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psychosis Flashcards

1
Q

what is schizophrenia?

A

Schizophrenia is a type of psychosis
- Distortion to thinking and perception and inappropriate or blunted affect

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2
Q

when is the onset for psychosis?

A

early
15-35

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3
Q

what features are seen in psychosis?

A

hallucinations
delusions
thought and speech disordeer
negative symptoms

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4
Q

describe hallucinations?

A

perceptions in absence

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5
Q

what can cause psychosis?

A

genetics
- Obstetric complications
- Parasitic infections – toxoplasma gondii
- Viral infections in second trimester of pregnancy
- Neuroinflammation
- Reaction of individual to stress
LES

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6
Q

what are positive symptoms?

A
  • Thought disorder
  • Disorganised behaviours
  • Affect disruption
  • Delusions
  • Hallucinations
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7
Q

what are negative symptoms?

A
  • Poverty of thought and speech
  • Impaired volition
  • Blunted affect
  • Withdrawal  motor suppressed
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8
Q

what types of delusions are there within psychosis?

A

of reference
of control

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9
Q

whata re delusions of reference?

A

that are other people, events or objects refer to the pt or are linked to one’s destiny – hidden meanings eg the sun shining at a certain time is indicative of something else

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10
Q

what are delusions of control?

A

external control of action
- Pt feels like a puppet
- Made to do/ think in certain ways  not own thoughts

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11
Q

what are logical associations?

A

poverty of speech
though block
neologisms

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12
Q

what is poverty of speech?

A

content incomprehensible speech, may become incoherent

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13
Q

what is thought block?

A

losing trail of thought, stop speaking and after pause may switch to a completely different topic

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14
Q

what is neologisms?

A

inventing new words/ phrases

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15
Q

what can be abnormal perceptions (hallucination) types?

A

auditory
second person
third
running commentary
though echo

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16
Q

what is second person auditory hallucination?

A

voice addressed pt directly

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17
Q

what is third person auditory hallucinatios?

A

voice addressed pt indirectly
eg sarah was saying this about

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18
Q

what would indicate a poor prognosis in schizophrenia?

A

early onset, family history, structural brain abnormalities

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19
Q

why can schizophrenia have a poor prognosis?

A
  • 5% lifetime risk suicide
  • Mortality gap in severe mental illness
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20
Q

what can lead to good prognosis in schizophrenia?

A

female, married, good premorbid functioning  social relationships, work, no previous psychiatric problems, good medication compliance, prompt treatment. Shorter duration episodes, absence of severe brain pathology

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21
Q

what neuropathology is linked to negative symptoms in schizophrenia?

A
  • Impairments on neuropsychological tests of prefrontal cortex – memory
    and having Low metabolic rates
  • Enlargement of lateral and third ventricles is frequently reported
  • large atrophy within fronatl and temporal lobes
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22
Q

what is the dopamine hypothesis within schizophrenia?

A
  • Overactivity in dopaminergic transmitter systems produces schizophrenia symptoms
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23
Q

what drugs can mimic schizophrenia and why?

A
  • LSD (partial D2 agonist) and ket (indirect increase and decrease D reuptake) mimic some schizophrenic psychosis
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24
Q

how does dopamine affect schizophrenia symptoms?

A
  • Low dopamine – negative
  • High dopamine – positive symptoms
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25
Q

what does typical antipsychotics bind to?

A

D2 receptors

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26
Q

what is the moa of atypical antipyschotics?

A

potent antagonists of 5HT2 receptor

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27
Q

what neurotransmitters do atypical antipsyhcotics affect?

A

mainly serotonin
- 5HT have role in modulating activity in dopaminergic systems

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28
Q

what does glutamate bind to?

A

NMDA receptors

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29
Q

how mnay nmda receptors are seen in schizophrenic patients?

A

reduced receptor wihtin temporal lobe

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30
Q

what does PCP ‘angel dust’ do in terms of schizophrenia?

A
  • PCP ‘angel dust’ – potent antagonist NMDA receptor and mimics positive symptoms
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31
Q

what is knights move thinking?

A

though and speech disorder
sentences have no connection between train of thought

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32
Q

what is alogia?

A

poverty of speech

33
Q

what is avoilition?

A

lack of self will

34
Q

what is used to diagnosis a pt with schizophrenia?

A

ICD-10 framework

35
Q

what is included within criteria for schizophrenia diagnosis?

A

In pts suffering a psychotic episode lasting at least one month, schizophrenia may be diagnosed and has one or more of following:
- Thought echo, thought insertion or thought broadcasting
- Delusions of control, influence, passivity – body or limb
- Hallucinatory voices
- perisistent delusions

36
Q

what are the subtypes of schizophrenia?

A

paranoid
hebephrenic
catatonic
undifferentiated

37
Q

what is paranoid schizophrenia?

A

: predominant symptom
- Often accompanied with hallucinations – auditory

38
Q

what is hebephrenic schizophrenia?

A

affective symptoms are prominent abnormal behaviour
- Negative behaviour is significant and social isolation

39
Q

what is catatonic schizophrenia?

A

psychomotor disturbance
- Hyperkinesis and stupor
- Automatic obedience and negativism
- Violent excitement

40
Q

what is undifferentiated schizophrenia?

A

: do not meet diagnostic threshold and do not fit into above categories

41
Q

what could be differentials for schizophrenia?

A
  • Rule out infection, metabolic abnormalities, organic brain disease
  • Autoimmune encephalitis – anti NMDA encephalitis  mimics schizophrenia
42
Q

what bedside investigtaions could be done for schizophrenia?

