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Psychiatry > Psychosis > Flashcards

Psychosis Flashcards

1
Q

Define psychosis

A

A mental state in which reality is grossly distorted, resulting in symptoms of perceptual disturbances, abnormal beliefs and thought disorder
Negative and psychomotor symptoms are also often seen

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2
Q

What are hallucinations

A

Perceptions occurring in the absence of an external physical stimulus
To the patient they appear exactly the same as a normal sensory experience
Can be experienced in any sensory modality

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3
Q

Define illusions

A

Misperceptions of real external stimuli eg dressing gown as a person
Common in healthy people, often associated with inattention or strong emotion

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4
Q

Define pseudohallucination

A

Appears to arise in the subjective inner space of the mind, not an external sensory organ
Patients describe sensations perceived within the inner eye, minds eye or ear
Common examples are flashbacks or a voice inside the head
Sometimes viewed as hallucinations that the patient has insight of

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5
Q

What are auditory hallucinations

A

Most common type of hallucination
Elementary = simple sounds eg whirring, buzzing or single words
Complex = phrases, sentences or dialogue

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6
Q

What are autoscopic hallucinations

A

Seeing oneself in external space

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7
Q

What are Lilliputian hallucinations s

A

Seeing miniature people or animals

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8
Q

What is Charles bonnet syndrome

A

Condition where people with severe visual loss describe complex visual hallucinations in the absence of any other symptoms

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9
Q

What are somatic hallucinations

A

Involve bodily sensations:
Superficial: on the skin
Visceral: deep sensations of organs throbbing or vibrating
Kinaesthetic: false perceptions of MSK sense eg arms being twisted

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10
Q

Define delusions

A

Unshakable false beliefs not accepted by other members of the patients culture
The patient cannot differentiate between delusion and normal thinking
The belief held can be true but the underlying reasoning makes it a delusion

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11
Q

What are primary delusions

A

Do not occur in response to any previous psycho pathological state
May be preceded by a delusional atmosphere where the world around them has altered, often in a sinister way

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12
Q

What are secondary delusions

A

The consequences of pre existing psychological states usually mood disorders

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13
Q

What are partial delusions

A

Beliefs previously found with delusional intensity but now held with less conviction

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14
Q

What are delusional perceptions

A

Delusions attached to a normal perception eg patient believes he is being spied on as he heard an aeroplane overhead

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15
Q

What are bizarre delusions

A

Ones which are completely impossible (characteristic of schizophrenia)

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16
Q

What are persecutory delusions

A

Belief that they are being harmed, are a victim

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17
Q

What are grandiose delusions

A

Belief of their exceptional power / importance

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18
Q

What are religious delusions

A

Beliefs with religious themes, often also grandiose

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19
Q

What are delusions of reference

A

Beliefs that external objects / people relate to them

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20
Q

Delusions of love

A

Beliefs that people are in love with them

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21
Q

Delusions of infidelity

A

Beliefs that their lover is unfaithful (othello syndrome)

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22
Q

What is capgras syndrome

A

Belief that a person has been replaced with an imposter

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23
Q

What is fregoli syndrome

A

Belief that a complete stranger is known to them

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24
Q

Thought insertion

A

Ideas inserted into the mind by an external power

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25
Q

Thought withdrawal

A

Ideas extracted by an external power

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26
Q

Thought broadcasting

A

Ideas are being broadcast to other so they know what the person is thinking

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27
Q

What is circumstantial thinking

A

Speech that is delayed in reaching its goals due to over-inclusion of details and diversions. If allowed to finish, the speaker will eventually reach their final goal

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28
Q

What is tangential thinking

A

Similar to circumstantial thinking but more indicative of pathology, with the speaker diverting from their initial train of thought but never returning to the original point, jumping from one topic to the next

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29
Q

What is flight of ideas

A

Thinking is markedly accelerated, resulting in a stream of connected concepts, which may or may not be relevant to goal of the conversation

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30
Q

What is loosening of association

A

Patients train of thoughts shifts suddenly to a very loosely / unrelated idea
- characteristic of schizophrenia and at its worse form it becomes word salad

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31
Q

What is thought blocking

A

Sudden cessation to the flow of thought, often in mid sentence and patients have no recall of what they were saying

