Psychosis Flashcards
Define Psychosis
a mental state in which reality is greatly distorted
Name the three prevalent features of Psychosis
- Delusions
- Hallucinations
- Thought Disorder
Define Delusions
fixed false beliefs despite being contradicted by reality
How many types of common delusions are there? Name and explain them.
7
1. persecutory - most common, person fears they will be harmed (they are being spied upon or poisoned)
2. grandeur - believes they are much greater or more influential than they really are (really rich or president of the USA)
3. jealousy - fear spouse/partner is being unfaithful, more common in men, go to severe extents to find out if they are unfaithful (spying/detectives/ UNFAITHFUL).
4. love/erotomania - believes the person they are fixated with is massively in love with them, stalks them, jealousy and aggression can occur, usually with celeb or unknown person (STALKER).
5. somatic - tactile (feel bugs) or physical thing wrong with them (body part not working, think they smell funny)
6. Hypochondriasis - cough = tuberculosis = death
7. mixed - more than one of the previously mentioned delusions
What other types of delusions are there?
- delusions of reference: TV is talking about them
- delusion of control: external forces controlling thoughts, feelings or behaviours.
- delusion of thought insertion, thought withdrawal & thought broadcasting (believes others can hear thoughts)
- delusions of guilt
- nihilistic delusions: believe they’re dead, lost organs etc.
- bizarre: alien invasion
Name three ways of classifying delusions
- Cause
- primary vs secondary (primary:occuring in the mind, no preceding reasons, secondary: can be understood due to the abnormality of another mental state issue) - Mood
- congruent vs incongruent (happy mood = mania, sad mood = depression/depressive thoughts, guilt etc.) - Plausibility
- bizarre vs non-bizarre (physically impossible beliefs vs potentially correct beliefs, being an alien vs being cheated on)
Name four organic causes of psychosis
- drug induced
- iatrogenic (steroids)
- dementia
- delirium (UTI)
(Lyme disease/other medical conditions may induce psychosis)
define schizophrenia
The most common form of psychosis characterised by hallucinations, delusions, and thought disorders which lead to functional impairment
Give three PREDISPOSING risk factors for schizophrenia
- Substance misuse
- Family history
- Neurochemical imbalance (dopamine increased, GABA decreased).
Give two PRECIPITATING risk factors for schiophrenia
- Smoking cannabis
- Adverse life events
Give three PERPETUATING risk factors for schizophrenia
- Substance misuse
- Poor medication compliance & doses
- Lack of social support
What are Schneider’s First Rank Symptoms for Schizophrenia?
- Delusional perception
- Third-person auditory hallucinations (he looks awful today - talking about the pt.)
- Thought Interference (insertion, withdrawal & broadcasting)
- Passivity phenomenon (they have no control)
when can +ve symptoms be seen in schizophrenia?
all the time but normally in acute phases
Delusions Held Firmly Think Psychosis - this mnemonic stands for?
D - delusions
H - hallucinations
F - formal thought disorder (inability to continue conversations fluently)
T - thought interference (insert, withdrawal broad).
P - passivity phenomenon
When are negative symptoms normally seen?
chronic phase schizophrenia
Give six features of Negative Symptoms
- flat affect (no emotion in the face)
- reduced social interaction
- anhedonia
- avolition (less motivation/focus)
- alogia (speaking less)
- catatonia (moving less)
how many main subtypes of schizophrenia are there?
7
Name the subtypes of schizophrenia
- paranoid
- hebephrenia
- post schizophrenic depression
- catatonic
- simple
- undifferentiated
- residual
Define paranoid schizophrenia?
usually characterised by stable delusions, hallucinations (usually auditory), and perceptual disturbances.
Define Hebephrenic schizophrenia (disorganised)
aimless, disorganised behavior, rambling, incoherent speech, fleeting hallucinations and delusions, negative symptoms & inappropriate emotions (diagnosed in adolescence)
Define post-schizophrenic depression
schizophrenia in the last 12 months but not now, depressed. some positive symptoms may still be present but won’t dominate the picture
Define catatonic schizophrenia
dominated psychomotor disturbances, stupor and hyperkinesis and hyper excitement at some points and can have maintained postures
Define undifferentiated schizophrenia
meet the threshold but don’t fit into other categories
Define Residual Schizophrenia
chronic phase of schizophrenia, less prominent positive symptoms and more prominent negative symptoms
Define Simple Schizophrenia
inability to function within society, loss of volition, and blunt affect (prominent negative symptoms related to SS), develop and proceed over psychotic symptoms.
What are the four symptoms in ICD10 Group A criteria of Schizophrenia
one or more required:
- hallucinatory voices
- thoughts echo, thought insertion/withdrawal, thought broadcasting (body limb thoughts)
- delusions of control, influence, or passivity
- persistent delusions that are culturally inappropriate and completely impossible, religion, political, superhuman powers
What are the five symptoms in ICD-10 Group B criteria of Schizophrenia
2 or more of the following:
- persistent hallucinations in any form
- breaks or interpolations in the train of thought
- catatonic behaviour
- negative symptoms
- a significant and consistent change in the overall quality of personal behvaiour (anhedonia etc.)
interpolations meaning
insertions of something irrelevant into a sentence
what is required to diagnose schizophrenia from ICD10 categories?
