Psychosis Flashcards
Effects of psychosis
Confused thinking - flow of thought, concentration, perplexed
False beliefs
Perceptual abnormalities
Changed feelings
Changed behaviour
Most common delusions
Persecution
Causes of psychosis
Psychological severe stres s
Physical illness
Drug induced
Mental illness - schizophrenia, affective disorder, dementia
Postiive symptoms schizophrenia
Delusions
Hallucinations
Thought disorder
Schizophrenia vs psychosis
Psychosis is a state with many causes (most commonly schizophrenia) schizophrenia is a condition with diagnostic criteria
What is psyschosis?
Conditions that affect the mind where there has been loss of contact with reality. Delusions, thought disorder. 3 in 100
Gender and schizophrenia
Males develop it earlier
Women are more likely to get it
Men get it more severely
Why are FBC important in psychosis?
Anaemia can cause psychosis
B12 + folate
WCC
Why do cognitive assessment
Differentiate dementia and learning disabilities from psychoiss
What to look at in bloods?
FBC, U+Es, LFTs, TFT, PTH, calcium, B12, CRP, lipids, glucose, prolactin
HIV, syphilis
Why monitor PTH in psychosis?
Why monitor prolactin in schizophrenia?
Antipsychotics side effect is increased
Other investigations with psychosis
ECG
EEG - if concerned could be epilepsy
Brain imaging - CT/MRI
What can see on ECG in psyh=chocis (cause)
QT prolongation
Delusional disorder vs schizophrenia
Delusional - only have delusions, no thought disorder
Diagnosis fro schizophrenia
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
What are negative symptoms?
Affective flattening, alogia, paucity of speech, avolition, asociality, anhedonia
Poverty of thought, affect ->
-social withdrawal
Emotional withdrawal
anhedonia
Avolition
Psychomotor disturbances
Catatonic restlessness or agitation, posturing, waxy flexibility, negativis,, mutism, stupor
Grossly disorgansied behaviour
Impedes goal directed activity
Affective symptoms
Dysphonia
Depression
Cognitive symptoms of schizophrenia
Attention
Memory - episodic and working
Executive function
Decision making
Positive symptoms schizophrenia
Disorgnaised thoughts
Delusions
Hallucinations
unusual behaviour
Differentials for psychosis
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
Vulnerability to psychosis
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
Drugs increasing risk of psychosis
Amphetamine
Cannabis - 4 x
LSD
Ecstasy
Group 1 schizophrenia illness pattern
One episode only - no impairment
Group 2 schizophrenia illness pattern
Severeal episodes with no or minimal impaorment
Group 3 - schizophrenia illness pattern
Impairment after the first episode with subsequent exacerbation and no return to normality
Group 4 schizophrenia illness pattern
Impairment increasing with each of several episodes and no return to normality
Which antipsychotic causes myo/endocarditis?
Clozapine
Which 1st gen antipsychotic can be injected once a month rather than tablets?
Flupenthixol
Which gen antipsychotics are effective in treatment resistant schizophrenia? Against negative symptoms?
Seocnd generation eg olanzapine, quetiapine
Additional risks of clozapine
Agranulocytosis -> monitoring
Paralytic ileus
Myocarditis/cardiomyopathy
When do you use clozapine in schizophrneia?
after patient hasn’t responded to 2 drugs
Monitoring on clozapine
weekly FBC blood for agranulocytosis for 18 weeks
What does being kept under section 2 mean?
Detained for assessment for 28 days
Ideas of referenve
Belieive being mentioned on radio/papers
EIP team
Early intervention for psychosis prevention team
Vulnerability stress model schizophrenia
Genetically inherited factors and environmental stress
Vulnerability stress model schizophrenia
Genetically inherited factors and environmental stress
Pre term risks for psychosis
Before 32 weeks - 2x increase
Low birth weight
Lack of oxygen during birth
Early risk factors vulnerability to psychosis
Urban upbringing
Migration
head injury
Childhood adversity
What is 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
What is schizoaffective disorder
Mood symptoms equally prominent (either pole) and come on simultaneously with psychotic symptoms
What is induced/secondary psychotic disorder
Medicacl condition - incl anitbody mediated encephalitis and SOL
Substance misuse
Assessmnet in psychosis
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…)
What is psychosis?
Disturbance in perception of reality - hallucinations, delusions, impairment of thought, speech, and behaviour
First line antipsychotic
Atypical
Then assess side affects and effectiveness and consider changing
Why is smoking status important in antipsychotics?
Esp in clozapine -> exacerbate side effects
Increased cardiovascular risk alongside already increased from antipsychotics
What antipsychotics prolong QTC?
Typicals eg haloperidol, some atypicals
When is someone treatment resistant?
2 antipsychotics
What are long acting medication options?
Depot
