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Aneesha Flashcards BRS 2 > Psychosis > Flashcards

Psychosis Flashcards

1
Q

Define psychosis

A
  • Psychosis is the difficulty perceiving and interpreting reality
  • It is caused many disorders with focus in research often in schizophrenia
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2
Q

Give examples of psychotic disorders

A

Schizophrenia
Schizoaffective disorder
Bipolar I
Depression with psychotic features
Delusional disorder
Due to another medical condition
Substance related

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3
Q

How heritable and polygenic is schizophrenia

A

Highly heritable- 46% concordance in MZ twins
Highly polygenic- lots of genes of small effect sizes, but ones found so far account for 20% of known genetic risk

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4
Q

What are the three categories of symptoms of psychosis?

A

Positive symptoms
Negative symptoms
Disorganised symptoms

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5
Q

What are the positive symptoms of psychosis

A

Delusions
Hallucinations

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6
Q

What are hallucinations? Give examples.

A

The presence of sensory phenomena in the absence of an external stimulus
These can be:
Auditory
VIsual
Somatic/ tacile
Olfactory (rare)
Voice commenting on you
Voices talking to each other

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7
Q

What are delusions? Give examples

A

Fixed, false beliefs which are out of keeping with social/ cultural background
These may be:
Persecutory
Jealousy
Control
Mind reading
Reference
Grandiosity
Religious
Guilt
Somatic
Sexual
Thought (broadcasting, withdrawal, insertion)

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8
Q

What are the negative symptoms of psychosis

A

Alogia
Avolition/ apathy
Anhedonia/ asociality
Affective flattening

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9
Q

What is alogia?

A

The poverty of speech
Includes
-paucity of speech (little content)
-slow to respond

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10
Q

What is anhedonia/ sociality?

A

Lack of pleasure
- Few close friends
- Few close hobbies
- Impaired social functioning

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11
Q

What is avolition/ apathy?

A

Complete lack of motivation and self care
- Lack of persistence at work/education
- Lack of motivation

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12
Q

What is affective flattening

A
  • Unchanging facial expressions
  • Few expressive gestures
  • Poor eye contact
  • Lack of vocal intonations
  • Inappropriate affect
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13
Q

What are the disorganisation symptoms of psychosis?

A

Bizarre behaviour
Thought disorder

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14
Q

Give examples of bizarre behaviour in psychosis

A

Bizarre social behaviour
Bizarre clothing/ appearance
Agression/ agitation
Repetitive/stereotyped behaviour

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15
Q

Give examples of thought disorder in psychosis

A

Derailment
Distractability
Pressure of speech
Circumstantial speech
Incoherent/ illogical speech

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16
Q

What is psychosis often preceded by?

A
  • Prodromal symptoms: These can be changes in social behaviour e.g. social withdrawal, and impairments in functioning
  • People at high risk of developing psychosis often have/had another mental disorder like affective disorders earlier in life
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17
Q

What environmental risk factors are there for psychosis?

A
  • Drug use, esp cannabis
  • Prenatal/birth complications
  • Maternal infections
  • Migrant status
  • Socioeconomic deprivation
  • Childhood trauma
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18
Q

What is the age of onset of psychosis?

A
  • Can occur at any age
  • Peak incidence = early 20s
  • Peak later in women
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19
Q

Describe the course of psychosis

A
  • Often chronic & episodic
  • Very variable
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20
Q

Why is morbidity substantial in psychosis?

A
  • Substantial because:
    • disorder itself increases morbidity
    • disorder can increase risk of common health problems, and therefore increase morbidity indirectly
  • Significant impact on education, employment & functioning
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21
Q

Why is mortality substantial in psychosis?

A
  • 2.5x increased risk of mortality
  • estimated 15 years life lost
  • high risk of suicide among schizophrenia- 28% of excess mortality
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22
Q

What happens after a psychotic episode?
How is psychosis managed in the long term?

A
  • Some completely recover after an episode, most follow an episodic course with periods of wellness and relapses
  • Long term management includes:
    - Community follow up
    - Managing antipsychotic side effects e.g. weight, diabetes
    - Health promotion- reducing risk factors e.g. smoking, diet
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23
Q

What is the psychiatric history?

A

Psychiatric history is the history of the patient that involves multiple segments that help in diagnosing and understanding patients problem

24
Q

What does psychiatric history consist of?

A

History of PC
Past psychiatric history
Past medical history/ medication
Bacgkround history
Corroborative history

25
Q

What is history of PC in psychiatric history?

