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Phase II - Psychiatry > Psychosis > Flashcards

Psychosis Flashcards

Schizophrenia.

1
Q

What is psychosis?

A

Mental state where reality is greatly distorted.

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2
Q

What are delusions?

A

Fixed false belief that is firmly held despite contrary evidence and goes against the individual’s normal social and cultural belief system.

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3
Q

What are hallucinations?

A

Perception in the absence of external stimulus.

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4
Q

What is a thought disorder?

A

Impairment in the ability to form thoughts from logically connected ideas.

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5
Q

What is the incidence of psychosis in England?

A

31.7/100,000.

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6
Q

What is schizotypal disorder?

A

Eccentric behaviour, suspiciousness, unusual speech, deviation of thinking, affect similar to schizophrenia. No delusions or hallucinations.

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7
Q

What is persistent delusional disorder?

A

Single or set of delusions for 3 months + where delusion is the main symptoms with thought and function preserved. Delusion is persecutory, grandiose, hypochondriacal. Related to life situation.

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8
Q

What is acute and transient psychosis?

A

Psychotic episode as with schizophrenia by lasts <1 month.

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9
Q

What is induced delusional disorder?

A

Uncommon disorder where 2+ individuals have similar delusions.

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10
Q

What is imposee in induced delusional disorders?

A

One person is dominant and forms the belief during a psychotic episode and imposes it on the other person.

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11
Q

What is simultanee type of induced delusional disorder?

A

Two people have their own psychotic symptoms but influence each other so the delusions line up.

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12
Q

What is schizoaffective disorder?

A

Schizophrenic symptoms + mood disorder symptoms in same illness. Mood symptoms meet criteria for depression or manic episodes + 1 or 2 typical schizophrenic symptoms.

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13
Q

What are mood disorders with psychosis?

A

Psychosis secondary to depression or mania.

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14
Q

What is puerperal psychosis?

A

Acute onset of manic or psychotic episodes after childbirth <2 weeks.

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15
Q

What is late paraphrenia?

A

Late-onset schizophrenia, hallucinations and delusions prominent but thought disorders and catatonic symptoms are rare.

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16
Q

What are the organic causes of schizophrenia?

A

Drugs, iatrogenic, complex partial epilepsy, delirium, dementia, Huntington’s disease, SLE, syphilis, endocrine disturbance, metabolic disorders.

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17
Q

Which factors are involved in developing schizophrenia?

A

Biological and environmental factors.

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18
Q

What is the dopamine hypothesis for schizophrenia?

A

Secondary to over-activity of mesolimbic dopamine pathways in the brain -> drugs block D2 receptors. Drugs that potentiate these pathways cause psychotic symptoms.

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19
Q

What is the expressed emotion theory?

A

Relatives that are over involved or make hostile/critical comments make relapses more likely.

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20
Q

What is the stress-vulnerability model?

A

Schizophrenia is due to environmental factors interacting with genetic predisposition so people need different levels of exposure to environmental factors to become psychotic.

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21
Q

What are the biological predisposing factors to schizophrenia?

A

Genetics, neurochemical (increased dopamine, decreased glutamate, serotonin, GABA), neurodevelopmental (intrauterine infection, premature birth, foetal brain injury, obs complications), aged 15-35 years, very young or very old parents.

22
Q

What are the psychological predisposing factors to schizophrenia?

A

Family history, childhood abuse.

23
Q

What are the social factors predisposing to schizophrenia?

A

Substance misuse, low SE status, migrants, urban area living.

24
Q

What are the precipitating factors for schizophrenia? (Biopsychosocial).

A

Bio - smoking cannabis, psychostimulant use.
Psycho - adverse life events, poor coping style.
Social - adverse life events.

25
Q

What are the perpetuating factors for schizophrenia?

A

Bio - substance misuse, poor compliance.
Psycho - adverse life events.
Social - poor social support, expressed emotion.

26
Q

What are the positive symptoms of schizophrenia?

A

‘Delusions Held Firmly Think Psychosis’

= delusions, hallucinations, formal thought disorder, thought interference, passivity phenomenon.

27
Q

What are delusions?

A

Fixed false belief that’s firmly held despite evidence to the contrary and goes against the individual’s normal social and cultural belief system.

28
Q

What are ideas of reference?

A

A patients thinks common events refer to them directly, e.g. newspaper articles.

