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Mental Health > Psychosis > Flashcards

Psychosis Flashcards

1
Q

Which antipsychotic is used for treatment resistant schizophrenia?

A

Clozapine

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2
Q

Which antipsychotic reduces the seizure threshold?

A

Clozapine

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3
Q

What is the main advantage of atypical antipsychotics?

A

Significant reduction in extrapyramidal side effects.

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4
Q

Are typical or atypical antipsychotics used first line in schizophrenia?

A

Atypical

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5
Q

List the adverse side effects of atypical antipsychotics

A

Weight gain, agranulocytosis (clozapine), hyperprolactinaemia.

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6
Q

What is there a risk of when using antipsychotics in the elderly?

A

Increased risk of stroke and VTE.

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7
Q

List examples of atypical antipsychotics

A

Clozapine, olanzapine, risperidone, quetiapine, amisulpride, aripiprazole.

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8
Q

Define cotard syndrome

A

Rare subtype of nihilistic delusion, in which the patients believes they’re dead or do not exist. Most commonly associated with severe depression.

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9
Q

Can steroids induce psychosis?

A

Yes

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10
Q

Describe the features of neuroleptic malignant syndrome and what causes it

A

Fever, confusion and muscle rigidity. It is a rare reaction that occurs in antipsychotic use.

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11
Q

Knight’s move thinking is a feature of what?

A

Schizophrenia.

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12
Q

What are thought disorders?

A

Insertion, withdrawal and broadcasting.

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13
Q

If clozapine doses are missed for > 48 hours what is the best course of action?

A

Restart clozapine again slowly (like when they first started on it).

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14
Q

What are the side effects of typical (first generation) antipsychotics?

A

Extrapyramidal side effects: akathisia (severe restlessness), Parkinsonism, acute dystonia (sustained muscle contraction, managed with procyclidine), tardive dyskinesia (late onset of abnormal, involuntary movements e.g. chewing and pouting of jaw).
Hyperprolactinaemia.
Weight gain, hyperlipidaemia (less common).
Anticholinergic effects.
Neuroleptic malignant syndrome.

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15
Q

Name some first generation antipsychotics

A

Haloperidol, chlopromazine, zuclopenthixol.

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16
Q

Which medication is used to treat tardive dyskinesia?

A

Tetrabenazine.

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17
Q

Which medications are used to treat acute dystonia?

A

Procyclidine and benztropine.

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18
Q

Propanol is useful for the treatment of what?

A

Akathisia (restlessness).

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19
Q

Define capgras syndrome

A

Delusion of misidentification where patients believe that a relative or friend has been replaced by an identical imposter. Normally associated with schizophrenia.

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20
Q

Define Charles Bonnet syndrome

A

Psychophysical visual disorder where patients with significant vision loss have vivid, often recurrent visual hallucinations. These hallucinations can be simple (shapes, patterns) or complex (detailed objects, people).

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21
Q

Define De Clérambault syndrome

A

Aka erotomania. Delusional disorder where patients (typically young women) believe another person (of higher social and/or professional standing) is in love with them. A common symptom is patients perceiving that they’re being sent messages from the false secret admirer via innocuous events (e.g. messages via number plate or TV).

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22
Q

Define Othello syndrome

A

Type of paranoid delusional jealousy, characterised by the false absolute certainty that their partner is being unfaithful without having any real proof.

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23
Q

Define Fregoli syndrome

A

Delusional belief that different people are in fact a single person who changes appearance or is in disguise.

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24
Q

Which atypical antipsychotic has the most tolerable side effect profile, particularly for prolactin elevation?

A

Aripiprazole.

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25
Q

What is the most common form of psychosis?

A

Schizophrenia.

26
Q

What affect does dopamine have on prolactin secretion?

A

Inhibits prolactin.

27
Q

Are positive or negative symptoms of schizophrenia easier to treat?

A

Positive.

28
Q

Differentials for patient presenting with psychotic symptoms?

A

Organic causes. Delirium.
Alcohol intoxication or withdrawal.
Drug induced psychosis (cocaine, amphetamine, LSD).
Schizophrenia.
Schizoaffective disorder.
Schizotypal personality disorder.
Persistent delusional disorder.
Specific delusional disorders.
Brief psychotic disorder.
Mania with psychotic symptoms.
Depression with psychotic symptoms.

29
Q

List the adverse effects of clozapine

A

Agranulocytosis, reduced seizure threshold, constipation, myocarditis, hypersalivation.

30
Q

What is the strongest risk factor for psychotic disorders?

A

FHx.

31
Q

What are the poor prognostic indicators for schizophrenia?

A

Pre-morbid social withdrawal, low IQ, FHx of schizophrenia, gradual onset, lack of obvious precipitant, negative symptoms, young age at diagnosis.