A
  • Description of presenting problem, what brings the patient to see doctor, why now
  • Includes the characteristics of problem:
    - Nature
    - Severity
    - Onset
    - Course
    - Worsening factors
    - Treatment received
26
Q

what 4 things are figured out from past psychiatric history?

A
  • Any known current diagnosis?
  • Any ongoing or previous treatment?
  • Known to community team?
  • Any previous hospital admissions?
27
Q

What is included in background history in psychiatric history?

A
  • Family history
    • Age of parents, siblings, relationship at home
    • Atmosphere at home
    • Mental disorder in family or household
    • Any family drug use or abuse or suicide
  • Personal history
    • Mother pregnancy and birth
    • Early development, separation, childhood illness
    • Education and occupational history
    • Intimate relationship
  • Social history
    • Living arrangements
    • Financial issues
    • Alcohol & illicit drug use
    • Forensic history - have they cause previous harm to anyone
28
Q

What is included in past medical/ medicine history in psychiatric history?

A
  • taking any current medications, including over the counter
  • any allergies to certain medications
  • What are interactions with medication like?
  • compliance
29
Q

Who do we take a corroborative history for and what is it used for?

A

Informants - relatives, friends, authority

Used for further clarification

30
Q

What is it important to ask for/ maintain when taking a corroborative history?

A
  • Confidentiality
  • Need patient consent if you want to inform relatives
31
Q

What is the Mental State Examination?

A

MSE is a snapshot of patient current mental state

32
Q

What does MSE consist of?

A

Appearance and behaviour
Speech
Mood
Thoughts
Perception
Cognition
Insight

33
Q

What do we look for under appearance and behaviour in the MSE?

A
  • General Appearance
    • If neglect, think - alcoholism, drug addiction, dementia, depression, schizophrenia
    • If weight loss, think - hyperthyroidism, cancer, depression, anorexia, financial issues
  • Facial Expression
    • Depressive
    • Anxious
    • “wooden” Parkinsonian - mask like
  • Posture
    • Depressive - Hunched shoulders, downcast head & eyes
    • Anxious - Sitting upright, head erect, hands gripping chair
  • Movement
    • Manic (overactive, restlessness)
    • Depressive (inactive, slow)
    • Stupor (immobile, mute)
    • tremors, tics, choreiform movements
    • Dystonia
    • Tardive Dyskinesia
    • Mannerism, stereotypes
  • Social behaviour
    • Withdrawal, preoccupied
    • Disinhibited, overfamiliar
    • Signs of impending violence (Raised voice, clenching fist, pointed fingers, intrusion of personal space)

Specifically in psychosis patients
- Bizarre or inappropriate clothing e.g. no shoes
- Agitation/aggression
- Poor personal hygiene or neglect of self care (negative symptoms)
- Injuries- people with psychosis are far more likely to be victims of violence

34
Q

What do we look for under speech in the MSE?

A
  • Quantity- less/more/mutism
  • Rate- slow, fast, pressure of speech
  • Spontaneity- latency
  • Volume
35
Q

What do we look for under mood in the MSE?

A
  • Subjective → when you directly ask how mood is
  • Objective → how you perceive their mood is without asking
  • Predominant mood
  • Constancy
    • Emotional incontinence/lability
    • Reduced reactivity/blunting/flattening
    • irritability
  • Congruity (cheerful when describing sad events)
36
Q

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

A
  • Some affective disorders can cause psychosis (e.g. bipolar, depression) with implications for treatment
  • People at high risk of psychosis often have another mental disorder
  • Depression is comorbid with schizophrenia in 30% of cases
37
Q

What do we look for under thought in the MSE?

A

-Stream (spontaneous thought production)

  • Form (How you are thinking, flight of ideas)
  • Content (What you are thinking of)
  • Preoccupation (thoughts that are constantly on your mind)
  • Morbid thoughts (suicidality)
  • Delusions
  • Obsessional thoughts
  • Compulsions
38
Q

What are the 3 types of delusions?

A
  • Primary- occurs suddenly
  • Secondary- arises from previous abnormal experiences (i.e. hallucinations, delusions)
  • Shared delusion (folie a deux)- same delusion shared by 2 individuals, solution is to separate the 2 people
39
Q

Obsessional thoughts- give examples

A
  • dirt and contamination
  • aggressive actions
  • orderliness
  • disease
  • sex
  • religion
40
Q

Compulsions- give examples

A
  • checking
  • cleaning
  • counting
  • dress rituals
41
Q

What do we look for under perceptions in the MSE?

