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Psychiatry > Psychosis > Flashcards

Psychosis Flashcards

1
Q

What is the ICD-10 Dx criteria of psychosis (3)

A

= mental state where reality grossly distorted
→ Delusions
→ Hallucinations
→ Formal thought disorder

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2
Q

What is the age of peak incidence age of schizophrenia in males + females?

A

M 23Y

F 26Y

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3
Q

What are the ICD-10 Dx criteria for schizophrenia? (4)

A

No organic cause
Symptoms present >28d (+ before mood Sx)

≥1 of: 1st rank symptoms

OR ≥2 of: 
Sustained hallucinations
Overvalued ideas/delusions
Disorganised thought
Catatonic symptoms
-ve symptoms
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4
Q

What is the difference b/wn psychosis + schizoaffective/mood disorder?

A

Depends on whether psychotic or mood symptoms predominate

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5
Q

What are some other psychotic disorders that could be a DDx for schizophrenia? (6)

A 
Schizoaffective disorder (1st ranks + mood)
Delusional disorder (>hallucinations)
Schizotypal disorder (psychotic personality disorder)
Substance use e.g. alc withdrawal, stimulant intoxication
Mood disorders (mania, severe depression)
Acute/transient psychotic disorder (<28d)
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6
Q

What are the RFs for schizophrenia? (bio (4) -psycho (2) -social (4))

A 
Biological:
Genetic
Obstetric complications
Dopamine theory
Neurodevelopmental theory
Psychological:
Cognitive errors (jumping to conclusions - esp delusions/paranoia)
Premorbid personality (schizotypal)

Social:
Urban living
Adverse life events (e.g. physical, sexual abuse)
Immigrants
Ethnicity (Afro-Caribbean + South Asians)

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7
Q

In Schizophrenia, list some good prognostic factors (8)

A

Female
Married (or good support network)

FH affective disorder
Mood symptoms predominate
Good premorbid personality

Rapid onset
Early treatment
Good response to treatment

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8
Q

In Schizophrenia, list some poor prognostic factors (7)

A 
Opposite of good prognostic factors
High expressed emotion (family critical/non-tolerant)
FH schizophrenia
Prominent negative symptoms
Substance misuse
Early/insidious onset
Lack of insight / non-compliance
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9
Q

What are the general prognostic outcomes in schizophrenia/psychosis (1/3rds)
What factors can increase risk of premature death (3)

A

1/3rd → will never have another episode
1/3rd → manageable but recurrent episodes (req extensive support network)
1/3rd → continuous illness not free of symptoms

Risk early death: suicide (10-15%), CV disease + T2DM

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10
Q

What is a delusion defined as? / what criteria must something meet to be classed as delusion (4)

A

= pathological belief

Cannot be rationalised in any way
No external proof (even w. contradictory evidence)
Of personal significance
Not part of individuals cultural/religious background

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11
Q

List some phenomena that are examples of formal thought disorder (4)

A

Loosening of association (derailment)
Flight of ideas
Tangential thoughts
Thought block

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12
Q

List the positive symptoms of schizophrenia (4)
List the negative symptoms (5)(PARBS)
List any psychomotor symptoms (3)

A

Hallucinations
Delusions
Thought disorder
Disorganised behaviour

Reduced attention
Avolition (no motivation)
Social withdrawal
Blunted affect
Poverty of speech

Stupor/tics/rigors

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13
Q

Describe the First Rank symptoms (ABCD)

A

Auditory hallucinations

Broadcasting of thought / thought insertion/withdrawal

Controlled thought (delusion of mind/body controlled by external force)

Delusional perception (normal sensory perception links to bizarre perception e.g. saw bird + thought was president

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14
Q

What is the prodrome phase of schizophrenia + what do the symptoms consist of? (3)

A

= the period of time when pt gradually developing symptoms but not yet met criteria for Dx

→ Non-specific -ve symptoms
→ Emotional distress/ agitation for no reason
→ Transient psychotic symptoms

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15
Q

Outline the general management of a patient first presenting with psychotic symptoms (5)

A 
1. Establish a Dx:
Hx / MSE
Ix (physical/psychosocial)
2. Manage
Where to manage? (in-pt/community) (dep on risk)
Who to manage? (which service)
Bio-psycho-social management
Support for carer
Follow-up
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16
Q

What are some organic causes for psychosis (MENDS)

A

Medication-induced (steroids, stimulants, DA agonists)
Endocrine e.g. Cushing, hyper/hypothyroid
Neuro disorder (temp lobe epilepsy, MS, Huntingtons)
Delirium
Systemic disease (SLE, porphyria)

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17
Q

Why are physical investigations done in psychosis? (2)

What Ix done (6) (BUMPER)

A

To rule out organic cause
Preparing for antipsychotics

Bloods: LFTs/TFTs/FBC/gluc/lipids/cholesterol
*Urine drug screen
MRI/EEG (if indicated)
*Physical Ex (neuro, BMI)
ECG
*Review all medications
18
Q

What psychosocial Ix can be done in psychosis? (4)

A

Collateral Hx from other informant

OT assessment of daily functioning
Social assessment of housing/benefits etc
Carer assessment

19
Q

What lifestyle factors contribute to poor co-morbidities in schizophrenia (5) (NARPS)

A 
Smoking
Poor diet
Reduced physical activity
Not engaging with physical health monitoring
Antipsychotics metabolic SEs
20
Q

What physical health monitoring must be done in SCZ? (5) + how often

A

Baseline Ix + yearly

PMH/FH of CHD/DM (in initial)
Smoking/drinking status
BP/BMI
FBC/RFT/LFT/Gluc/Lipid
ECG
21
Q

List some psychiatric (7) + non-psychiatric (4) indications for anti-psychotics

A 
SCZ
Mood disorders with psychotic features
Organic psychosis
Delirium
Behavioural disturbance in dementia
Insomnia
Anxiety disorders

Motor tics (e.g. Tourette’s)
N+V
Incontractable hiccups / pruritis
Rapid tranquilisation

22
Q

What are the main dopaminergic pathways (3) that anti-psychotics work on?

