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Mental Health > Psychosis > Flashcards

Psychosis Flashcards

1
Q

Effects of psychosis

A

Confused thinking - flow of thought, concentration, perplexed
False beliefs
Perceptual abnormalities
Changed feelings
Changed behaviour

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2
Q

Most common delusions

A

Persecution

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3
Q

Causes of psychosis

A

Psychological severe stres s
Physical illness
Drug induced
Mental illness - schizophrenia, affective disorder, dementia

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4
Q

Postiive symptoms schizophrenia

A

Delusions
Hallucinations
Thought disorder

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5
Q

Schizophrenia vs psychosis

A

Psychosis is a state with many causes (most commonly schizophrenia) schizophrenia is a condition with diagnostic criteria

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6
Q

What is psyschosis?

A

Conditions that affect the mind where there has been loss of contact with reality. Delusions, thought disorder. 3 in 100

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7
Q

Gender and schizophrenia

A

Males develop it earlier
Women are more likely to get it
Men get it more severely

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8
Q

Why are FBC important in psychosis?

A

Anaemia can cause psychosis
B12 + folate
WCC

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9
Q

Why do cognitive assessment

A

Differentiate dementia and learning disabilities from psychoiss

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10
Q

What to look at in bloods?

A

FBC, U+Es, LFTs, TFT, PTH, calcium, B12, CRP, lipids, glucose, prolactin
HIV, syphilis

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11
Q

Why monitor PTH in psychosis?

A
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12
Q

Why monitor prolactin in schizophrenia?

A

Antipsychotics side effect is increased

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13
Q

Other investigations with psychosis

A

ECG
EEG - if concerned could be epilepsy
Brain imaging - CT/MRI

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14
Q

What can see on ECG in psyh=chocis (cause)

A

QT prolongation

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15
Q

Delusional disorder vs schizophrenia

A

Delusional - only have delusions, no thought disorder

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16
Q

Diagnosis fro schizophrenia

A

At least one of a to d or one month
a - persisten delusions
b - Persistent hallucinations
c - Disorganised thinking
d - Experiences of influence, passivity or contol
e - negative symptoms
Grossly disorganised behaviour
Psychomotor disturbances

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17
Q

What are negative symptoms?

A

Affective flattening, alogia, paucity of speech, avolition, asociality, anhedonia
Poverty of thought, affect ->
-social withdrawal
Emotional withdrawal
anhedonia
Avolition

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18
Q

Psychomotor disturbances

A

Catatonic restlessness or agitation, posturing, waxy flexibility, negativis,, mutism, stupor

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19
Q

Grossly disorgansied behaviour

A

Impedes goal directed activity

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20
Q

Affective symptoms

A

Dysphonia
Depression

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21
Q

Cognitive symptoms of schizophrenia

A

Attention
Memory - episodic and working
Executive function
Decision making

22
Q

Positive symptoms schizophrenia

A

Disorgnaised thoughts
Delusions
Hallucinations
unusual behaviour

23
Q

Differentials for psychosis

A

Delusional disorder
Narrower range of symptoms than schizophrenia
Acute and transient psychotic disorder
Time course usually shorter than schizophrenia (usually symptom duration less than one month, but can still be diagnosed if less than three months) and always more fluctuant in symptom type/intensity
Schizoaffective disorder
Mood symptoms equally prominent (either pole) and come on simultaneously with psychotic symptoms
Induced/secondary psychotic disorder
Medical condition – including antibody mediated encephalitis and SOL
Substance misuse

24
Q

Vulnerability to psychosis

A

Genetic factors
Pre-term birth - low weight, O2 starved, before 32 weeks
Early risk factors - Urban upbringing
Migration
Head injury
Childhood adversity
Stresses - drug abuse
Psychological stress

25
Q

Drugs increasing risk of psychosis

A

Amphetamine
Cannabis - 4 x
LSD
Ecstasy

26
Q

Group 1 schizophrenia illness pattern

A

One episode only - no impairment

27
Q

Group 2 schizophrenia illness pattern

A

Severeal episodes with no or minimal impaorment

28
Q

Group 3 - schizophrenia illness pattern

A

Impairment after the first episode with subsequent exacerbation and no return to normality

29
Q

Group 4 schizophrenia illness pattern

A

Impairment increasing with each of several episodes and no return to normality

30
Q

Which antipsychotic causes myo/endocarditis?

A

Clozapine

31
Q

Which 1st gen antipsychotic can be injected once a month rather than tablets?

A

Flupenthixol

32
Q

Which gen antipsychotics are effective in treatment resistant schizophrenia? Against negative symptoms?

A

Seocnd generation eg olanzapine, quetiapine

33
Q

Additional risks of clozapine

A

Agranulocytosis -> monitoring
Paralytic ileus
Myocarditis/cardiomyopathy

34
Q

When do you use clozapine in schizophrneia?

A

after patient hasn’t responded to 2 drugs

35
Q

Monitoring on clozapine

A

weekly FBC blood for agranulocytosis for 18 weeks

36
Q

What does being kept under section 2 mean?

A

Detained for assessment for 28 days

37
Q

Ideas of referenve

A

Belieive being mentioned on radio/papers

38
Q

EIP team

A

Early intervention for psychosis prevention team

39
Q

Vulnerability stress model schizophrenia

A

Genetically inherited factors and environmental stress

39
Q

Vulnerability stress model schizophrenia

A

Genetically inherited factors and environmental stress

40
Q

Pre term risks for psychosis

A

Before 32 weeks - 2x increase
Low birth weight
Lack of oxygen during birth

41
Q

Early risk factors vulnerability to psychosis

A

Urban upbringing
Migration
head injury
Childhood adversity

42
Q

What is Acute and transient psychotic disorder

A

Time course usually shorter than schizophrenia (usually symptom duration less than one month, but can still be diagnosed if less than three months) and always more fluctuant in symptom type/intensity

43
Q

What is schizoaffective disorder

A

Mood symptoms equally prominent (either pole) and come on simultaneously with psychotic symptoms

44
Q

What is induced/secondary psychotic disorder

A

Medicacl condition - incl anitbody mediated encephalitis and SOL
Substance misuse

45
Q

Assessmnet in psychosis

A

History
Physical examination, including neurological
MSE
Consider:
cognitive assessment, needs, adherence assessments, formulation
General medical evaluation:
Incl. FBC, U&E, LFTs, TFT, PTH, calcium, B12, CRP, lipids, glucose, prolactin
ECG, EEG
Urine drug screen
Based on clinical suspicion:
Brain imaging: CT/ MRI
HIV and syphilis
Consider antibodies (NMDA, VGKC…)

46
Q

What is psychosis?

A

Disturbance in perception of reality - hallucinations, delusions, impairment of thought, speech, and behaviour

47
Q

First line antipsychotic

A

Atypical
Then assess side affects and effectiveness and consider changing

48
Q

Why is smoking status important in antipsychotics?

A

Esp in clozapine -> exacerbate side effects
Increased cardiovascular risk alongside already increased from antipsychotics

49
Q

What antipsychotics prolong QTC?

A

Typicals eg haloperidol, some atypicals

50
Q

When is someone treatment resistant?

A

2 antipsychotics

51
Q

What are long acting medication options?

A

Depot

Mental Health (57 decks)

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