A

lllusions (Misperception of external stimulus)

Hallucinations
- Pseudohallucination- Sensory experience vivid enough to be considered hallucination but considered by person unreal
- Hypnogogic (transition state of consciousness from awake to sleep)
- Hypnopompic (transition state of consciousness from sleep to awake)
- Auditory - second person, third person
- Visual (Charles Bonnet syndrome- seeing things that aren’t there when your eyes start to deteriorate- can be simple patterns or detailed images of people/places/things)
- Olfactory
- Tactile/deep sensation

Distortion (thoughts that distort one’s perception of reality)

42
Q

What do we look for under cognition in the MSE?

A
  • Consciousness
  • Orientation
  • Memory
  • Language
  • Attention + concentration
  • Visuospatial functioning
43
Q

What do we look for under insight in the MSE?

A
  • Awareness of oneself as presenting phenomena that other people consider abnormal
  • Recognition that these phenomena are abnormal
  • Acceptance that these abnormal phenomena caused by mental illness
  • Awareness that treatment required
  • Acceptance of treatment
44
Q

What are the 3 different types of treatment options available for psychosis?

A
  • Pharmacological- - Antipsychotic meds, often mainstay of treatment
  • Psychological
    • Cognitive behavioural therapy
    • avatar therapy
  • Social support- what does this include?
    - Supportive environment, structures and routines
    - Housing, benefits
    - Support with budgeting/employment
45
Q

What neurotransmitter system is most implicated in the mechanism of antipsychotics?
What others?

A

Dopamine- but antipsychotics act on many neurotransmitters including serotonin, acetylcholine, histamine

46
Q

What is increased dopamine activity associated with in psychosis?
What evidence shows increased dopamine activity and where?

A
  • In causing reality distortion in psychosis
  • Evidence from imaging, drug models and post mortem studies show elevated presynaptic dopamine in striatum
47
Q

What kind of drugs are most antipsychotics?
Name an exception

A
  • Dopamine antagonists
  • Aripiprazole is a partial agonist
48
Q

What type of drugs can cause psychotic symptoms due to excess dopamine?

A

Dopamine agonists like those used in Parkinson’s disease

49
Q

What are Extra Pyramidal Side Effects (EPSEs) of antipsychotics?

A

Side effects that are caused by post-synaptic dopamine blockage in the extra pyramidal system (parts of brain that enable us to maintain posture and tone)

50
Q

What examples of EPSEs are there?

A

Parkinsonism
Dystonia
Tardive dyskinesia
Akathisia

51
Q

Parkinsonism symptoms

A
  • Rigidity- characteristic cog-wheeling
  • Slow and shuffling gait
  • Lack of arm swing in gait - early sign
  • Pill rolling tremor- slow movement of thumb across other fingers
52
Q

Dystonia symptoms

A
  • Increase muscle tone → abnormal contraction and posture
  • Spasm
  • Can occur shortly after taking dopamine antagonist
  • Can be acute, frightening, painful, even fatal (laryngeal dystonia)
53
Q

Tardive dyskinesia symptoms

A
  • Repeated oral/facial/buccal/lingual movements
  • Initially subtle - can progress to tongue involvement, lip smacking
  • Increased risk include long term antipsychotics use, female
54
Q

Akathisia symptoms

A
  • Inner restlessness
  • Feel compelled to move but do little to alleviate
  • Can lead to overt, relentless movement
  • Legs most commonly affected, in constant movement
55
Q

What makes something a ‘typical’ vs ‘atypical’ antipsychotic

A
  • Typical cause EPSE
  • Atypical e.g. olanzapine are less likely to cause EPSE
56
Q

How do we manage EPSEs?

A
  • Avoid them in the first place- atypical antipsychotics are usually first line, typical usually old psychotics
  • Change medication
  • Anticholinergic medications can help e.g. procyclidine
  • Fully inform patients about risks
57
Q

What are side effects of antipsychotics?

A
  • CNS → EPSEs, sedation
  • Haematological → agranulocytosis, neutropenia
  • Metabolic → increased appetite, weight gain, diabetes
  • GI → constipation
  • Pituitary → more prolactin (release suppressed by dopamine)
  • Cardiac → dysrhythmia, long QTc (can cause palpitations, fainting, seizures)

Aneesha Flashcards BRS 2 (47 decks)

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