Psychosis Flashcards
What is schizophrenia and how is it characterised?
Group of brain disorders characterised by disorders of thought, behaviour, perception and emotion
What is the one pathognomonic symptom of schizophrenia?
There isn’t one!
Having more than one symptom increases the risk
There is a strong genetic link to schizophrenia. True/False?
True
List 3 “positive” symptoms of schizophrenia
Delusions
Hallucinations
Thought disorder
List 4 “negative” symptoms of schizophrenia
Apathy
Lack of volition
Social withdrawal
Cognitive impairment
Positive symptoms are harder to treat than negative symptoms in schizophrenia. True/False?
False
Positive symptoms are often easier to treat
According to Schneider’s first rank symptoms for schizophrenia, list some thought disorders
Thoughts spoken out loud
Running commentary
3rd person voices talking
Thought withdrawal, broadcasting or insertion
What is passivity phenomena?
Experience where acts/emotions/feelings are being controlled by an external party
A patient must have Schneider’s first rank symptoms to be diagnosed with schizophrenia. True/False?
False
They are not pathognomonic and can be seen in other psychoses
What is a delusion?
A fixed belief that cannot be changed by logical thought or evidence
What is a hallucination?
Perceptual, fantastical experience that is believed to be real without evidence
List the different modalities by which hallucinations can occur
Auditory (most common) Visual Olfactory Gustatory Tactile Kinaesthetic
Which type of auditory hallucination - 1st, 2nd or 3rd person - is more typical of schizophrenia?
3rd person
What is meant by “word salad”?
Mish mash of words that together don’t make sense
What is meant by thought withdrawal?
Belief that thoughts are being removed by an external party - a delusional explanation for thought blocking
What is meant by thought broadcasting?
Belief that people understand your thoughts without you having to voice them
List features of emotional disorder that can occur in psychoses such as schizophrenia
Blunted affect Incongruent mood Apathy Lack of motivation Anhedonia
What is the main motor disorder that may occur in schizophrenia?
Catatonia
What is catatonia?
State of increased tone of muscles at rest, abolished by voluntary activity
What are the main treatments for catatonia?
ECT
Benzodiazepines
What is the peak incidence of schizophrenia for men and women?
Men: 15-25
Women: 25-35
List factors that indicate good prognosis for schizophrenia
Older age of onset
Being female
Mood disturbance (elation especially)
Family history of mood disorder
List factors that indicate poor prognosis for schizophrenia
Long duration of untreated psychosis
Insidious early onset
Cognitive impairment
Enlarged brain ventricles
Psychosis is a diagnosis. True/False?
False
Description of symptoms rather than diagnosis
What is psychosis?
Inability to distinguish subjective experience from reality, characterised by lack of insight
List psychotic experiences
Hallucinations Delusions Thought disorders Emotional disturbance Physical disruption
List the main differential diagnoses of psychosis
Schizophrenia Schizoaffective disorder Drug toxicity Mania Depression Delusional disorder Puerperal psychosis Delirium Dementia
What is meant by flight of ideas?
Jumping from topic to topic by associating words together inappropriately
How does tangential thinking differ from circumstantial thinking?
Tangential: wander off from topic/question and never return
Circumstantial: excessive detail relating to topic, eventually return to topic
What is meant by self-referential experience?
Belief that environment is reacting to you, i.e. external events are related to oneself
e.g. tv/radio is talking to you specifically
List some common drugs that can cause psychosis
Steroids Cannabis Amphetamine Cocaine Tobacco Alcohol Opioids
How is depressive psychosis classically typified?
Mood congruent with psychosis - delusions of guilt/pessimism on top of depressed mood
What is a grandiose delusion?
Delusion where one thinks they are vastly superior and have superhuman like qualities
What is schizoaffective disorder?
Mixed picture of schizophrenia + bipolar disorder where someone displays schizophrenia but their mood is also affected
At what time of day is delirium typically worse at?
Night
What are the 3 main cortical changes that occur in schizophrenia?
Reduced frontal lobe volume
Reduced frontal lobe grey matter
Enlarged ventricles
Which neurotransmitter causes a psychotic state when in excess?
Dopamine
List the 3 main dopaminergic pathways in the brain
Nigrostriatal
Mesolimbic
Tuberoinfundibular
Which dopaminergic pathway is typically involved in schizophrenia?
Mesolimbic system
Name some dopamine antagonists (anti-psychotics) that can be used for schizophrenia
Haloperidol
Raclopride
Clozapine
Subcortical dopamine hyperactivity/hypoactivity leads to psychosis
Subcortical dopamine hyperactivity leads to psychosis
What is the benefit of atypical antipsychotics over typical antipsychotics?
Less likely to induce extra-pyramidal side effects
Better efficacy
List some atypical antipsychotics
Clozapine
Aripiprazole
Risperidone
What is the fatal side effect of clozapine that makes it a 3rd line agent for psychosis?
Agranulocytosis