29
Q

What are hallucinations?

A

Perception in the absence of external stimulus.

30
Q

What is the normal hallucination form in schizophrenia?

A

Third person auditory, sometimes running commentary.

31
Q

What is formal thought disorder?

A

Abnormalities in the way thoughts are linked together.

32
Q

What is thought interference?

A

Thought insertion, withdrawal, or broadcast.

33
Q

What is passivity phenomenon?

A

The belief that actions, feelings, or emotions are being controlled by an external force.

34
Q

What are the negative symptoms of schizophrenia?

A

Avolition, asocial behavious, anhedonia, alogia, affect blunted, attention.

35
Q

What is avolition?

A

Decreased motivation and reduce ability to initiate and persist in goal-directed behaviour.

36
Q

What is alogia?

A

Poverty of speech.

37
Q

What is paranoid schizophrenia?

A

Positive symptoms of hallucinations and delusions.

38
Q

What is hebephrenic schizophrenia?

A

Thought disorganisation, early onset 15-25 years, poorer prognosis.

39
Q

What is catatonic schizophrenia?

A

1+ catatonic symptoms (abnormality of tone, posture, movement from disturbed mental state - excessive or decreased motor activity).

40
Q

What is undifferentiated schizophrenia?

A

Meets schizophrenic criteria but no particular type.

41
Q

What is post-schizophrenic depression?

A

Depression predominates with schizophrenic illness in past 12 months, some symptoms persist.

42
Q

What is residual schizophrenia?

A

1 year of chronic negative symptoms after clear-cut psychotic episode.

43
Q

What is simple schizophrenia?

A

Rare form with negative symptoms and no psychotic symptoms.

44
Q

What are the ICD-10 criteria for diagnosing schizophrenia?

A

One of group A + 2 or more from group B for 1 or more months. No organic brain disease.
Group A - thought echo/insertion/withdrawal/broadcast; delusions of control, influence, passivity phenomenon; running commentary auditory hallucinations; bizarre persistent delusions
Group B - hallucinations in other modalities that are persistent; thought disorganisation; catatonic symptoms; negative symptoms.

45
Q

What are the features of schizophrenia on MSE?

A

Appearance - normal or inappropriate with poor self-care (-ve).
Behaviour - preoccupied, restless, noisy, suspicious (+ve) or withdrawn, poor eye contact and apathy (-ve).
Speech - reflect thought disorder, interruptions to flow of thought, poverty of speech (-ve).
Mood - incongruity of affect or mood changes (depression, anxiety, irritability) or flattened (-ve).
Thoughts - delusion, thought insertion/withdrawal/broadcast, formal thought disorder (+ve).
Perception - hallucinations (+ve).
Cognition - normal orientation or attention and concentration impaired (+ve) or cognitive deficits (-ve).
Insight - poor.
Risk - needs assessing.

46
Q

What are the investigations needed for schizophrenia?

A

Bloods - FBC, TFTs, glucose, HbA1c, serum Ca, U+Es, LFTs, cholesterol, vitamin B12, folate. Urine drug test. ECG to check QT interval. CT to rule out organic causes. EEG to rule out temporal lobe epilepsy.

47
Q

What is the management plan for schizophrenia? (Summary of all aspects).

A

Early intervention in psychosis team used in first presentation to reduce duration of untreated psychosis.
Bio - antipsychotics,adjuvants, ECT.
Psycho - CBT, art therapy, social skills training.
Social - support groups, peer groups, supported employment programmes.

48
Q

What are the poor prognostic factors for schizophrenia?

A

Strong family history, gradual onset, decreased IQ, premorbid history of social withdrawal, no obvious precipitant.

49
Q

What are the pharmacological steps to managing schizophrenia?

A

Antipsychotics - atypical first line then clozapine third line for treatment-resistant schizophrenia.
Adjuvants - benzodiazpines for short-term behavioural relief.
ECT - if resistant to all or catatonic.

50
Q

What are the psychological steps in managing schizophrenia?

A

CBT to reduce residual symptoms.
Family intervention for persisting symptoms.
Art therapy to alleviate negative symptoms.
Social skills training for interpersonal, self-care, and coping skills.

51
Q

What are the social steps in managing schizophrenia?

A

Support groups.

Peer groups - support worker has recovered from psychosis and schizophrenia is stable.

Phase II - Psychiatry (14 decks)

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