A

BM, urine dip (delirium – UTI), ECG

43
Q

what bloods can be done for investigation schizophrenia?

A

FBC (agranulosis risk), LFT, TFT, syphilis serology (syphilis – mimics pyschosis), bloodborne virus screen, autoimmune screen (ANA, antiDS dna- lupus)

44
Q

how can you screen for drugs/ alcohol and what is disadvan?

A

blood, hair, urinary screen may be used
- Used if presenting with acute psychosis of unknown cause

may take a week

45
Q

what imaging/ procedures can be done to investigate schizophrenia?

A

: CT, MRI head, EEG, lumbar puncture and CSR sample

46
Q

when would you refer a pt if ?schizophrenia?

A

Preventing and anticipating – NICE
- Refer those to specialist who are distressing ad declining social function and…
- Transient or attenuated psychotic symptoms
- Other experiences of behviour suggestive of possible psychosis
- First degree relative with psychosis/ schizophrenia

47
Q

what do those with schizophrenia usually die of?

A
  • Those with severe mental illness eg bipolar die 10-20yrs earlier than general population and it is due to CVD, DM causing early death
48
Q

apart from CVS and DM what else are those with schizophrenic at risk of?

A

hyperglycaemia, HTN, dyslipidaemia, hyperlipidaemia

49
Q

what is flat affect?

A

: lack of reaction to emotional stimuli (negative symptom)

50
Q

what are the benefits of long acting depo?

A

medicine slow release over several weeks  aids compliance
- First and 2nd gen can be depot – many types
- Depo advan: more convenient, ensure adherence, regular monitoring due to contact when administering

51
Q

what are disadvan of long acting depo?

A

dose is titrated low, long-lived side effects due to long half life, long time before therapeutic effect

52
Q

how does autoimmune encephalitis link to psychosis?

A
  • Potentially treatable cause of mental disorder
  • Present with altered mental state – psychosis and delirium
53
Q

what is the pathology linked to autoimmune encephalitis?

A
  • Encephalitis related to NMDA receptor auto-AB can be most common cause
54
Q

what are red flags indicating AI encephalitis?

A
  • Autonomic disturbance: hypo/hyperthermia, unstable BP, high RR, tachycardiac, suspected neuro malignant syndrome
  • Cog impairment – short term memory, disorientation
  • Hyponatraemia
  • Prodromal headache or raised temp prior to onset of psychosis
  • Seizures
  • Rapid onset psychosis
55
Q

what advice can be given about weight gain within clozapine/ olanzapine?

A
  • Risk of obesity and DM  olanzapine interferes with insulin cascade, appetite and hunger
  • To remain on olanzapine: review pt diet/ exercise
56
Q

what could you switch olanzapine/ clozapine for due to excess weight gain?

A

arpiprazole – low weight gain risk

57
Q

what affect does smoking have on clozapine/ olanzapine?

A
  • Smoking: can reduce plasma conc (same in clozapine)  if in hosp – check dose
    when stop smoking - conc increases
58
Q

what are the risks of changing antipsychotics?

A

There is a risk of non-response and relapse during switch

59
Q

how would you change antipsychotics?

A
  • Need full MDT with pt, family/ carers and support network
  • Slow dose reduction of original and then slow incremental increase of new drug
  • SAFETY NET: how to spot signs of relapse and what to do
60
Q

what investigations are important prior to starting clozapine?

A

medical hx
drug hx
full physical exam
blood
smoking status/ habits
bowel habits

61
Q

what needs to be checked within MHx when initiating clozapine?

A

CVS, epilepsy, DM, haematological disorders

62
Q

what needs to be checked within DHx when initiating clozapine?

A

bone marrow suppressants, anticholinergics, anti-HTN, alcohol, MAOIs, CNS depressants, phenytoin, lithium

63
Q

what needs to be included within physical exam prior to starting clozapine?

A

weight, pulse, temp and BP

64
Q

what bloods are needed prior to starting clozapine?

A

: FBC, U&Es, LFT, HBA1c, full lipid profile, troponin, CRP, BNP, ESR

65
Q

if a clozapine dose is missed wihtin 48-72hrs, what do you do?

A

rapid re-titration

66
Q

does the pill affect clozapine?

A

can increase clozapine conc

67
Q

what is neuroleptic malignant syndrome?

A

Serious and life-threatening adverse effect from taking antipsychotic

68
Q

when would NMS start?

A
  • Subacute onset – 24-72 hrs post initiation of medication
69
Q

what signs indicate NMS?

A

Signs: autonomic fluctuations  variable BP/ pulse
- Confusion
- Extreme hyperthermia
- Fever, muscle rigidity, sweating
- Raised CK
- Deranged LFTs, WCC and plasma myoglobin

70
Q

what other psych meds are linked to NMS?

A

other psych medications – antidepressants, valproate and lithium

71
Q

what are RF of NMS?

A

agitation, first gen antipsychotics high potency, dehydrated, male, younger age, recent or rapid dose increase

72
Q

how do you manage NMS?

A

: EMERGENCY: stop causative meds, manage unstable vitals, replace fluids
- Bromocriptine/ dantrolene prescribed
- Help stop renal failure

73
Q

what can clozapine and codeine do?

A

constipate

74
Q

what does risperidone react with to cause hypotension?

A

CCB

75
Q

what antipsychotics increase risk of seizures?

A

TCA and chloropromazine

76
Q

what antipsychotics are linked to increased weight gain?

A

clozapine and olanzapine

77
Q

which antibiotic reacts with clozapine?

A

ciprofloxacin and increases clozapine conc

78
Q
A

Mental Health (4 decks)

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