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32
Q

What are neologisms

A

New words created by the patient

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33
Q

What is idiosyncratic word use

A

Attributing a non-recognised meaning to recognised words

34
Q

What is perseveration

A

An initially correct response is unnecessarily repeated
Highly suggestive of organic disease

35
Q

What is echolalia

A

Patients senselessly repeat words like a parrot

36
Q

Positive symptoms of psychosis

A

Delusions
Hallucinations
Loosening of associations
Bizarre behaviours

37
Q

Negative symptoms of psychosis

A

Marked apathy, blunted affect
Poverty of thought / speech
Social isolation, poor self care
Cognitive deficits

38
Q

When are psychomotor effects common in schizophrenia

A

In developed countries mainly as side effects of medication but can occur in the absence of medication

39
Q

What is catatonic rigidity

A

Maintaining a fixed position and resisting movements

40
Q

What is catatonic posturing

A

Adopting and maintaining an unusual posture

41
Q

What is catatonic stupor

A
42
Q

What is catatonic rigidity

A

Maintaining a fixed position and resisting movement

43
Q

What is catatonic posturing

A

Adopting and maintaining unusual posture

44
Q

What is catatonic stupor

A

Complete lack of movement, voice or responsiveness in an otherwise alert patient

45
Q

What is catatonic waxy flexibility

A

Patient can be moved into a position but will not move from there

46
Q

What is echopraxia

A

Repetition or mimicking of actions of those around them

47
Q

7 risk factors of schizophrenia

A
  • family history (40% if both parents affected, 15% if one)
  • urban living
  • immigration
  • cannabis use
  • obstetric complications
  • late winter / early spring birth (influenza exposure during neuronal development)
  • advanced paternal age at conception
48
Q

What is the dopamine hypothesis

A

Theorises that schizophrenia is caused by dopamine Overactivity in the brain

49
Q

What is evidence for the dopamine hypothesis

A

All effective antipsychotics block dopamine (D2) receptors
- dopamine agonists can cause psychotic symptoms
- schizophrenia sufferers have been shown to have excess D2 receptors

50
Q

What is evidence against the dopamine hypothesis

A

Normal dopamine metabolite levels in CSF of sufferers
- 30% do not respond to conventional medicines
- clozapine has less D2 blocking activity than conventional antipsychotics (yet is more effective)

51
Q

What can antipsychotics be effective at treating

A

Psychosis
Mood disorders
Anxiety disorders
Insomnia
Rapid tranquilisation
Nausea and vomiting
Hiccups
Tics in Tourette’s

52
Q

Name the 3 dopaminergic pathways

A

Tuberoinfundibular - blockage can cause hyperprolactinaemia
Mesocortical / Mesolimbic - blockage is the MOA of antipsychotics
Nigostriatal - blockage can cause EPS

53
Q

What should be checked when commencing antipsychotics

A

ECG
Weight / height
BP
FBC
U&Es
Prolactin
Glucose / HbA1c
Fasting lipids

54
Q

What is the MOA of typical antipsychotics

A

dopamine receptor 2 antagonism

55
Q

Neurological side effects of typical antipsychotics

A

Neuroleptic malignant syndrome
Seizure threshold lowered
Sedation
EPS

56
Q

Autonomic side effects of typical antipsychotics

A

Blood pressure
Temperature

57
Q

Endocrine side effects of typical antipsychotics

A

Raised prolactin due to blockage of the tuberoinfundibular pathway

58
Q

Psychiatric side effects of typical antipsychotics

A

Apathy
Confusion
Depression

59
Q

What are the 4 EPSE

A

Akathisia - restlessness including pacing, rocking, repeatedly crossing legs
Parkinsonism- tremor rigidity and bradykinesia
Acute dystonia - involuntary muscle spasms which produce briefly sustained abnormal postures
Tardive dyskinesia - abnormal involuntary hyperkinetic movements. Is potentially irreversible. Inc abnormal tongue movements, pouting, smacking of lips, chewing, head nodding

60
Q

What are the features of metabolic syndrome

A

Central obesity
Insulin resistance
Impaired glucose regulation
Hypertension
Raised plasma triglycerides
Raised LDL cholesterol level

61
Q

What are the features of neuroleptic malignant syndrome

A

Hyperthermia
Muscle rigidity
Confusion
Tachycardia
Hyper/hypotension
Tremor
Raised creatinine kinase
Low pH

