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4th year passmedicine by topic > Psychosis > Flashcards

Psychosis Flashcards

1
Q

Psychosis is a term used to describe

A

a person experiencing things differently from those around them.

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2
Q

Psychotic features include:

A

hallucinations (e.g. auditory)
delusions
thought disorganisation

agitation/aggression
neurocognitive impairment (e.g. in memory, attention or executive function)
depression
thoughts of self harm

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3
Q

Psychotic thought features

A

alogia: little information conveyed by speech
tangentiality: answers diverge from topic
clanging
word salad: linking real words incoherently → nonsensical content

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4
Q

Psychotic symptoms may occur in a number of conditions:

A

schizophrenia
depression (psychotic depression, a subtype more common in elderly patients)
bipolar disorder
puerperal psychosis
brief psychotic disorder: where symptoms last less than a month
neurological conditions e.g. Parkinson’s disease, Huntington’s disease
prescribed drugs e.g. corticosteroids
certain illicit drugs e.g. cannabis, phencyclidine

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5
Q

The peak age of first-episode psychosis is around

A

15-30 years

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6
Q

The atypical antipsychotics were developed due to

A

the problematic extrapyramidal side-effects which are associated with the first generation of typical antipsychotics.

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7
Q

Typical antipsychotics

Mechanism of action

A

Dopamine D2 receptor antagonists, blocking dopaminergic transmission in the mesolimbic pathways

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8
Q

Typical antipsychotics

Adverse effects

A

Extrapyramidal side-effects and hyperprolactinaemia common

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9
Q

Typical antipsychotics

Examples

A

Haloperidol

Chlopromazine

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10
Q

Atypical antipsychotics

Mechanism of action

A

Act on a variety of receptors (D2, D3, D4, 5-HT)

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11
Q

Atypical antipsychotics

Adverse effects

A

Extrapyramidal side-effects and hyperprolactinaemia less common
Metabolic effects

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12
Q

Atypical antipsychotics

Examples

A

Clozapine
Risperidone
Olanzapine

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13
Q

typical antipsychotics Extrapyramidal side-effects (EPSEs)

A

Parkinsonism
acute dystonia
akathisia
tardive dyskinesia

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14
Q

acute dystonia is

A

sustained muscle contraction (e.g. torticollis, oculogyric crisis)

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15
Q

acute dystonia mx

A

procyclidine

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16
Q

akathisia is

A

severe restlessness

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17
Q

tardive dyskinesia is

A

late onset of choreoathetoid movement
abnormal, involuntary
may occur in 40% of patients
may be irreversible

most common is chewing and pouting of jaw

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18
Q

The Medicines and Healthcare products Regulatory Agency has issued specific warnings when antipsychotics are used in elderly patients:

A

increased risk of stroke

increased risk of venous thromboembolism

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19
Q

reduced seizure threshold less/greater with atypicals

A

greater

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20
Q

which drug particularly prolong QT

A

haloperidol)

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21
Q

neuroleptic malignant syndrome tetrad

A

pyrexia

muscle rigidity

autonomic lability: typical features include hypertension, tachycardia and tachypnoea

agitated delirium with confusion

22
Q

S/E antipsychotics?

A

antimuscarinic: dry mouth, blurred vision, urinary retention, constipation
sedation, weight gain
raised prolactin
may result in galactorrhoea
due to inhibition of the dopaminergic tuberoinfundibular pathway
impaired glucose tolerance

23
Q

Antipsychotics frequency of monitoring

Full blood count (FBC), urea and electrolytes (U&E), liver function tests (LFT)

A

at the start of therapy
annually
clozapine requires much more frequent monitoring of FBC (initially weekly)

24
Q

Antipsychotics frequency of monitoring

Lipids, weight

A

at the start of therapy
at 3 months
annually

25
Q

Antipsychotics frequency of monitoring

Fasting blood glucose, prolactin

A

at the start of therapy
at 6 months
annually

26
Q

Antipsychotics frequency of monitoring

Blood pressure

A

baseline

frequently during dose titration

27
Q

Antipsychotics frequency of monitoring

Electrocardiogram

A

baseline

28
Q

Antipsychotics frequency of monitoring

Cardiovascular risk assessment

A

annually

29
Q

typical/Atypical antipsychotics should now be used first-line in patients with schizophrenia

