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BRS Flashcards (Y2) > Psychosis > Flashcards

Psychosis Flashcards

1
Q

What is psychosis?

A

Difficulty perceiving and interpreting reality - a clinical syndrome that can be caused by many disorders

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2
Q

What are the different types of psychotic disorder?

A

Schizoaffective disorder
Depression with psychotic symptoms
Bipolar
Schizophrenia
Delusional disorder
Drug induced
Due to other medical conditions

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3
Q

What are the positive symptoms of psychosis?

A

Hallucinations
Delusions

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4
Q

What are hallucinations?

A

Perception in absence of stimulus
Can occur in any sensory modality

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5
Q

Describe the different types of auditory hallucination

A

1st (thought echo), 2nd, 3rd person
Running commentary
Command hallucinations

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6
Q

What is a delusion?

A

Fixed, false belief not in keeping with social/cultural norms

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7
Q

What are the different themes of delusion?

A

Persecutory/Paranoid
Reference
Grandiosity
Religious
Pathological jealously
Nihilistic/Guilt
Somatic
Erotomanic

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8
Q

What are passivity experiences and what are some examples?

A

Belief that one’s thoughts or actions are influenced or controlled by an external agent
- Thought broadcasting
- Thought insertion
- Thought withdrawal

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9
Q

What are the negative symptoms of psychosis?

A

Alogia
- Paucity/poverty of speech, little content
- Slow to respond
Anhedonia/asociality
- Few close friends
- Few hobbies/interests
- Impaired social functioning
Avolition/apathy
- Poor self-care
- Lack of drive/persistence at work/education
- Lack of motivation
Affective flattening
- Unchanging facial expressions
- Few expressive gestures
- Poor eye contact
- Lack of vocal intonations
- Limited emotional range

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10
Q

What are the disorganisation symptoms of psychosis?

A

Bizarre behaviour
Formal thought disorder

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11
Q

Describe bizarre behaviour

A

Bizarre social behaviour
Bizarre clothing/appearance
Aggression/agitation
Repetitive/stereotyped behaviours

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12
Q

Describe formal thought disorder and its different presentations

A

Lack of logical connection between thoughts
- Word salad
- Derailment/loosening of associations
- Flight of ideas
- Tangential thought
- Circumstantial thought

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13
Q

Describe the onset of psychosis

A

Can occur at any age
Peak incidence in adolescence/early 20s
Peak is later in women

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14
Q

Describe the course of psychosis

A

Often chronic and episodic
Variable presentations and prognosis

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15
Q

Describe morbidity associated with psychosis

A

Substantial - due to disorder itself and increased risk of other health problems, e.g. heart disease
Significant impact on education, employment and functioning

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16
Q

Describe mortality associated with psychosis

A

All-cause mortality 2.5x higher, ~15 years life expectancy lost
High risk of suicide in schizophrenia - 28% of excess mortality

17
Q

Psychosis is often preceded by what symptoms?

A

‘Prodromal’ symptoms
Changes in social behaviour and impairments in functioning

18
Q

What are the ‘prodromal’ symptoms of psychosis often misdiagnosed as?

A

Depression

19
Q

What are the genetic risk factors of schizophrenia?

A

Highly heritable ~46% concordance in MZ twins
Highly polygenic - lots of genes of small effect sizes but together account for ~20% of known genetic risk

20
Q

What are the environmental risk factors for schizophrenia?

A

Drug use, esp. cannabis
Prenatal/birth complications
Maternal infections
Migrant status
Socioeconomic deprivation
Childhood trauma

21
Q

Outline some additional sources of information for a history

A

Collateral history (with consent):
- Family
- Friends
- Work/education
Healthcare records:
- GP
- Contact with mental health services
- Presentations to A+E

22
Q

What may you look for in appearance and behaviour in someone with psychosis?

A

Bizarre or inappropriate clothing
Psychomotor retardation/agitation
Abnormal movements (medication related)
Self-neglect
Self-harm injuries
Echophenomena (echopraxia, echolalia)

23
Q

Why is it important to assess for mood in people with psychosis?

A

Some affective disorders, e.g. bipolar and depression can cause psychosis - has implications for treatment
Depression is comorbidities with schizophrenia in ~30% of cases
People at high-risk of psychosis often have another mental disorder
Lifetime risk of suicide is 5% in schizophrenia

24
Q

What cognitive impairments are associated with schizophrenia?

A

Working memory and executive functioning impairments
Poorer educational attainment (from childhood)

25
Q

What difficulties might you have treating someone with very poor insight into their psychosis?

A

Concordance with treatment
Attendance at follow-up
Would not stay in hospital
Impact on ability to have capacity to consent to treatment

26
Q

Why wouldn’t you diagnose schizophrenia on the basis of a single consultation?

A

Heterogeneity within disorder categories
Takes time to observe before giving a diagnosis like schizophrenia
Many people who have a first episode of psychosis will not have another

27
Q

What are the different management routes for psychosis?

A

Pharmacological:
- Antipsychotic medications
Psychological:
- CBT
- Avatar therapy
Social support:
- Supportive environments, structures and routines
- Housing, benefits
- Support with budgeting/employment

28
Q

Increased activity of what hormone is implicated in causing positive symptoms of psychosis?

A

Increased dopamine activity in the mesolimbic dopamine system (elevated presynaptic dopamine in striatum)

29
Q

Most antipsychotics are what?

A

Dopamine antagonists
However, newer agents (e.g. aripiprazole) are partial agonists

30
Q

What can dopamine agonists used in Parkinson’s Disease cause?

A

Psychotic symptoms

31
Q

What are extrapyramidal side effects of dopamine antagonists caused by and what do they include?

A

Caused by dopamine blockade in the nigrostriatal (extrapyramidal) dopamine system (parts of the brain that enable us to maintain posture and tone)
Includes:
- Parkinsonism
- Acute dystonic reactions
- Tardive dyskinesia
- Akathisia

32
Q

Describe Parkinsonism symptoms

A

Bradykinesia
Postural instability
Rigidity - characteristic ‘cog-wheeling’
Slow and shuffling gait
- Festination (chasing centre of gravity)
- Lack of arm swing in gait - early sign ‘pill-rolling’ tremor

33
Q

Describe the ‘pill-rolling’ tremor in Parkinsonism

A

Slow (4-6 Hz) movement of thumb across other fingers

34
Q

What makes something an ‘atypical’ vs ‘typical’ antipsychotic?

A

Typical - older agents, increased risk of causing EPSEs
Atypical - newer, e.g. Olanzapine, less likely to cause ESPEs due to 5HT-2A antagonism
However, can be caused by all antipsychotics

35
Q

What are some other side effects of antipsychotics?

A

CNS: ESPEs and sedation
Haematological: Agranulocytosis, neutropenia
Metabolic: Increased appetite, weight gain, Diabetes
Gastrointestinal: Constipation
Pituitary: Increased prolactin
Cardiac: Dysrhythmia, long QTc

BRS Flashcards (Y2) (79 decks)

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