62
Q

Which typical antipsychotics can you give as a depot

A

Haloperidol
Flupentixol
Zuclopenthixol
Fluphenazine

63
Q

Which atypical antipsychotics can you give as a depot

A

Risperidone
Olanzapine
Aripiprazole

64
Q

Describe the profile of aripiprazole

A

Partial dopamine agonist (limits maximum response)
Dose usually 5-30mg
Long half life

Side effects: nausea, restlessness, insomnia, initial exacerbation of psychosis, least weight gain, minimal metabolic effect

65
Q

Describe the profile of olanzapine

A

Treats psychosis and also used in rapid tranquilisation - IM
Usually oral dose 5-20mg

Side effects: sedation, weight gain, raised triglycerides, pro glycaemic, dizziness, anti cholinergic

66
Q

Describe the profile of quetiapine

A

Requires titration
Usually dose 300-600mg/day in 2 doses
Also effective in bipolar

Side effects: sedation, weight gain, less metabolic disturbance than olanzapine, possible QT prolongation

67
Q

Describe the profile of risperidone

A

Usual dose 4-6mg
Depot available

Side effects: sedation, weight gain, hyperprolactinaemia, sexual dysfunction, EPSE

68
Q

Describe the profile of clozapine

A

Indicated in treatment resistant schizophrenia
Improved efficacy over other antipsychotics
Positive effect on symptomology and suicide risk

Is a D4 blockade

Side effects: myocarditis / cardiomyopathy, orthostatic hypotension, agranulocytosis

69
Q

What is Schizoaffective disorder

A

Presentation of both schizophrenic and mood symptoms at the same time
The mood symptoms must meet the criteria for a depressed or manic episode, and patients should have at least one of the first rank schizophrenic symptoms

Mood symptoms present first, then psychotic symptoms

70
Q

What is delusional disorder

A

Development of delusions for at least 3 months with no / few other symptoms
Usually onsets in middle age and delusions may persist throughout life
Delusions can be persecutory, grandiose or hypochondriacal (doesnt include thought control)
Hallucinations will only be brief if present, and some depressive symptoms may also be evident
Affect / speech / behaviour / social function are generally normal

71
Q

What is schizotypal personality disorder

A

Eccentric behaviour and peculiarities of thinking / appearance without any clear psychotic symptoms

72
Q

List some organic causes of psychosis

A

Delirium
Medication induced eg steroids
Endocrine disorders eg cushings
Neurological disorders eg temporal lobe epilepsy
Systemic diseases eg SLE, porphyria
Psychoactive substance abuse
Alcohol withdrawal

73
Q

Describe the biological approach for management of schizophrenia

A

1st line is atypical antipsychotics
Benzodiazepines can be used in short term for relief of behavioural disturbance, insomnia, aggression and agitation
Antidepressants / lithium sometimes used in treatment resistant cases
ECT used rarely where symptoms are severe and not responding to initial therapy

74
Q

Describe the psychological approach to treating schizophrenia

A

Psychotherapy with drug treatment
CBT shown to reduce some symptoms and help patients gain insight
Family therapy reduces relapse rates
Psychoeducation
Psychiatric rehabilitation eg social skills and budgeting

75
Q

Describe the social approach to managing schizophrenia

A

Social benefits
Accommodation
Social supports
Support groups
Reduce any social stress that might induce relapse

76
Q

What is treatment resistant schizophrenia

A

Lack of satisfactory clinical improvement despite sequential use of 2 antipsychotics for 6-8 weeks
Check concordance and confirm diagnosis is correct
Check psychological therapy progress and comorbid substance use
Treat with clozapine

77
Q

What factors are associated with good schizophrenia prognosis

A

Female sex
Marriage
Older age of onset
Abrupt onset
Precipitated by life stress
Absence of negative symptoms
Good Premorbid functioning

78
Q

Describe the prognosis of schizophrenia

A

20% have a single lifetime episode and no relapses
30% have poor outcomes characterised by continuous symptoms and repeated psychotic episodes
10% will die by suicide
Most at risk are young, educated men with a high degree of insight

79
Q

What are poor prognostic factors of schizophrenia

A

Significant family history
High carer expressed emotion
Substance misuse
Poor compliance and long prodrome / duration of untreated psychosis

80
Q

Management of acute dystonia secondary to antipsychotics

A

Procyclidine

Psychiatry (6 decks)

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