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Psych Y5 > Psychosis > Flashcards

Psychosis Flashcards

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1
Q

4 first rank thought symptoms of schizophrenia?

A

Thought insertion and withdrawal
Thought broadcasting
Thought control and passivity phenomena
Delusional perception

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2
Q

4 first rank perception symptoms of schizophrenia?

A

Running commentary
Thought echo
3rd person auditory hallucinations
Gustatory or somatic hallucinations

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3
Q

What must a hallucination be experienced through to be considered a true hallucination?

A

The organ of perception - e.g. Ears for auditory hallucination

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4
Q

What is the basic premise of schizotypal disorder?

A

Eccentric behaviour and anomalies of thinking and affect similar to schizophrenia but never reaching diagnosis

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5
Q

What relationship does schizotypal disorder have to schizophrenia?

A

Often a FH of schizophrenia in typal disorder

Typal may develop into full blown schizophrenia

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6
Q

What is often the course of schizotypal disorder?

A

Chronic with fluctuating intensity and occasional quasi psychoses
Occasionally evolves into schizophrenia

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7
Q

What are the 3 major differentials for schizotypal disorder that make it difficult to diagnose?

A

Paranoid PD
Schizoid PD
Simple schizophrenia

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8
Q

What are the 3 hallmarks of an acute and transient psychotic episode?

A

Acute onset (less than 2 weeks)
Typical syndromes - polymorphic or schizophrenic
Associated acute stress

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9
Q

What does polymorphism mean in acute and transient psychotic disorders?

A

Nature of psychotic symptoms varies from day to day and within days

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10
Q

What is acute schizophrenia-like psychotic disorder?

A

Psychotic episode meeting criteria for schizophrenia but lasting less than 1 month

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11
Q

What is required for a diagnosis of schizoaffective disorder and how is it subdivided?

A

Both psychotic and affective symptoms come on simultaneously and neither predominate, meeting criteria for both schizophrenia and mania/depression
Subdivided based on manic type, depressive type and mixed type

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12
Q

What MRI findings are occasionally present in schizophrenia and what do they mean?

A

Ventriculomegaly
Reduced cortical volume
Bad prognostic sign

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13
Q

Does schizophrenia tend to present later in men or women?

A

Women

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14
Q

Organic differentials for schizophrenia?

A 
Temporal lobe epilepsy 
Encephalitis e.g. Limbic
Cerebral infection e.g. Syphilis 
SoL
Delirium, dementia
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15
Q

What are the 4 main symptoms of schizophrenia of which at least one must be present for at least 1 month according to ICD10?

A

Thought echo/insertion/withdrawal/broadcasting
Delusional perception or passivity phenomena (thought control)
Running commentary or other 3rd person auditory hallucination
Persistent bizarre delusions

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16
Q

What are the 4 less major schizophrenia symptoms of which at least 2 must be present for at least 1m according to icd 10?

A

Negative symptoms
Catatonia
Persistent any modality hallucinations
Thought disorder or neologisms

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17
Q

What symptoms are often less severe or absent in paranoid schizophrenia compared to other subtypes?

A

Formal thought disorder
Negative symptoms
Affect often not as blunted

18
Q

When does hebephrenic schizophrenia often present compared to other subtypes?

A

Earlier - age 15-25

19
Q

What features are prominent in hebephrenic schizophrenia?

A

Rapid negative symptom progression
Disorders or affect and volition and prominent formal thought disorder
Characteristically aimless behaviour, empty of purpose
Often inappropriate giggling or self satisfied smiling
Positive symptoms less significant

20
Q

What is residual schizophrenia?

A

Negative symptoms remaining and persisting for at least one year with no or few positive symptoms, with evidence of at least one schizophrenic episode

21
Q

What is simple schizophrenia?

A

Slowly progressive negative symptoms over at least 1 year but no major positive psychotic symptoms
Significant changes in personal behaviour like an exaggerated schizophrenia prodrome
Often leading to vagrancy

22
Q

What schizophrenic patients are most risky in terms of suicide, self neglect and risk to others?

A

Suicide - young males with insight
Self neglect - negative symptoms, cognitive deficit
Risk to others - substance use, command hallucinations, male, concurrent antisocial PD or forensic Hx

23
Q

What is Capgras delusion?

A

Belief that a person close to sufferer has been replaced by identical clone

24
Q

Describe the illness course of schizophrenia?

A

Prodrome - mixed symptomatology, mood Sx, Withdrawal etc.
Acute episode
Critical period which determines long term function
Stable period/treatment resistance
Rule of thirds long term

25
Q

What causes positive Sx in schizophrenia?

A

Interaction of dopaminergic pathways with cortex - mesolimbic
Hyperdopaminergic Sx in this pathway

26
Q

What causes negative Sx in schizophrenia?

A

Reduced dopaminergic in frontal lobe + mesocortical pathway - decrease in reward dependent behaviour and experience of pleasure

27
Q

What is the relationship between serotonin 5-HT2a and dopamine? What pharmacological impact does this have?

A

Serotonin 5-HT2a receptors inhibit dopamine release

So most atypicals have 5-HT2a antagonistic action to reverse the dopamine blockade in a selective way

28
Q

What 2 atypical antipsychotics are the best for avoiding EPSEs and tardive dyskinesia?

A

Clozapine

Risperidone

29
Q

How long is improvement demonstrable for when using clozapine as antipsychotic?

A

Over 12-18 months

30
Q

How long does antipsychotic effect usually take to onset?

A

1-6 weeks

31
Q

Roughly how long should you treat for first episode of schizophrenia?

A

At least 1 year after Sx resolution, maybe 2

32
Q

For how long should you treat after more than one relapse of schizophrenia?

A

5 years after Sx resolution with tapering dose

33
Q

What might constitute a reasonable trial of a new antipsychotic?

A

Use one at a time, slowly increase dose to avoid side effects
Continue for 4 weeks at max dose
Consider compliance, substance abuse and depression comorbid

34
Q

What is Cotard delusion?

A

Belief that sufferer is dead or does not exist

35
Q

What is Fregoli syndrome?

A

Belief that several different people are in fact the same person who changes appearance or disguises

36
Q

3 diagnostic features of delusional disorder?

A

Last at least 3 months
Usually simple, single delusion
Often not functionally impairing

37
Q

Which antipsychotic is safest for QTc and metabolic effects?

A

Aripiprazole

38
Q

What side effect can Aripiprazole have short term and how do you avoid this?

A

Agitation - give benzos alongside

39
Q

What antipsychotic had the highest risk of QTc?

A

Quetiapine

40
Q

For roughly how long max would you give hypnotics/sedatives before worrying about dependence?

A

3 weeks

41
Q

What CBT method is best for depression?

A

Behavioural reactivation

Psych Y5 (13 decks)

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