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Phase 1b - Psychiatry > Psychosis > Flashcards

Psychosis Flashcards

1
Q

Outline the prevelance of delirium (5).

A
  • 20% of acute hospital patients > 65 have delirium on admission
  • 30% of patietns on wards have delirium
  • 80% of patients in intense care have delirium
  • 50% of delirium patients are hypoactive
  • 50% of delirium patients go undetected
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2
Q

What are the predisposing factors of delirium (9)?

A
  • Impaired activities of daily living
  • Dementia
  • Urinary catheterization
  • Sensory impairement
  • Advanced age
  • Malnutrition
  • Immobility
  • Depression
  • Alcohol
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3
Q

What are the causes of delirium (14)?

A
  • Infection (urine / pneumonia / cellulitis / wound etc.)
  • Change in environment (ITU / HDU / ward)
  • Medication (opiates / anticholinergics / steroids)
  • Liver / Renal impairement
  • Alcohol withdrawl
  • Hyponatraemia
  • Surgery
  • Pain
  • Hypoxia
  • Encephalitis
  • Constipation
  • Dehydration
  • Urine detection
  • Stroke
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4
Q

How is delirium managed (6)?

A
  • Anticipate
  • Early diagnoses
  • Treat the causes
  • Modify risk factors if possible
  • Medication
  • Good nursing (Single room / Well lit / Familiar staff & family)
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5
Q

What is stigma?

A
  • Refers to challenges faced by people with mental illness related to knowledge, attitudes and behaviour of people they meet
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6
Q

What are the causes of stigma (3)?

A
  • Poor understanding of mental health
  • Negative attitude
  • Social exclusion
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7
Q

What are the 3 types of stigma?

A
  • Intrapersonal stigma
  • Interpersonal stigma
  • Structural stigma
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8
Q

What is intrapersonal stigma (2)?

A
  • Direct effect on the individual
  • Internalised discrimination
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9
Q

What is interpersonal stigma (3)?

A

Stigma from:

  • Family
  • Friends
  • Colleagues
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10
Q

What is structural stigma (2)?

A
  • Poor resources & funding
  • Access to physical healthcare
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11
Q

What is delirium?

A
  • Organic syndrome characterised by concurrent disturbances of consciousness and attention, perception, thinking, memory, psychomotor behaviour, emotion and the sleep-wake schedule
  • The duration is variable and the degree of severity ranges from mild to very severe
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12
Q

What is psychosis?

A
  • A group of mental illnesses that features a difficulty perceiving and interpreting reality
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13
Q

Which type of mental illnesses are associated wit psychosis (7)?

A
  • Schizoaffective disorder
  • Bipolar I
  • Schizophrenia (1%)
  • Delusional disorder
  • Depression with psychotic features
  • Substance related
  • Due to other medical condition
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14
Q

What is the epidemiological onset of psychosis?

A
  • Can occur at any age
  • Peak incidence in adolesence / early 20s
  • Peak later in women
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15
Q

Outline the course of psychosis.

A
  • Often chronic & episodic
    • Very variable
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16
Q

Outline the morbidity of psychosis (2).

A
  • Increased risk of common health problems (e.g. heart disease)
  • Significant impact on education, employment & functioning
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17
Q

Outline the mortality of psychosis (2).

A
  • All - cause mortality 2.5 time higher (~15 years of life expectancy lost)
  • High risk of suicide in schizophrenia ~ 28% of excess mortality
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18
Q

What are the genetic risk factors for psychosis & schizophrenia?

A
  • Schizophrenia is highly heritable
  • Psychosis is highly polygenic
19
Q

What are the environmental risk factors for psychosis (6)?

A
  • Cannabis and drug use
  • Maternal infections
  • Migrant status
  • Socioeconomic deprivation
  • Childhood trauma
  • Prenatal / birth complications
20
Q

What type of symptoms typically precede psychosis?

A
  • Prodromal symptoms
    • Changes in social behaviour, social withdrawal and impairments in functioning
21
Q

What are the 3 domains of psychosis symptoms?

A
  • Positive symptoms
  • Negative symptoms
  • Disorganisation
22
Q

What are the 2 main positive symptoms of psychosis?