A

Tuberoinfundibular (→ hyperprolactinaemia)
Nigrostriatal (→ EPSEs)
Mesocortical/mesolimbic

23
Q

What type of drugs are typical (1st Gen) anti-psychotics?

List some examples (8)

A

D2-R antagonists

Chlorpromazine
Fluphenazine
Pipothiazine
Trifluoperizine
Haloperidol
Zuclopenthixol
Flupentixol
Sulpiride
24
Q

What are the categories of diff SEs of antipsychotics (PEN CHAP)

A

Psychiatric (worsen -ve symps): depression, apathy, confusion
Endocrine (hyperprolactinaemia): galactorrhoea, amenn, sexual dysfunc
Neurological: NMS, seizures (threshold lowered), sedation, EPSEs

Cardiac: arrhythmia, QT prolongation, myocarditis
Hypersensitivity reactions: skin/liver/marrow
Autonomic: BP, Temp
Peripheral autonomic: muscarinic SEs, alpha antag (post hypo)

25
Q

What are the Extra-Pyramidal Side Effects? (ADAPT)

A

Acute Dystonia (invol musc spasms → brief abnorm postures)

Akathisia (subj feelings of restlessness - obj signs e.g. pacing, rocking)

Parkinsonism (tremor, rigidity, bradykinesia)

Tardive dyskinesia (abnormal invol hyperkinetic movements e.g. gurn-type, head-nod, grimacing)

26
Q

What are the features of metabolic syndrome with anti-psychotics? (6)

Which antipsychotics have the highest risk (2)

A 
Central obesity
Impaired glucose regulation
Insulin resistance
Hypertension
Raised triglycerides
Raised LDL:HDL

Olanzapine + Clozapine have biggest risk (therefore physical monitor more freq)

27
Q

Which typicals (4) /atypicals (5) can be given as a depot injection?

A

Fluphenazine
Flupentixol
Zuclopenthixol
Haloperidol

Olanzapine
Risperidone
Quetiapine
Arirpiprazole
Amisulpride
28
Q

List the symptoms of neuroleptic malignant syndrome (8) HMCT HMCT

A

Hyperthermia
Muscle Rigidity
CK (creatine kinase) raised
Metabolic acidosis

Tremor
Confusion
Tachycardia
Hypo/hypertension

29
Q

What are some reasons for poor compliance with antipsychotic Tx (5)

A 
Lack of insight
Side effects 
Delusions about medication/prescriber
Pt feels better when 'ill'
Pt in remission sees medication no longer required
30
Q

What is treatment-resistant SCZ defined as?

What 3 things must be checked before making Dx

A

= lack of response to adequate (high) doses of 2 different antipsychotics

  1. Review Dx
  2. Rule out co-morbid substance misuse
  3. Ensure dose, duration + compliance with prev Tx
31
Q

What are the SEs of clozapine? (6)

A

Neutropenia / agranulocytosis (v rare)
Metabolic syndrome
Seizures/epilepsy (lowers threshold)
Cardiomyopathy / myocarditis

Hypersalivation
Hunger/wt gain

32
Q

What are the contraindications of clozapine? (6)

A 
Severely reduced consciousness (v sedating)
Epilepsy
Parkinsons
Pheochromocytoma
Cardiac disease (esp arrhythmias)
H/o agranulocytosis
33
Q

What other things should be considered when prescribing an anti-psychotic? (5)

A 
PMH/FH of DM or metabolic syndrome
Current obesity
Concerns about wt gain
Potential impact of sedation
Child-bearing age (ideally use typicals)
34
Q

What is the general guideline advice when prescribing / titrating dose of anti-psychotic (5)

A

Use lowest effective dose
Start low go slow (can take weeks for response)
Precribe 1 psychotic at a time
Monitor SEs
Assess concordance before making any changes

35
Q

What psychological therapies are available for psychosis? (2+4)

A

CBT (NICE guidelines - CBTp)
Family Intervention Therapy (FIT) (NICE guidelines)

Psychotherapy (crisis plans, relapse prevention)
Coping strategies
Maastricht therapy
Concordance therapy

36
Q

What are the benefits of CBT in psychosis (3)

How does FIT help in psychosis (3)

A

Helps with symptoms
Helps improve insight
Helps improve compliance with meds
(in reality cannot be used in acute psychosis)

Helps change relative behaviour/beliefs
Reduces relapse + admission
Builds alliances / sets approp expectations + limits

37
Q

What things should be considered in the social side of management for psychosis? (7)

A 
Daily activities + hobbies/ employment/ education
Family
Relationships
Safeguarding
Housing
Benefits
Cultural needs
38
Q

What things need to be considered in follow-up of psychosis management? (5)

A 
Monitor treatment effectiveness / SEs
Monitor mental state
Monitor risk
Monitor support system
Further psychoeducation
39
Q

What are some risks of using anti-psychotics in delirium?

+ in dementia?

A

Anti-psychotics in delirium: reduces seizure threshold in alc withdrawal

Anti-psychotics in dementia: increased risk CVA

40
Q

Describe any psychotic symptoms that may appear with mania

What % manic pts experience 1st rank Sx?

A

Delusions*: mood congruent, grandiose beliefs, persecutory (with irritability)

Hallucinations: rare, mood congruent, 2nd person auditory

10% manic pts have 1st rank Sx

Psychiatry (11 decks)

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