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Year 5 Psych > Psychosis > Flashcards

Psychosis Flashcards

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1
Q

Illusion

A

Perception triggered by external stimulus (misinterpreted)

E.g. mistaking shadow for person

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2
Q

Delusion

A

False, fixed belief contrary to evidence and rational argument. Cannot be explained by cultural, religious, or educational background

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3
Q

Biological causes schizophrenia

A

Genetics–multiple susceptibility genes
Birth: maternal malnutrition, PET, emergency CS
Substance misuse, esp cannabis, amphetamines, cocaine, LSD
Neurodevel: enlarged ventricles, smaller/lighter brains, no gliosis. Low pre-morbid IQ, poor learning/memory/executive function
NTs: Excess Da in mesolimbic (positive sxs), reduced Da in mesocortical tracts (negative sxs)

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4
Q

Psychosocial causes/risk factors schizophrenia

A

Schizoid personality, schizotypal disorder
Adverse life events
Cognitive behaviors e.g. tendency to jump to conclusions
Fear of madness drives denial and rationalization, and a delusional system to explain persecutory voices
Low socio-economic status
Migrants
Black Afro-Caribbean
High expressed emotion, with highly critical or over-involved relativees

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5
Q

Schneider’s first rank symptoms

A

Thought echo, insertion, withdrawal, broadcasting
Delusions of control, passivity
Delusional perception
3rd person auditory hallucinations
Persistent delusions of other kinds that are culturally inappropriate

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6
Q

Dx-schizophrenia

A

At least one of Schneider’s first rank sxs or two of following (lasting at least 1/12):

  • Fleeting/half-formed delusions without clear affective content, persistent over-valued ideas
  • Incoherent speech/thought
  • Catatonic behavior
  • Negative sxs
  • Signif and consistent change in overall quality of aspect behavior or interest
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7
Q

Schizophrenia prodrome

A

Low grade sxs e.g. social withdrawal, loss of interest.

No frank psychosis

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8
Q

Chronic schizophrenia

A

Mostly negative sxs

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9
Q

Negative sxs

A 
Apathy
Blunted affect
Anhedonia
Social withdrawal
Poverty of speech/thought
Self-neglect
Catatonia
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10
Q

Difference between affective disorder with psychotic symptoms and schizoaffective disorder

A

Schizoaffective=50/50

Affective with psychotic features–e.g. hx depression getting worse and eventually developing psychotic sxs

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11
Q

Schizotypal personality disorder

A

Odd, eccentric

No delusions

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12
Q

Delusional disorder

A

At least one non-bizarre delusion without thought disorder, prominent hallucinations, mood disorder, flattening of affect

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13
Q

Hypnagogic hallucinations

A

When going to sleep

Normal

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14
Q

Hypnapompic hallucinations

A

When waking up

Often normal

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15
Q

Ix-schizophrenia

A

Bloods: U&Es, LFT, Ca, FBC, gluc, VDRL, TFT, PTH, cortisol, tumor markers
Imaging: CT or MRI, CXR as indicated by hx
Urine: drugs, MCS
Others: EEG, 24 hr urinary cortisol, 24hr catecholamines/5-HIAA if suspected pheo, OT assess ADLs, social worker assessment

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16
Q

Biological Tx-schizophrenia

A
  1. atypical antipsychotic or long acting benzo to control non-acute anxiety/behavioral disturbance
  2. typical antipsych, titrating upwards

Atypicals used to be first line but now a joint decision between doc and pt considering sxs and SEs

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17
Q

Atypical anti-psychotics (2nd generation)

A

Work better on negative sxs than typicals (but positive still more so than negative)
Fewer EPS side effects, more anti-cholinergic SEs than typicals

Olanzapine (SE weight gain)
Risperidone
Quetiapine
Ziprasidone (prolongs QT)
Clozapine (extremely effective esp with negative sxs but can cause agranulocytosis so requires regular monitoring and is only indicated if at least two other antipsychs have failed)
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18
Q

Psychological treatment-schizophrenia

A

Family treatment to reduce expressed emotion, psychoeducation
CBT: less evidence, focus is reality testing. Gently challenge thinking and aid awareness of illogical thinking
Concordance therapy

19
Q

Social treatment schizophrenia

A

Rehabilitate, including trial at rehab facility
Appropriate housing
Community psych nurse input. Consider OT, PT
Refer to helpful organizations
Carer support

20
Q

Extrapyramidal side effects

A

Acute dystonia–acute sustained painful muscle spasm
Akathisia–restlessness lower limbs
Parkinsonism
Tardive dyskinesia. Irreversible.

21
Q

Neuroleptic malignant syndrome

A

Muscle stiffness and rigidity, altered consciousness, autonomic disturbance (fever, tachy, labile BP)
Raised CK and WCC. May get ARF

22
Q

Schizophreniform disorder

A

Schizophrenia

23
Q

Otehello syndrome

A

Obsession that spouse/partner is unfaithful

Part of delusional disorder

24
Q

Hallucination

A

Perception without external stimulus

25
Q

Affect illusion

A

Perception altered depending on mood state. E.g. frightened kid on Halloween thinks tree branches are attacker

26
Q

Completion illusion

A

Lack of attention paid

E.g. reading a book when tired and misinterpret

27
Q

Pareidolic illusion

A

See shapes in other objects

E.g. animals in clouds

28
Q

Functional hallucination

A

Hallucination in same modality.

E.g. hears voices only when listening to classical music

29
Q

Neologism

A

New words created by pt

30
Q

Echolalia

A

Repeats words/phrases back, sometimes continuously or incessantly.
Often organic cause

31
Q

Catalepsy

A

Rigid limbs

May have wavy flexibility (can move arms into different positions and they’ll stay like that)

32
Q

Cataplexy

A

Sudden, transient loss of muscle tone

33
Q

Clanging

A

Words based on sound/rhyming

E.g. “A cat pat on my hat sack, ate the bait and skated”

34
Q

Delusional atmosphere

A

Feels like something is “going on” but can’t say what

35
Q

Derailment

A

Formal thought disorder. Disjointed thoughts, no meaningful connections

36
Q

Negativism

A

Catatonic patients do opposite of what asked

37
Q

Cotard’s syndrome

A

Belief that part of body has ceased to exist

Seen in psychotic depression

38
Q

Ekbom’s syndrome

A

Delusional parasitosis

39
Q

Fregoli’s syndrome

A

Complete strangers are actually well-known to them…but in disguise.

40
Q

Hebephrenic schizophrenia

A 
Aka disorganized
Predominantly thought and affective sxs
Social withdrawal common
Affect often fatuous and child-like
Prominent negative sxs
May have delusions but not prominent sxs
41
Q

Clerambault’s phenomenon

A

Aka erotomania
Sufferer, usually single female, becomes delusionally convinced that someone of exalted status (e.g. celebrity) has become infatuated with them
Often part of schizophrenic illness

42
Q

Drug for rapid tranquilization

A

2g IM lorazepam

43
Q

Capgras syndrome

A

Person close to them replaced by doppleganger

Schizophrenia and organic illnesses, e.g. dementia

Year 5 Psych (5 decks)

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