1 from group A, 2 from group B
Name 4 lab investigations to diagnose schizophrenia
- liver
- prolactin
- urine drug
- urine dip
name 4 other investigations to diagnose schizophrenia
- BP
- ECG
- BMI
- head CT
What type of pharmacological Tx is available for schizophrenics
typical and atypical antipsychotics
what does the typical and atypical drugs target
dopaminergic neurons in the nigostriatal, mesolimbic & tuberoinfundibular
4 examples of typical older drugs
- chlorpromazine (tablets, liquids, injections, suppositories)
- haloperidol (haldol) - rapid tranq
- flupentixol (depixol) - tablets, depot
- zuclopenthixol (clopixol) - tablets, depot
What ion does GABA receptors respond to and what ions influx to cause a reduce in membrane potential
GABA and chloride
Akathisia meaning?
Restlessness
Tardive dyskinesia meaning?
Typically involves the face and involves repetitive involuntary withdrawing movements (lip smacking, tongue protrusion and grimacing)
Parkinsonism meaning?
General term that mimics Parkinson’s disease (bradykinesia, cogwheel rigidity and shuffling gait)
Catatonia meaning?
Appear to be in stupor, maintain odd postures and appear awake but unresponsive to external stimuli
What suggests mania over Hypomania
Psychotic symptoms, 7 days or more - delusions of grandeur
Several functional impairment
Mood and irritability in both
First line treatments for bipolar (3)?
Psychological interventions, lithium and valproate
First line option of treatment for ADHD
Methylphenidate or lisdexamfetamine
Underlying cause of Korsakoff’s syndrome?
Untreated thiamine deficiency
What is WE (Wernickes encephalopathy)?how does it manifest? (4)
Acute deterioration in neurological function manifesting as nystagmus, ataxia, opthalmoplegia and/or encephalopathy
Persistent, recurrent WE can lead to what?
Korsakoff syndrome
Korsakoff is what?
Deficits in anterograde (no new memory) and retrograde memory that can lead to confabulation
What are key signs of psychotic depression
Mood-congruent delusions
Typical antipsychotics MOA
D2 receptor antagonists, blocking dopaminergic transmission in the mesolimbic pathways = increased dopamine
Adverse effects of typical antipsychotics
Extrapyramidal side-effects, hyperprolactinaemia
Examples of typical antipsychotics
Haloperidol, chlorpromazine
Atypical antipsychotics MOA
Act on a variety of recpetors D2, D3, D4, 5-HT)
Adverse effects of atypical antipsychotics
Extrapyramidal side effects and hyperprolactinaemia less common, metabolic effects
Examples of atypical antipsychotics
Clozapine, risperidone, olanzapine,
Examples of EPSEs
Parkinsonism
Acute dystonia
Akathisia
Tardive dyskinesia
Examples of antimuscarinic side effects
- dry mouth, blurred vision, urinary retention, constipation
Atomoxetine MOA
Norepinephrine reuptake inhibitor
Zopliclone is what type of drug? MOA?
Non-benzo hypnotic acting on the alpha2-subunit of the GABA receptor
What are Z drugs
Zolpidem, zopiclone, zaleplon non-benzos that act on alpha 2 subunit gaba receptors
3 most common signs of ptsd
Re-experiencing
Avoidance
Hyperarousal (hypervigilance, sleep issues)
MOA behind the medication that leads to Tardive dyskinesia
Long term dopamine receptor blockade causing hypersensitivity of dopamine receptors in the nigrostriatal pathway
2 common medications that cause hyperprolactinaemia
Haloperidol and risperidone
What is the best management for OCD
ERP and CBT
What is an elementary hallucination
Buzzing, whistling etc
Guilty delusions are a symptom of what?
Psychotic depression
Persecutors delusions are suggestive of what?
Schizophrenia
When is lorazepam preferred over chlordiazepoxide?
Patients with hepatic failure
Flumazenil opposes the action of what?
Benzodiazepines
Alcohol withdrawal symptoms start?
6-12 hrs - sweating, tremor, tachy and anxiety
36 - seizures
48-72 - coarse tremor, confusion, delusion, auditory and visual halllucinations, fever tachy
First line treatment for patients with alcohol withdrawal
Long acting benzos - chlordiazepoxide or diazepam (lorazepam for hepatic failure pts)
Carbamazepine
Phenytoin is said not to be as effective in the tx of alcohol withdrawal seizures
Section 2?
Held for 28 days for review
Section 3?
6 months detained for review, can be viewed for further 6 months then another 12 months
Section 4
72 hours
Section 5
Holding powers, 6 hours and 72 hours
Benzos main side effect is?
Respiratory depression
Thiamine is vit what ?
Vit b1
Tuberoinfundibular pathway is related to what symtpoms
hyperprolactinaemia
Mesolimbic pathway is related to?
Positive symptoms
mesocortical pathways related to?
Negative symptoms
Nigrostriatal pathway is related to?
Parkinson’s
Corticospinal tract?
Movement
Explain how a D2 antagonist works
Block dopamine receptors reducing dopamine transmission and then dopamine levels
Precipitating meaning?
Trigger
Predisposing meaning?
Past relevant history
Perpetuating meaning?
Ongoing events not helping the behaviour