32
Q

Define psychosis

A

Gross disorder of perception and/or thought form/content, derangement of personality and loss of contact with reality, causing deterioration of social functioning.

33
Q

List some causes of psychosis

A

Depression, mania, schizophrenia, drug-induced, stress-induced, puerperal psychosis, brief psychotic disorder, delusional disorder, organic (injury, neurological).

34
Q

Describe the clinical features of psychosis

A

Disorder of perception: hallucinations (auditory, visual, gustatory, olfactory, somatic, tactile, hypnopompic/hypnagogic).
Disorders of thought: poverty/pressure of speech, derailment, flight of ideas, clang associations, circumstantiality, tangentiality, neologisms, word salad, preservation, echolalia, delusions (persecutory, paranoid, idea of reference, passivity, thought control, grandiose, guilt, nihilistic, delusional mood, delusional perception, delusional memory).

35
Q

Define hallucination

A

Sensory perception experienced in absence of external stimulus.

36
Q

Define delusion

A

False beliefs that are held with extraordinary conviction/subjective certainty and are impervious to other experiences/compelling counterarguments.

37
Q

Define Ekbom’s syndrome

A

Delusional belief their infested with parasites.

38
Q

Define schizophrenia

A

Characterised by disorders of perception and thought with an inappropriate or blunted affect. Symptoms must be present for > 1 month.

39
Q

Name the positive symptoms of schizophrenia

A

Thought echo, thought insertion or withdrawal, thought broadcasting, 3rd person auditory hallucinations, delusions, passivity, odd/bizarre behaviour, thought disorder (e.g. blocking, neologisms, circumstantiality), lack of insight.

40
Q

Name the negative symptoms of schizophrenia

A

Blunted affect, apathy, social isolation, alogia, avolition, catatonia, anhedonia.

41
Q

What are the first rank symptoms of schizophrenia?

A

Thought echo, thought insertion, thought withdrawal, thought broadcasting, 3rd person auditory hallucinations, delusions, passivity phenomena, somatic hallucinations.

42
Q

What is the most common subtype of schizophrenia?

A

Paranoid.

43
Q

Describe the subtypes of schizophrenia

A

Paranoid - auditory hallucinations and paranoid delusions.
Hebephrenic - adolescents and young adults, mood changes, unpredictable behaviour, shallow affect, fragmentary hallucinations.
Simple - negative symptoms only.
Catatonic - psychomotor symptoms e.g. posturing, rigidity, stupor.
Undifferentiated - symptoms don’t fit into other categories.
Residual - negative symptoms, usually when positive symptoms have ‘burnt out’.

44
Q

Are men and women equally affected in schizophrenia?

A

Yes.

45
Q

Is the age of onset of schizophrenia earlier in men or women?

A

Men - aged 18-25, whereas women is 25-35.

46
Q

Describe the pathophysiology of schizophrenia

A

Excess dopamine in mesolimbic pathway gives rise to positive symptoms. Decreased dopamine in mesocortical pathway causes negative symptoms.

47
Q

Which dopaminergic pathway is associated with EPSE?

A

Nigrostriatal pathway.

48
Q

Which dopaminergic pathway is inhibited using antipsychotics giving rise to hyperprolactinaemia?

A

Tuberoinfundibular pathway.

49
Q

What are the risk factors associated with schizophrenia?

A

FHx, viral infection in-utero, cannabis, living in urban area, migrant, low SES, trauma/abuse, social isolation, increased parental age and black Caribbean ethnicity.

50
Q

What is the MOA of antipsychotics?

A

D2 dopamine receptor antagonist.

51
Q

What is the MOA of aripiprazole?

A

Partial D2 dopamine agonist.

52
Q

Define schizoaffective disorder

A

Episodic disorders in which both affective and schizophrenic symptoms are prominent within the same episode of illness. Doesn’t meet the criteria for either schizophrenia or a depressive/manic episode.

53
Q

What is the most common symptom of schizophrenia?

A

Lack of insight.

54
Q

What is the prevalence of schizophrenia?

A

1%

55
Q

Define catatonia

A

Stopping of voluntary movement or staying still in an unusual position.

56
Q

The risk of developing schizophrenia if one monozygotic twin is affected is approximately…

A

50%

57
Q

Oculogyric crisis is an example of what side effect of antipsychotic medication?

A

Acute dystonia.

58
Q

Torticollis is an example of what side effect of antipsychotic medication?

A

Acute dystonia.

59
Q

Chewing and pouting of the jaw is an example of what side effect of antipsychotic medication?

A

Tardive dyskinesia.

60
Q

What can cause a rise in clozapine blood levels?

A

Smoking cessation, alcohol binges.

61
Q

What is the risk for developing schizophrenia if a parent or singling has the condition?

A

Parent has schizophrenia = 10-15%
Sibling has schizophrenia = 10%

Mental Health (13 decks)

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