A
  • Hallucinations (Percepts in absence of stimulus)
  • ​Delusions (Fixed, false believes, out of keeping with social / cultural background)
23
Q

What are hallucinations in psychotic patients (6)?

A
  • Auditory
  • Voices commenting on you
  • Voices talking to each other
  • Visual
  • Somatic/tactile
  • Olfactory
24
Q

What are delusions in psychotic patients (11)?

A
  • Persecutory
  • Control
  • Reference
  • Mind reading
  • Grandiosity
  • Religious
  • Guilt / Sin
  • Somatic
  • Thought broadcasting
  • Thought insertion
  • Thought withdrawal
25
Q

What are the 4 main negative symptoms of psychosis?

A
  • Alogia
  • Avolution / Apathy
  • Anhedonia / Asociality
  • Affective flattening
26
Q

Define Alogia (2).

A
  • Paucity of speech, little content
  • Slow to respond
27
Q

Define Avolution / Apathy (3).

A
  • Poor self-care
  • Lack of persistence at work / education
  • Lack of motivation
28
Q

Define Anhedonia / Asociality (3).

A
  • Disengaged interest and pleasure within conducting activities
    • Few close friends
    • Few hobbies/interests
    • Impaired social functioning
29
Q

Define Affective flattening (5).

A
  • Unchanging facial expressions
  • Few expressive gestures
  • Poor eye contact
  • Lack of vocal intonations
  • Inappropriate affect
30
Q

What are the 2 main forms of disorganisation symptoms?

A
  • Bizarre behaviour
  • Thought disorder
31
Q

What is classified as bizarre behaviour (4)?

A
  • Bizarre social behaviour
  • Bizarre clothing / appearance
  • Aggretion / agitation
  • Repetitive / sterotyped behaviours
32
Q

What is classified as thought disorder (5)?

A
  • Derailment
  • Circumstantial speech
  • Pressured speech
  • Distractibility
  • Incoherent / illogical speech
33
Q

How is psychosis diagnosed (2)?

A
  • Psychiatric History
  • Mental State Examination (MSE)
34
Q

What is included in a psychiatric history (5)?

A
  • History of presenting concern (HPC)
  • Past psychiatric history (PPH)
  • Background history (family, personal & social)
  • Past medical history and medicine (PMH)
  • Corroborative history (Requires consent)
    • Educational, occupational history, relationships, separation, childhood illness
35
Q

What is included in a social history (4)?

A
  • Living arrangements
  • Financial issues
  • Alcohol and illicit drug use
  • Forensic history
36
Q

What is included in a mental state examination (6)?

A
  • Appearance and behaviour
  • Speech
  • Mood
  • Thoughts
  • Perceptions
  • Cognition
37
Q

What additional sources of information are available to support a diagnosis of psychosis (2)?

A
  • Collateral history from family, friends and work
  • Healthcare records: GP, Mental health services
38
Q

What is insight in terms of assessing a patient’s mental state (4)?

A
  • Awareness of onself as presenting phenomena that other people consider abnormal
  • Recognition that these phenomena are abnormal
  • Acceptance that these abnormal phenomena are caused by mental illness
  • Awareness that treatment is required
39
Q

What difficulties are encountered when treating someone with very poor insight into their psychosis (3)?

A
  • Concordance with treatment
  • Attendance at follow-up
  • Would not stay in hospital
40
Q

What are the differentials for psychosis (6)?

A
  • Delirium
  • Schizophrenia
  • Personality disorder
  • Dementia
  • Drugs
  • Encephalitis (behavioural changes)
41
Q

What are the 3 types of psychosis management?

A
  • Pharmacological
  • Psychological (CBT and avatar therapy)
  • Social support
42
Q

What is the pharmacological management of psychosis (1)?

A
  • Antipsychotic medications

Depends on patient

43
Q

What is the psychological management of psychosis (2)?

A
  • CBT for psychosis
  • Newer therapies also avaialble (i.e. avatar therapy)
44
Q

What is the social support management of psychosis (3)?

A
  • Supportive environments, structures and routines
  • Housing, benefits
  • Support (i.e. budgeting / employment)

Phase 1b - Psychiatry (8 decks)

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