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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
what does typical antipsychotics bind to?
D2 receptors
26
what is the moa of atypical antipyschotics?
potent antagonists of 5HT2 receptor
27
what neurotransmitters do atypical antipsyhcotics affect?
mainly serotonin - 5HT have role in modulating activity in dopaminergic systems
28
what does glutamate bind to?
NMDA receptors
29
how mnay nmda receptors are seen in schizophrenic patients?
reduced receptor wihtin temporal lobe
30
what does PCP 'angel dust' do in terms of schizophrenia?
- PCP ‘angel dust’ – potent antagonist NMDA receptor and mimics positive symptoms
31
what is knights move thinking?
though and speech disorder sentences have no connection between train of thought
32
what is alogia?
poverty of speech
33
what is avoilition?
lack of self will
34
what is used to diagnosis a pt with schizophrenia?
ICD-10 framework
35
what is included within criteria for schizophrenia diagnosis?
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
what are the subtypes of schizophrenia?
paranoid hebephrenic catatonic undifferentiated
37
what is paranoid schizophrenia?
: predominant symptom - Often accompanied with hallucinations – auditory
38
what is hebephrenic schizophrenia?
affective symptoms are prominent abnormal behaviour - Negative behaviour is significant and social isolation
39
what is catatonic schizophrenia?
psychomotor disturbance - Hyperkinesis and stupor - Automatic obedience and negativism - Violent excitement
40
what is undifferentiated schizophrenia?
: do not meet diagnostic threshold and do not fit into above categories
41
what could be differentials for schizophrenia?
- Rule out infection, metabolic abnormalities, organic brain disease - Autoimmune encephalitis – anti NMDA encephalitis  mimics schizophrenia
42
what bedside investigtaions could be done for schizophrenia?
BM, urine dip (delirium – UTI), ECG
43
what bloods can be done for investigation schizophrenia?
FBC (agranulosis risk), LFT, TFT, syphilis serology (syphilis – mimics pyschosis), bloodborne virus screen, autoimmune screen (ANA, antiDS dna- lupus)
44
how can you screen for drugs/ alcohol and what is disadvan?
blood, hair, urinary screen may be used - Used if presenting with acute psychosis of unknown cause may take a week
45
what imaging/ procedures can be done to investigate schizophrenia?
: CT, MRI head, EEG, lumbar puncture and CSR sample
46
when would you refer a pt if ?schizophrenia?
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
what do those with schizophrenia usually die of?
- 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
apart from CVS and DM what else are those with schizophrenic at risk of?
hyperglycaemia, HTN, dyslipidaemia, hyperlipidaemia
49
what is flat affect?
: lack of reaction to emotional stimuli (negative symptom)
50
what are the benefits of long acting depo?
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
what are disadvan of long acting depo?
dose is titrated low, long-lived side effects due to long half life, long time before therapeutic effect
52
how does autoimmune encephalitis link to psychosis?
- Potentially treatable cause of mental disorder - Present with altered mental state – psychosis and delirium
53
what is the pathology linked to autoimmune encephalitis?
- Encephalitis related to NMDA receptor auto-AB can be most common cause
54
what are red flags indicating AI encephalitis?
- 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
what advice can be given about weight gain within clozapine/ olanzapine?
- Risk of obesity and DM  olanzapine interferes with insulin cascade, appetite and hunger - To remain on olanzapine: review pt diet/ exercise
56
what could you switch olanzapine/ clozapine for due to excess weight gain?
arpiprazole – low weight gain risk
57
what affect does smoking have on clozapine/ olanzapine?
- Smoking: can reduce plasma conc (same in clozapine)  if in hosp – check dose when stop smoking - conc increases
58
what are the risks of changing antipsychotics?
There is a risk of non-response and relapse during switch
59
how would you change antipsychotics?
- 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
what investigations are important prior to starting clozapine?
medical hx drug hx full physical exam blood smoking status/ habits bowel habits
61
what needs to be checked within MHx when initiating clozapine?
CVS, epilepsy, DM, haematological disorders
62
what needs to be checked within DHx when initiating clozapine?
bone marrow suppressants, anticholinergics, anti-HTN, alcohol, MAOIs, CNS depressants, phenytoin, lithium
63
what needs to be included within physical exam prior to starting clozapine?
weight, pulse, temp and BP
64
what bloods are needed prior to starting clozapine?
: FBC, U&Es, LFT, HBA1c, full lipid profile, troponin, CRP, BNP, ESR
65
if a clozapine dose is missed wihtin 48-72hrs, what do you do?
rapid re-titration
66
does the pill affect clozapine?
can increase clozapine conc
67
what is neuroleptic malignant syndrome?
Serious and life-threatening adverse effect from taking antipsychotic
68
when would NMS start?
- Subacute onset – 24-72 hrs post initiation of medication
69
what signs indicate NMS?
Signs: autonomic fluctuations  variable BP/ pulse - Confusion - Extreme hyperthermia - Fever, muscle rigidity, sweating - Raised CK - Deranged LFTs, WCC and plasma myoglobin
70
what other psych meds are linked to NMS?
other psych medications – antidepressants, valproate and lithium
71
what are RF of NMS?
agitation, first gen antipsychotics high potency, dehydrated, male, younger age, recent or rapid dose increase
72
how do you manage NMS?
: EMERGENCY: stop causative meds, manage unstable vitals, replace fluids - Bromocriptine/ dantrolene prescribed - Help stop renal failure
73
what can clozapine and codeine do?
constipate
74
what does risperidone react with to cause hypotension?
CCB
75
what antipsychotics increase risk of seizures?
TCA and chloropromazine
76
what antipsychotics are linked to increased weight gain?
clozapine and olanzapine
77
which antibiotic reacts with clozapine?
ciprofloxacin and increases clozapine conc
78

Mental Health (4 decks)

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