A

Atypical antipsychotics should now be used first-line in patients with schizophrenia

30
Q

Adverse effects of atypical antipsychotics

A

weight gain

clozapine is associated with agranulocytosis hyperprolactinaemia

31
Q

Examples of atypical antipsychotics

A 
clozapine
olanzapine
risperidone
quetiapine
amisulpride
aripiprazole
32
Q

Which atypical antipsychotics higher risk of dyslipidemia and obesity

A

Olanzapine

33
Q

Which atypical antipsychotics generally good side-effect profile, particularly for prolactin elevation

A

aripiprazole

34
Q

Clozapine, one of the first atypical agents to be developed, carries a significant risk of agranulocytosis and full blood count monitoring is therefore essential during treatment.

A

true

35
Q

Clozapine should be introduced if schizophrenia is

A

not controlled despite the sequential use of two or more antipsychotic drugs (one of which should be a second-generation antipsychotic drug), each for at least 6–8 weeks.

36
Q

Adverse effects of clozapine

A

agranulocytosis (1%), neutropaenia (3%)
reduced seizure threshold - can induce seizures in up to 3% of patients
constipation
myocarditis: a baseline ECG should be taken before starting treatment
hypersalivation

37
Q

Dose adjustment of clozapine might be necessary if what is started or stopped during treatment.

A

smoking

38
Q

ICD10 definition of hallucination:

A

false sensory perception in the absence of an external stimulus. Maybe organic, drug-induced or associated with mental disorder.

39
Q

generally accepted definition that a pseudohallucination is

A

a false sensory perception in the absence of external stimuli when the affected is aware that they are hallucinating.

40
Q

An example of a pseudohallucination is a hypnagogic hallucination which occurs when transitioning from wakefulness to sleep. These are experienced vivid auditory or visual hallucinations which are fleeting in duration and may occur in anyone

A

true

41
Q

The relevance of pseudohallucinations in practice is that patients may need reassurance that these experiences are normal and do not mean that they will develop a mental illness.

A

true

42
Q

Pseudohallucinations commonly occur in people who are

A

grieving

43
Q

Charles-Bonnet syndrome (CBS) is characterised by

A

persistent or recurrent complex hallucinations (usually visual or auditory), occurring in clear consciousness. This is generally against a background of visual impairment (although visual impairment is not mandatory for a diagnosis). Insight is usually preserved. This must occur in the absence of any other significant neuropsychiatric disturbance.

44
Q

Charles-Bonnet syndrome (CBS) Risk factors include:

A 
Advanced age
Peripheral visual impairment
Social isolation
Sensory deprivation
Early cognitive impairment
45
Q

Charles-Bonnet syndrome (CBS) The most common ophthalmological conditions

A

associated with this syndrome are age-related macular degeneration, followed by glaucoma and cataract

Well-formed complex visual hallucinations are thought to occur in 10-30 per cent of individuals with severe visual impairment.

Prevalence of CBS in visually impaired people is thought to be between 11 and 15 per cent.

46
Q

CBS is equally distributed between sexes and does not show any familial predisposition.

A

true

47
Q

CBS generally not a transient experience

A

true

48
Q

CBS ?% find the hallucinations themselves an unpleasant or disturbing experience

A

a third

49
Q

Cotard syndrome is

A

rare mental disorder where the affected patient believes that they (or in some cases just a part of their body) is either dead or non-existent. This delusion is often difficult to treat and can result in significant problems due to patients stopping eating or drinking as they deem it not necessary.

50
Q

Cotard syndrome is associated with

A

severe depression and psychotic disorders.

51
Q

De Clerambault’s syndrome

A

also known as erotomania, is a form of paranoid delusion with an amorous quality. The patient, often a single woman, believes that a famous person is in love with her.

52
Q

Othello’s syndrome is

A

Othello’s syndrome is pathological jealousy where a person is convinced their partner is cheating on them without any real proof. This is accompanied by socially unacceptable behaviour linked to these claims.

4th year passmedicine by topic (96 decks)

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