1c (Antipsychotics can cause metabolic syndrome)
  • Serum Calcium (Hypercalcemia)
  • Baseline U&Es & LFTs for before giving antipsychotics
  • Cholesterol - atypical antipsychotics cause metabolic sydnrome
  • vit b12 and folate - deficiencies cause psychosis
34
Q

Other than blood tests, name four investigations for Schizophrenia

A
  • Urine drug tests
  • ECG (Antipsychotics can cause Long QT)
  • CT (rule out SOL)
  • EEG (Rule out Tempora Lobe Epilepsy)
35
Q

Describe the pharmacological management of Schizophrenia

A

1) Atypical Antipsychotics (Risperidone, Olanzapine)
2) Clozapine reserved for treatment resistant Schizophrenia

Adjuvants: Short term Benzodiazepines, Antidepressants, Lithium

36
Q

When would you consider ECT for a Schizophrenic patient?

A

If Resistant or Catatonic

37
Q

Name four potential psychological interventions for Schizophrenia

A

CBT
Family Intervention
Art Therapy
Social Training Skills

38
Q

How does Family Intervention help Schizophrenic patients?

A

Psychoeducation helps families decrease high levels of expressed emotion which reduces relapse rates

39
Q

Name three Social Interventions that can be done for Schizophrenic Patients

A
  • Support groups (Rethink, Sane)
  • Peer Support
  • Supported Employment Programmes
40
Q

treatment of first-episode schizophrenia flow chart

A
41
Q

Define Paraphrenia

A

Late onset schizophrenia characterised by positive symptoms
Similar to Paranoid Schizophrenia but less severe
Thought disorder and catatonic symptoms are rare

Psychiatry (18 decks)

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